International Psychogeriatrics

Research Article

Capacity to make decisions on medication management in Chinese older persons with mild cognitive impairment and mild Alzheimer's disease

Victor Wing-Cheong Luia1 c1, Linda Chiu-Wa Lama2, Rachel Ching-Man Chaua2, Ada Wai-Tung Funga2, Billy Mou-Lam Wonga2, Grace Tak-Yu Leunga1, Kwok-Fai Leunga3, Helen Fung-Kum Chiua2, Jason H. T. Karlawisha4 and Paul S. Appelbauma5

a1 Department of Psychiatry, Tai Po Hospital, Hong Kong

a2 Department of Psychiatry, Chinese University of Hong Kong, Hong Kong

a3 Occupational Therapy Department, Queen Elizabeth Hospital, Hong Kong

a4 Division of Geriatric Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

a5 Division of Law, Ethics, and Psychiatry, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, USA


Background: This study aimed to assess if decisional capacity and the four decision-making abilities related to decisions concerning medication management were impaired among community-dwelling Chinese older persons in Hong Kong with amnestic mild cognitive impairment (MCI) and mild Alzheimer's disease (AD), as compared with cognitively normal older adults.

Methods: Two hundred and ninety-one Chinese community-dwelling older adults were recruited. The four decision-making abilities and decisional capacity were assessed by using the Chinese version of the Assessment of Capacity for Everyday Decision-Making (ACED) and independent clinician ratings based on the definition in the UK Mental Capacity Act 2005, respectively.

Results: Ninety-nine participants (34%) were diagnosed with MCI and ninety-five (33%) with mild AD. Although almost all (96%) of the participants in the MCI group were found to be mentally competent to make decisions on medication management in clinician ratings, their decision-making abilities as measured by the ACED were significantly lower than those of the cognitively normal controls.

Conclusions: Results from this study suggest that abilities related to decisions on medication management are impaired before the clinical diagnosis of dementia is made. Use of specific and structured assessment of the relevant decisional abilities may enhance clinical judgment.

(Received October 16 2011)

(Revised December 14 2011)

(Revised January 02 2012)

(Accepted January 12 2012)

(Online publication February 16 2012)


c1 Correspondence should be addressed to: Dr. Victor Wing-Cheong Lui, Department of Psychiatry, Tai Po Hospital, 9 Chuen On Road, Tai Po, Hong Kong. Phone: +852 26076111; Fax: +852 26623568. Email: