RT Journal Article
SR Electronic
T1 Decisional Capacity in Amyotrophic Lateral Sclerosis
JF Journal of the American Academy of Psychiatry and the Law Online
JO J Am Acad Psychiatry Law
FD American Academy of Psychiatry and the Law
SP 210
OP 217
VO 43
IS 2
A1 Eindra Khin Khin
A1 Darlinda Minor
A1 Amanda Holloway
A1 Ayla Pelleg
YR 2015
UL http://jaapl.org/content/43/2/210.abstract
AB The cognitive and behavioral changes that can be observed in the neurodegenerative terminal disease amyotrophic lateral sclerosis (ALS), once characterized as purely a motor neuron disease, have become increasingly recognized over the past century. Detecting cognitive deficits earlier and identifying continued changes at regular intervals can lead to improved care, proactive treatments, and earlier discussions about end-of-life wishes. Although medical decisional capacity is required for every treatment decision made, its importance becomes paramount when making decisions on complex medical treatments that will invariably and significantly affect quality of life or life itself. In this review, we conducted a critical analysis of the evidence-based literature on the cognitive and behavioral impairments in ALS that can compromise medical decisional capacity. We review specific ALS-related clinical scenarios in which decisional capacity is of utmost importance and discuss a practical framework for cognitive and behavioral assessment that can be routinely and efficiently used, while being mindful of the confounding factors associated with ALS. Finally, we review models for preserving patient choices that can be used in patients with ALS to help safeguard autonomy and retain dignity toward the end of life.