Question

should dementia patients be involved in decision making or not

Answer 1

Capacity to make one's own decision is fundamental to the autonomy of the individual. People with dementia cannot be assumed to be incapable of making decisions on their diagnosis alone as they may have retained cognitive abilities. Capacity is a functional assessment made by clinician to determine if a patient is capable of making a specific decision. Capacity evaluation for a patient with dementia is used to determine whether the patient is capable of giving informed consent, participate in research, manage their finances, live independently, make a will, and have ability to drive. Patients with dementia cannot be assumed to have impaired capacity. Even a patient with moderate or sever dementia, with obviously impaired capacity may still be able to indicate a choice and show some understanding. Four key components of decision making in a capacity evaluation include:

• Understanding
• Communicating a choice
• Appreciation
• Reasoning

Assessment of capacity requires a direct interview with patient using open ended question and may include both informal and formal approaches depending in the situation and the context. A baseline cognitive evaluation with a simple test to assess executive function is often useful in capacity evaluation. All capacity evaluations are situation specific, relating to the particular decision under consideration, and are not global in scope. The clinician needs to spend adequate time with the patient and the family allaying their anxieties and also consider the sociocultural context.

It is crucial to strike a balance between respecting the patient autonomy and acting in his or her best interest.