Neuropsychologic Predictors of Competency in Alzheimer's Disease Using a Rational Reasons Legal Standard

doi:10.1001/archneur.1995.00540340035011

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Vol. 52 No. 10, October 1995

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Neuropsychologic Predictors of Competency in Alzheimer's Disease Using a Rational Reasons Legal Standard

Daniel C. Marson, JD, PhD; Heather A. Cody; Kellie K. Ingram; Lindy E. Harrell, MD, PhD

Arch Neurol. 1995;52(10):955-959.

Abstract

Objective
To identify neuropsychologic predictors of competency performanceand status in Alzheimer's disease (AD) using a specific legalstandard (LS). This study is a follow-up to the competency assessmentresearch reported in this issue of the ARCHIVES.

Design
Univariate and multivariate analyses of independent neuropsychologictest measures with a dependent measure of competency to consentto treatment.

Setting
University medical center.

Subjects
Fifteen normal older control subjects and 29 patients with probableAD.

Main Outcome Measures
Subjects were administered a battery of neuropsychologic measurestheoretically linked to competency function, as well as twoclinical vignettes testing their capacity to consent to medicaltreatment under five different LSs. The present study focusedon one specific LS: the capacity to provide "rational reasons"for a treatment choice (LS4). Neuropsychologic test scores werecorrelated with scores on LS4 for the normal control group andthe AD group. The resulting univariate predictors were thenanalyzed using stepwise regression and discriminant functionto identify the key multivariate predictors of competency performanceand status under LS4.

Results
Measures of word fluency predicted the LS4 scores of controls(R²=.33) and the AD group (R₂=.36). A word fluency measure alsoemerged as the best single predictor of competency status forthe full subject sample (n=44), correctly classifying 82% ofcases. Dementia severity (Mini-Mental State Examination score)did not emerge as a multivariate predictor of competency performanceor status. Interestingly, measures of verbal reasoning and memorywere not strongly associated with LS4.

Conclusions
Word fluency measures predicted the normative performance andintact competency status of older control subjects and the decliningperformance and compromised competency status of patients withAD on a "rational reasons" standard of competency to consentto treatment. Cognitive capacities related to frontal lobe functionappear to underlie the capacity to formulate rational reasonsfor a treatment choice. Neuropsychologic studies of competencyfunction have important theoretical and clinical value.

Author Affiliations

From the Department of Neurology and the Alzheimer's Disease Center, University of Alabama at Birmingham.

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