Capacity to make medical treatment decisions in multiple sclerosis: A potentially remediable deficit

Abstract

Ability to make decisions about medical treatment is compromised in significant numbers of people with neurological and psychiatric illness, and this incapacity frequently corresponds with compromised neuropsychological function. Although cognitive deficits occur often in people with multiple sclerosis (MS), no research has studied decisional capacity in that disease. The present investigation examined ability to understand treatment disclosures, which is a core component of decisional capacity, in 36 people with MS and 16 normal controls. MS patients with diminished neuropsychological function showed poor understanding of treatment disclosures compared to the control group, and diminished new learning and executive function correlated with poorer understanding. Nonetheless, with sufficient cuing, the MS patients with diminished neuropsychological function were able to display understanding that was equivalent to that of the control group. Implications of these results for clinical practice and medical research involving people with MS are discussed.

Keywords:

• Multiple sclerosis
• Neuropsychological function
• Informed consent
• Decision making

Acknowledgments

This research was funded by grants to the first author from the National Multiple Sclerosis Society, Oklahoma Center for the Advancement of Science and Technology, and the National Institute of Neurological Diseases and Stroke (R01 NS043362-01A2). The first author expresses gratitude to helpful support from the Oklahoma Chapter of the National Multiple Sclerosis Society and to J. Carpenter.