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[对阿尔茨海默病中同意的认识与理解]

[Awareness and understanding of consent in Alzheimer's disease].

作者信息

Bouyer C, Teulon M, Toullat G, Gil R

机构信息

Service de neurologie, unité de neuropsychologie et rééducation du langage, CHU de Poitiers, 2, rue de La Milétrie, 86021 Poitiers cedex 05, France.

Service de neurologie, unité de neuropsychologie et rééducation du langage, CHU de Poitiers, 2, rue de La Milétrie, 86021 Poitiers cedex 05, France.

出版信息

Rev Neurol (Paris). 2015 Feb;171(2):189-95. doi: 10.1016/j.neurol.2014.09.002. Epub 2014 Dec 18.

Abstract

Before a patient can take part in a clinical research, French legislation requires his/her free, express and informed consent. In the same way, the information must be given in a clear, fair and appropriate manner. However, in the context of Alzheimer's disease, one might wonder about the patient's capacity to consent. The goal of our research was to study the capacity to provide informed consent in a group of patients with mild Alzheimer's disease and in a control group, using two specialized clinical vignettes inspired by Marson's studies. The aim of the study was to assess discernment in capacity to consent to a treatment and to determinate the possible links between impaired capacities to consent and cognitive and behavioral impairments involved in Alzheimer's disease. The data collected confirm that the capacity to make and maintain a choice is preserved while the capacities to appreciate the consequences of choosing a treatment, to reason and to understand the treatment situation are already impaired in mild Alzheimer's disease. The impairment of these capacities can be linked to dysexecutive syndrome, apathy and impaired self-awareness. Caregivers and family should take into account the risk of weakened capacities of discernment as soon as possible.

摘要

在患者能够参与临床研究之前,法国法律要求其给予自由、明确且知情的同意。同样,信息必须以清晰、公正且恰当的方式提供。然而,在阿尔茨海默病的背景下,人们可能会质疑患者的同意能力。我们研究的目的是使用受马森研究启发的两个专业临床案例,研究一组轻度阿尔茨海默病患者和一个对照组中提供知情同意的能力。该研究的目的是评估同意接受治疗的能力中的辨别力,并确定同意能力受损与阿尔茨海默病所涉及的认知和行为障碍之间可能存在的联系。收集到的数据证实,在轻度阿尔茨海默病中,做出并维持选择的能力得以保留,而理解选择治疗的后果、进行推理以及理解治疗情况的能力已经受损。这些能力的受损可能与执行功能障碍综合征、冷漠和自我意识受损有关。护理人员和家属应尽快考虑到辨别能力减弱的风险。

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