Neuropsychological and Psychological Factors of Everyday Decision-Making Capacity in Alzheimer's Disease

Abstract

The current study investigated Everyday Decision-Making Capacity (EDMC) related to medication management in Alzheimer's (AD) patients and Healthy Elders (HE) using the Assessment of Capacity for Everyday Decision-Making (ACED) inventory. Comparisons between AD patients and HE were made. Within the AD subset, neuropsychological and psychological variables and their relationship to the ACED were analyzed. The study purported that different aspects of cognition would relate differently to the ACED total score and sought to identify the cognitive domain that is most highly associated with the ACED total score as well as with the four components of ACED (Understanding, Appreciating, Reasoning, and Expressing). As an exploratory aim, the impact of EDMC on the patients' Quality of Life, was analyzed. As hypothesized, AD subjects had lower ACED scores than HE, suggesting AD subjects' ability to make everyday decisions related to medication management is lower than healthy older adults. Neuropsychological tests in the domains of Global Cognition, Working Memory, and Executive Functioning were not significantly correlated with ACED total scores or subtest scores. However, there was a marginally significant correlation between the measure of Global Cognition (MMSE) and ACED total (r = .36, p = .062), pointing to a role for Global Cognition in ACED performance. This may be, in part, because the MMSE includes orientation measures, which capture the patient's ability to understand their relationship to their surrounding time and place, and self-monitoring abilities; qualities uniquely inherent in EDMC. The AD population will continue to grow at a rapid pace and need increased assistance making everyday decisions, and a great deal rides on capacity assessments. The fact that this study did not show statistically significant correlations between neuropsychological and psychological tests with EDMC suggests one of at least two things. It may indicate that we still do not fully understand the components of EDMC. It may also suggest that the ACED may be measuring a concept that is a unique entity, which may not have a direct relationship with specific neuropsychological measurements. Therefore, specifically measuring EDMC may be a necessity if one truly wants to understand everyday decisional capacities. Further implications are discussed.