Attention: Neuropsychological predictor of competency in Alzheimer's disease

This study was undertaken to examine the relationship between two different competencies, financial and medical decision making, and explore whether n europsychological testing can identify a common underlying cognitive operat ion impaired in patients with AD. The objective was to examine the neuropsy chological predictors of financial and medical decision-making competencies in patients with Alzheimer's disease (AD). Twenty individuals with mild to moderate AD and 20 control subjects matched for age and education were eva luated at a university medical center. All participants were administered a financial competency questionnaire, a competency test for medical decision making, and a set of standardized neuropsychological tests selected to ref lect cognitive processes theoretically related to competency. In addition, an informant provided information regarding banking history for each partic ipant. AD patients performed more poorly on all measures, including both me asures of competency, which were highly related (R = .718, P < .001). Two t ests, Trails A and Word List Recall, were significantly correlated with bot h competency measures, with Trails A predicting over 85% of the variance in competency scores. Trails A discriminated competent from not competent par ticipants with an accuracy ranging from 77% to 82%. Measures of financial a nd medical decision-making competency were significantly correlated among p atients with AD. One brief neuropsychological test of attention, Trails A, proved to be highly predictive of performance on both competency measures a nd useful in the discrimination of competent performance on these measures and by informant report.