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Monday, 16 October 2006


Susie A. Sami, MA1, Neal Dawson, MD2, Marian B. Patterson, PhD1, Mendel E. Singer, PhD3, Kathleen A. Smyth, PhD1, Iahn Gonsenhauser, MBA1, and Peter J. Whitehouse, MD, PhD1. (1) Case Western Reserve University, Cleveland, OH, (2) Case Western Reserve University - MetroHealth Medical Center, Cleveland, OH, (3) Case Western Reserve University School of Medicine, Cleveland, OH

Purpose: The purpose of this study was to assess associations between cognitive deficits and ability of patients with dementia (PWD) to state their health care preferences. Method: In this cross-sectional study, visual analog scale, time trade-off, and standard gamble health state valuation (HSV) techniques were used. Sixty PWD were asked to provide HSV for 2 practice states (dependence on glasses; blindness), their current health, and 3 hypothetical disease states (mild memory problems; mild to moderate dementia; severe dementia). The outcome variable, ability to perform HSV, was scored dichotomously. Patients received scores of 1 if they completed and provided logically consistent responses to both practice states and at least one additional HSV using any 1 of the 3 techniques. Those not able to perform at this level received scores of 0. Patients completed a neuropsychological test battery to assess 4 cognitive domains: executive function, language, attention and concentration, and verbal memory. Logistic regression was used to examine associations between cognitive domain scores and HSV performance. Results: The sample was 55% male and had a mean age of 74.9 (s.d.=9.4). Most participants (87%) had at least a high school education. Participants had mild to moderate dementia (Mini Mental State Exam mean = 22.8, s.d. =5.5). Cognitive subscale items were standardized before computing the domain scores. Means and standard deviations were as follows: executive function (-0.04, 1.38), language (0.12, 2.77), attention and concentration (0.03, 2.21) and verbal memory (0.13, 2.47). Higher language and verbal memory scores increased the odds of completing the HSV (OR=4.24, p=0.002; OR =1.79, p=0.04, respectively). There was a trend for higher scores on attention and concentration to be associated with a decreased odds of completing the HSV tasks (OR=0.44, p=0.059). The association between executive function scores and completion of the HSV tasks was not significant. The model c statistic was 0.90 (p<0.001). Conclusion: Dementia patients with relatively preserved language and verbal memory abilities are better able to complete the complex tasks involved in HSV. Clinically, these patients may still be able to state their health care preferences. The findings regarding attention and concentration are puzzling. Further study of the relationship between these cognitive functions and ability to perform HSV are needed.

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See more of The 28th Annual Meeting of the Society for Medical Decision Making (October 15-18, 2006)