2011 Articles

Memory Awareness Influences Everyday Decision Making Capacity about Medication Management in Alzheimer's Disease

Cosentino, Stephanie; Metcalfe, Janet A.; Cary, Mark S.; De Leon, Jessica L.; Karlawish, Jason

Memory awareness in early Alzheimer’s disease (AD) influences capacity to provide informed consent for a memory treatment. This study investigated the extent to which aspects of memory awareness influence everyday decision-making capacity about medication management in AD. 42 participants with mild AD and 50 healthy elders underwent clinical ratings of memory awareness, metamemory testing, and an interview of everyday decision-making capacity regarding medication management. 45% of AD subjects were classified as aware (AAD) and 55% as unaware (UAD) based on clinical ratings and supported by metamemory testing (P = .01). Capacity was impaired in each of the AD groups as compared to the healthy elders F(2, 67) = 17.63, UAD, P less than .01; AAD, p = .01). Within the AD group, capacity correlated selectively with awareness as measured with clinical ratings (r = -.41, P = .007) but not objective metamemory testing (r = -.10, P = .60). Appreciation scores were lower in UAD as compared with AAD F(1, 35) = 8.36, P = .007. Unawareness of memory loss should heighten clinicians’ concern about everyday decision-making capacity in AD.