TY  - JOUR
PY  - 2015//
TI  - Neurocognitive models of medical decision-making capacity in traumatic brain injury across injury severity
JO  - Journal of head trauma rehabilitation
A1  - Triebel, Kristen L.
A1  - Novack, Thomas A.
A1  - Kennedy, Richard
A1  - Martin, Roy C.
A1  - Dreer, Laura E.
A1  - Raman, Rema
A1  - Marson, Daniel C.
SP  - E49
EP  - 59
VL  - 31
IS  - 3
N2  - OBJECTIVE: To identify neurocognitive predictors of medical decision-making capacity (MDC) in participants with mild and moderate/severe traumatic brain injury (TBI). SETTING: Academic medical center. PARTICIPANTS: Sixty adult controls and 104 adults with TBI (49 mild, 55 moderate/severe) evaluated within 6 weeks of injury. <br><br>DESIGN: Prospective cross-sectional study. MAIN MEASURES: Participants completed the Capacity to Consent to Treatment Instrument to assess MDC and a neuropsychological test battery. We used factor analysis to reduce the battery test measures into 4 cognitive composite scores (verbal memory, verbal fluency, academic skills, and processing speed/executive function). We identified cognitive predictors of the 3 most clinically relevant Capacity to Consent to Treatment Instrument consent standards (appreciation, reasoning, and understanding). <br><br>RESULTS: In controls, academic skills (word reading, arithmetic) and verbal memory predicted understanding; verbal fluency predicted reasoning; and no predictors emerged for appreciation. In the mild TBI group, verbal memory predicted understanding and reasoning, whereas academic skills predicted appreciation. In the moderate/severe TBI group, verbal memory and academic skills predicted understanding; academic skills predicted reasoning; and academic skills and verbal fluency predicted appreciation. <br><br>CONCLUSIONS: Verbal memory was a predictor of MDC in controls and persons with mild and moderate/severe TBI. In clinical practice, impaired verbal memory could serve as a "red flag" for diminished consent capacity in persons with recent TBI.<p />  <p>Language: en</p>
LA  - en
SN  - 0885-9701
UR  - http://dx.doi.org/10.1097/HTR.0000000000000163
ID  - ref1
ER  -