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Biomedical subjects

D Marson

Publications and source records attributed to D Marson.

5 recordsLinked to original sources
PubMed2001

Informed consent, competency, and the neurologist.

BACKGROUND: Obtaining informed consent to treatment is an important medical-legal and clinical aspect of neurological practice. REVIEW SUMMARY: This review discusses the doctrine of informed consent and its role in neurological practice. We first provide an overview of the informed consent doctrine and discuss its historical origins and current modern form. The three component elements of informed consent--being informed, voluntary, and competent--are presented, with a focus placed on the competency element. The increasingly important role of informed consent in everyday neurological practice is profiled, with particular emphasis on patients with dementia. Recent empirical research is presented on loss of consent capacity (competency) in patients with Alzheimer's disease and Parkinson's disease. Finally, a conceptually based approach to clinical assessment of competency is presented to assist neurologists dealing with these issues. CONCLUSIONS: The increasing prevalence of patients with neurodegenerative disorders in neurological practice heightens the importance of obtaining valid informed consent to treatment.

Journal Article↗
PubMed1999

Executive dysfunction and loss of capacity to consent to medical treatment in patients with Alzheimer's disease.

Loss of medical decision making capacity (competency) is an inevitable consequence of Alzheimer's disease (AD) and is an important subject for neuropsychological investigation. Consent capacity involves a complex set of comprehension, encoding, information processing, decision making, and communication abilities, which ultimately must have an explicit neurological basis. This article examines the role of executive dysfunction in loss of consent capacity in patients with AD. The authors first describe a cognitive neuropsychological model for understanding loss of consent capacity in AD. The article also reviews neuropsychological studies that have used a psychometric instrument to test consent capacity under different legal standards (Capacity to Consent to Treatment Instrument). These studies indicate that when multiple cognitive functions are associated with declining competency of AD patients on the Capacity to Consent to Treatment Instrument legal standards, measures of simple executive function are the predominant predictors. These empirical findings are discussed and related to the conceptual model. The findings support the growing body of literature linking frontal neural systems and executive cognitive functions to competency and to higher order functional capacities.

Aged↗
PubMedDate not supplied

Clinical trials in Alzheimer disease: debate on the use of placebo controls.

During the past 10 years, there has been a rapidly growing number of pharmaceutical industry-sponsored drug trials for treatment of Alzheimer disease (AD) and other neurodegenerative diseases. As public awareness and concerns about AD have grown, so has interest in developing drug therapies for retarding symptom progression, delaying onset, and ultimately curing the disease. Ethical debate on the use of placebo control trials in AD research has come of age in the United States with the availability of treatments approved by the Food and Drug Administration. The experts and the public agree that more effective therapies are necessary, and new therapeutic options are being developed as rapidly as possible. The arguments on each side of the debate are provocative and important but do not provide unequivocal justification for either the abandonment or the maintenance of placebo-controlled trials in all AD research. Clinical trials differ with respect to scientific and practical goals, and these factors inherently affect the ethical priorities of each study. We present these contrasting points of view to delineate some of the issues rather than to make specific recommendations other than to urge that all clinical trials in AD should be designed with careful consideration of the ethical issues surrounding the use of placebo controls. As new and more effective treatments emerge, the ethical framework for placebo use in AD studies will require frequent re-examination. To make wise choices, patients, caregivers, physicians, and ethicists (among others) must have a voice in this continuing discussion.

Alzheimer Disease↗
PubMedDate not supplied

The Severe Mini-Mental State Examination: a new neuropsychologic instrument for the bedside assessment of severely impaired patients with Alzheimer disease.

The bedside and office assessment of cognitive abilities in moderately to severely impaired patients with Alzheimer disease could be enhanced by a well-standardized instrument. The authors' group has developed such an instrument (i.e., Severe Mini-Mental State Examination; SMMSE) to assess this population. Based on the Folstein Mini-Mental State Examination (MMSE), the SMMSE, which totals 30 points, was designed to briefly assess cognitive domains relatively preserved in moderate to severe Alzheimer disease. One hundred eighty-two patients with possible or probable Alzheimer disease were administered both the MMSE and SMMSE. Performances on the SMMSE and MMSE were found to correlate significantly only when MMSE fell below 9 points (p < 0.0001). However, as performance on the MMSE approached floor levels, patients continued to score at half maximal levels on the SMMSE. Functional staging with the Clinical Dementia Rating Scale and the Global Deterioration Scale also were found to significantly correlate with performance on the SMMSE (p < 0.001). Test-retest performance on both the SMMSE and MMSE was relatively stable over a period of 5 months. Inter-rater reliability of the SMMSE was excellent. These results suggest that the SMMSE has both construct and criterion validity for assessing severely impaired Alzheimer disease patients. Our results also suggest that the SMMSE may be a useful instrument for assessing severely impaired patients at the bedside and in the office.

Aged↗