National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
Ann Clin Transl Neurol. 2023 Oct;10(10):1816-1823. doi: 10.1002/acn3.51871. Epub 2023 Aug 6.
Cognitive contributions to decisional capacity are complex and not well understood. Capacity to consent for research has been linked to executive function, but executive function assessment tools are imperfect. In this study, we examine the relationship between decisional capacity and a newly developed executive function composite score and determine whether cognitive performance can predict impaired decisional capacity.
This is a cross sectional study of participants at the National Institutes of Health with frontotemporal dementia-amyotrophic lateral sclerosis spectrum disorders enrolled between 2017 and 2022. A structured interview tool was used to ascertain research decisional capacity. Study participant Uniform Data Set (v3.0) executive function (UDS3-EF) composite score, Clinical Dementia Rating Scale©, and Neuropsychiatric Inventory was determined.
A decrease in UDS3-EF composite score significantly increased the odds of impaired decisional capacity (OR = 2.92, 95% CI [1.66-5.13], p = 0.0002). Executive function was most impaired in frontotemporal dementia (-2.86, SD = 1.26) and least impaired in amyotrophic lateral sclerosis (-0.52, SD = 1.25) participants. The UDS3-EF composite score was also strongly correlated to the Clinical Dementia Rating Scale©.
Decisional capacity is intrinsically related to executive function in neurodegenerative disorders, and executive dysfunction may predict a lack of decisional capacity alerting investigators of the need for additional scrutiny during the informed consent process.
认知对决策能力的贡献是复杂的，目前尚未得到很好的理解。研究同意的能力与执行功能有关，但执行功能评估工具并不完善。在这项研究中，我们研究了决策能力与新开发的执行功能综合评分之间的关系，并确定认知表现是否可以预测受损的决策能力。
这是一项横断面研究，参与者为 2017 年至 2022 年间在国立卫生研究院患有额颞叶痴呆-肌萎缩侧索硬化症谱障碍的患者。使用结构化访谈工具确定研究决策能力。确定研究参与者的统一数据集中（v3.0）执行功能（UDS3-EF）综合评分、临床痴呆评定量表（Clinical Dementia Rating Scale©）和神经精神问卷（Neuropsychiatric Inventory）。
UDS3-EF 综合评分下降显著增加了决策能力受损的几率（OR = 2.92，95%CI [1.66-5.13]，p = 0.0002）。执行功能在额颞叶痴呆患者中受损最严重（-2.86，SD = 1.26），在肌萎缩侧索硬化症患者中受损最不严重（-0.52，SD = 1.25）。UDS3-EF 综合评分也与临床痴呆评定量表©呈强相关。
决策能力与神经退行性疾病中的执行功能密切相关，执行功能障碍可能预示着缺乏决策能力，提醒研究人员在知情同意过程中需要额外审查。
