Association of MoCA-measured cognitive functions with decision-making capacity in older adults with cognitive impairment

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The rising cognitive impairment prevalence challenge healthcare systems and the independence of older adults. Since the capacity to make decisions about everyday activities and medical treatment is central to maintaining autonomy, we investigated how MoCA-measured cognitive functions are associated with this capacity. Cross-sectional data were collected from 457 older adults with cognitive impairment. Cognitive functions were measured by the Montreal Cognitive Assessment (MoCA) Beijing Version. The Chinese version of the Assessment of Capacity for Everyday Decision-making (ACED) and the MacArthur Competency Assessment Tool for Treatment (MacCAT-T) were used to assess the decision-making capacity for both medication management and treatment from understanding, appreciation, reasoning, and expressing a choice. Multiple linear regression was conducted to analyze the association of MoCA-measured cognitive functions with decision-making capacity for medication management and treatment. MoCA-measured cognitive domains accounted for 30.1%-67.4% of the variance in decision-making capacities to medication management and treatment in multivariate models. Attention and language abilities consistently emerged as the strongest predictors across all four domains of decision-making capacities for both medication management and treatment. Visuospatial and executive abilities and orientation showed significant effect on understanding and appreciation in both decision contexts. Abstract thinking and delayed recall were non-significant in the models of both decision-making capacities. Our findings identified attention and language abilities as the strongest predictors of decision-making capacity for both medication management and treatment for older adults with cognitive impairment. These results underscore the potential for MoCA-based cognitive assessments to inform evaluations of decision-making autonomy, thereby guiding the provision of person-centered long-term care. Not applicable. • Decision-making capacity is a crucial factor in determining the extent of cognitively impaired older adults’ participation in future medical treatment and daily care. • Previous studies related to decision making, such as those on advance care planning, always classified the study populations based on cognitive function, seldom consider the participants’ decision-making capacity. Cognitive correlates of decision-making capacity are poorly studied. • Attention and language abilities consistently emerged as the strongest predictors across all four domains of decision-making capacities for both medication management and treatment. • Abstract thinking and delayed recall were non-significant in the models of both decision-making capacities.

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