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Decline in complex abilities is a crucial early clinical dimension of neurodegenerative diseases such as Alzheimer dementia (AD)1–3 and Parkinson disease (PD),4,5 and of their prodromal states such as mild cognitive impairment (MCI).6,7 As memory and executive cognitive abilities decline, these patients demonstrate initially subtle but increasingly salient changes in important decisional capacities such as treatment consent, research consent, and financial decision-making. These progressive decisional impairments raise critically important ethical issues concerning patients' personal autonomy and competency, with implications for patients and families, and for physicians, scientists, bioethicists, and legal professionals.1,4 For example, meaningful consent to participate in research is possible only when the person giving it has the capacity to understand and use disclosed information to decide whether to enroll in a proposed research protocol.8 Such decisional capacity assessments are particularly relevant, but have not always been conducted, in aggressive surgical trials such as deep brain stimulation.9
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.
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- © 2013 American Academy of Neurology
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