DURABLE POWER OF ATTORNEY AND INFORMED CONSENT WITH ALZHEIMERS-DISEASE PATIENTS - A CLINICAL-STUDY

Objective: Experience with a new surrogate consent system for patients with Alzheimer's disease is reviewed. It was hypothesized that as pat ients' cognitive status deteriorated surrogate consent through a durab le power of attorney would become necessary to facilitate continued in volvement in clinical research. Method: The authors retrospectively re viewed the charts of inpatients with Alzheimer's disease who participa ted in research between January 1989 and December 1994 at the Geriatri c Psychiatry Unit of the National Institute of Mental Health. Seventy- nine patients were included. The main outcome measures were the Clinic al Dementia Rating, Global Deterioration Scale for primary degenerativ e dementia, and Mini-Mental State. Results: Most patients were in the mild-to-moderate stage of the illness when they chose to participate i n research and assign a durable power of attorney (96% scored 2 or les s on the Clinical Dementia Rating, and 92% scored 5 or less on the Glo bal Deterioration Scale). On average, the subjects participated in 3.8 (SD=2.6) studies. For 35 patients with multiple admissions over this period (average=3.1 years), scores on the Clinical Dementia Rating and Global Deterioration Scale declined by 2.0 and 1.5 points, respective ly. Conclusions: The durable power of attorney allows research partici pation for subjects with Alzheimer's disease at all stages. The linchp in is assignment of a durable power of attorney in the early-to-modera te stage of Alzheimer's disease, before subjects lose the capacity to give informed consent. This approach could also be adapted to patients with cognitive decline due to other debilitating diseases.