Examining Voting Capacity in Older Adults with and without Cognitive Decline †
Abstract
:1. Introduction
2. Purpose and Hypotheses of the Study
3. Methods
3.1. Design
3.2. Ethical Standards
3.3. Participants
3.4. Measures
3.4.1. The CAT-V Assessment
3.4.2. Mini-Mental State Examination (MMSE)
3.5. Data Statistical Analysis
4. Results
4.1. Ability of the MMSE Exact Score to Discriminate Adequate Voting Capacity from Inability as Regards Specific Aspects/Categories—Questions of the CAT-V
4.2. Demographic Effects and Effects of General Cognitive Status on the Total Voting Score of CAT-V
4.3. Ability of the CAT-V Total Score to Discriminate PwADD from PwtD in Each Age Group
5. Discussion
6. Limitations
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Schriner, K.; Ochs, L.; Shields, T. The Last Suffrage Movement: Voting Rights for Persons with Cognitive and Emotional Disabilities. Publius J. Fed. 1997, 27, 75–96. [Google Scholar] [CrossRef]
- Thompson, E.; Kaur, R. Mental Capacity and the Vote: Divergent International Approaches and Shared Problems. Royal College of Psychiatry E-Newsletter. 2015. Available online: http://www.rcpsych.ac.uk/workinpsychiatry/divisions/trent/enewsletters-trent/enewsletter-summer2015/votingandcapacity-etrk.aspx?theme=mobile> (accessed on 15 November 2022).
- Sachdev, P.; Blacker, D.; Blazer, D.; Ganguli, M.; Jeste, D.V.; Paulsen, J.S.; Petersen, R.C. Classifying neurocognitive disorders: The DSM-5 approach. Nat. Rev. Neurol. 2014, 10, 634–642. [Google Scholar] [CrossRef] [PubMed]
- Han, S.; Boyle, P.; James, B.; Yu, L.; Bennett, D. Mild Cognitive Impairment Is Associated with Poorer Decision-Making in Community-Based Older Persons. J. Am. Geriatr. Soc. 2015, 63, 676–683. [Google Scholar] [CrossRef] [Green Version]
- Sinz, H.; Zamarian, L.; Benke, T.; Wenning, G.; Delazer, M. Impact of ambiguity and risk on decision making in mild Alzheimer’s disease. Neuropsychologia 2008, 46, 2043–2055. [Google Scholar] [CrossRef] [PubMed]
- Association A. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5®); American Psychiatric Publishing: Washington, DC, USA, 2013. [Google Scholar]
- Petersen, R.; Caracciolo, B.; Brayne, C.; Gauthier, S.; Jelic, V.; Fratiglioni, L. Mild cognitive impairment: A concept in evolution. J. Intern. Med. 2014, 275, 214–228. [Google Scholar] [CrossRef] [Green Version]
- Campos-Magdaleno, M.; Díaz-Bóveda, R.; Juncos-Rabadán, O.; Facal, D.; Pereiro, A. Learning and serial effects on verbal memory in mild cognitive impairment. Appl. Neuropsychol. Child 2015, 23, 237–250. [Google Scholar] [CrossRef] [PubMed]
- Poptsi, E.; Lazarou, I.; Markou, N.; Vassiloglou, M.; Nikolaidou, E.; Diamantidou, A.; Siatra, V.; Karathanassi, E.; Karakostas, A.; Zafeiropoulou, F.K.; et al. A Comparative Single-Blind Randomized Controlled Trial with Language Training in People With Mild Cognitive Impairment. Am. J. Alzheimer’s Dis. Other Demen. 2018, 34, 176–187. [Google Scholar] [CrossRef]
- Johns, E.; Phillips, N.; Belleville, S.; Goupil, S.; Babins, L.; Kelner, N.; Ska, B.; Gilbert, B.; Massoud, F.; de Boysson, C.; et al. The Profile of Executive Functioning in Amnestic Mild Cognitive Impairment: Disproportionate Deficits in Inhibitory Control. J. Int. Neuropsychol. Soc. 2012, 18, 541–555. [Google Scholar] [CrossRef] [Green Version]
- Poptsi, E.; Moraitou, D.; Tsardoulias, E.; Symeonidisd, A.; Tsolaki, M. Is the Discrimination of Subjective Cognitive Decline from Cognitively Healthy Adulthood and Mild Cognitive Impairment Possible? A Pilot Study Utilizing the R4Alz Battery. J. Alzheimer’s Dis. 2020, 77, 715–732. [Google Scholar] [CrossRef]
- Perneczky, R.; Pohl, C.; Sorg, C.; Hartmann, J.; Tosic, N.; Grimmer, T.; Heitele, S.; Kurz, A. Impairment of activities of daily living requiring memory or complex reasoning as part of the MCI syndrome. Int. J. Geriatr. Psychiatry 2006, 21, 158–162. [Google Scholar] [CrossRef]
- Doe v. Rowe, 156 F. Supp. 2d 35 (2001), 51. Applying Strict Scrutiny Analysis to a Voter Restriction against Those under Guardianship. Available online: http://www.leagle.com/decision/2001191156FSupp2d35_1186.xml (accessed on 15 November 2022).
- Irastorza, L.; Corujo, P.; Bañuelos, P. Capacity to Vote in Persons with Dementia and the Elderly. Int. J. Alzheimer’s Dis. 2011, 2011, 1–6. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Appelbaum, P.; Bonnie, R.; Karlawish, J. The Capacity to Vote of Persons with Alzheimer’s Disease. Am. J. Psychiatry 2005, 162, 2094–2100. [Google Scholar] [CrossRef]
- Alzheimer’s Disease International. World Alzheimer Report; Alzheimer’s Disease International: London, UK, 2019. [Google Scholar]
- Statista. Percentage of Citizens Who Abstained from Voting for the European Parliament Elections in France in 2019, by Age. 2021. Available online: https://www.statista.com/statistics/1010978/abstainees-voting-european-elections-france/ (accessed on 15 November 2022).
- Beckman, L. The Accuracy of Electoral Regulations: The Case of the Right to Vote by People with Cognitive Impairments. Soc. Policy Soc. 2014, 13, 221–233. [Google Scholar] [CrossRef] [Green Version]
- Grisso, T.; Appelbaum, P. Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Healthcare Professionals; Oxford University Press: New York, NY, USA, 1998; ISBN 0195103726/9780195103724. [Google Scholar]
- Kyllonen, P. Reasoning Abilities. In Oxford Research Encyclopedia of Education; Oxford University Press: Oxford, UK, 2021; Available online: https://oxfordre.com/education/view/10.1093/acrefore/9780190264093.001.0001/acrefore-9780190264093-e-878 (accessed on 15 November 2022).
- Little, D.; Lewandowsky, S.; Craig, S. Working memory capacity and fluid abilities: The more difficult the item, the more more is better. Front. Psychol. 2014, 5, 239. [Google Scholar] [CrossRef]
- Biella, M.; de Siqueira, A.; Borges, M.; Ribeiro, E.S.; Magaldi, R.M.; Busse, A.L.; Apolinario, D.; Aprahamian, I. Decision-making profile in older adults: The influence of cognitive impairment, premorbid intelligence and depressive symptoms. Int. Psychogeriatr. 2020, 32, 697–703. [Google Scholar] [CrossRef]
- De Siqueira, A.; Yokomizo, J.; Jacob-Filho, W.; Yassuda, M.; Aprahamian, I. Review of Decision-Making in Game Tasks in Elderly Participants with Alzheimer Disease and Mild Cognitive Impairment. Dement. Geriatr. Cogn. Disord. 2017, 43, 81–88. [Google Scholar] [CrossRef] [PubMed]
- Beresford, B.; Sloper, P. Understanding the Dynamics of Decision-Making and Choice; Social Policy Research Unit, University of York: York, UK, 2008. [Google Scholar]
- Tiraboschi, P.; Chitò, E.; Sacco, L.; Sala, M.; Stefanini, S.; Defanti, C. Evaluating Voting Competence in Persons with Alzheimer Disease. Int. J. Alzheimer’s 2011, 2011, 1–6. [Google Scholar] [CrossRef] [Green Version]
- Folstein, M.; Folstein, S.; McHugh, P. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J. Psychiatric Res. 1975, 12, 189–198. [Google Scholar] [CrossRef]
- Yesavage, J. Geriatric depression scale. Psychopharmacol. Bull. 1988, 24, 709–711. [Google Scholar]
- Fountoulakis, K.; Tsolaki, M.; Iacovides, A.; Yesavage, J.; O’hara, R.; Kazis, A.; Ierodiakonou, C. The validation of the short form of the Geriatric Depression Scale (GDS) in Greece. Aging Clin. Exp. Res. 1999, 11, 367–372. [Google Scholar] [CrossRef]
- Beck, A.T.; Steer, R.A.; Brown, G. Beck depression inventory–II. Psychol. Assess. 1996. [Google Scholar]
- Sinoff, G.; Ore, L.; Zlotogorsky, D.; Tamir, A. Short anxiety screening test—A brief instrument for detecting anxiety in the elderly. Int. J. Geriatr. Psychiatry 1999, 14, 1062–1071. [Google Scholar] [CrossRef]
- Grammatikopoulos, I.; Sinoff, G.; Alegakis, A.; Kounalakis, D.; Antonopoulou, M.; Lionis, C. The Short Anxiety Screening Test in Greek: Translation and validation. Ann. Gen. Psychiatry 2010, 9, 1. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cummings, J.; Mega, M.; Gray, K.; Rosenberg-Thompson, S.; Carusi, D.; Gornbein, J. The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology 1994, 44, 2308. [Google Scholar] [CrossRef] [Green Version]
- Politis, A.; Mayer, L.; Passa, M.; Maillis, A.; Lyketsos, C. Validity and reliability of the newly translated Hellenic Neuropsychiatric Inventory (H-NPI) applied to Greek outpatients with Alzheimer’s disease: A study of disturbing behaviors among referrals to a memory clinic. Int. J. Geriatr. Psychiatry 2004, 19, 203–208. [Google Scholar] [CrossRef]
- Fountoulakis, K.; Tsolaki, M.; Chantzi, H.; Kazis, A. Mini Mental State Examination (MMSE): A validation study in Greece. Am. J. Alzheimer’s Dis. Other Demen. 2000, 15, 342–345. [Google Scholar] [CrossRef]
- IBM SPSS Statistics for Windows; Version 23.0; IBM Corp.: Armonk, NY, USA, 2015.
- Hosmer, D.W., Jr.; Lemeshow, S.; Sturdivant, R.X. Applied Logistic Regression; John Wiley & Sons: Hoboken, NJ, USA, 2013. [Google Scholar]
- Hanley, J.; McNeil, B. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982, 143, 29–36. [Google Scholar] [CrossRef] [Green Version]
- Irastorza, L.; Corujo, P.; Bañuelos, P. Competencia para votar en pacientes con demencia. Rev. Neurol. 2007, 44, 321. [Google Scholar] [CrossRef]
- Raad, R.; Karlawish, J.; Appelbaum, P. The Capacity to Vote of Persons with Serious Mental Illness. Psychiatr. Serv. 2009, 60, 624–628. [Google Scholar] [CrossRef]
Demographic Characteristics | Sample (n = 391) |
---|---|
Gender (Male/Female) | n = 105/286 |
Age [M (SD)] | 72.04 (8.69) |
Age range | 51–95 |
Education in years [M (SD)] | 10.98 (4.71) |
Age groups | |
Μiddle-aged adults | 51–65: n = 94 |
Young-old adults | 66–75: n = 155 |
Old adults | 76–85: n = 120 |
Oldest-old adults | 86–95: n = 22 |
Educational level groups (according to years of schooling) | |
Low | 0–6: n = 121 |
Middle | 7–12: n = 133 |
High | >13: n = 137 |
CAT-V’s Sub-Questions | CAT-V’s Scores | ||
---|---|---|---|
No Voting Capacity n (%) | Doubtful Voting Capacity n (%) | Adequate Voting Capacity n (%) | |
Understands the nature of voting | 44 (11.3) | 13 (3.3) | 334 (85.4) |
Understands the results/effects of voting | 59 (15.1) | 16 (4.1) | 316 (80.8) |
Choice | 63 (16.1) | 9 (2.3) | 319 (81.6) |
Comparative Reasoning | 111 (28.4) | 39 (10.0) | 241 (61.6) |
Consequential Reasoning | 142 (36.3) | 55 (14.1) | 194 (49.6) |
Appreciation | 53 (13.6) | 36 (9.2) | 302 (77.2) |
Age Group | CAT-V Score | ||||
---|---|---|---|---|---|
PwADD | PwtD | p-Value | |||
Years | M (SD) | n | M (SD) | n | |
51–65 | 4.77 (1.00) | 7 | 11.11 (0.38) | 88 | 0.000 |
66–75 | 6.43 (0.48) | 35 | 10.78 (0.29) | 120 | 0.000 |
76–85 | 4.59 (0.55) | 51 | 10.08 (0.32) | 64 | 0.000 |
86–95 | 1.61 (0.81) | 11 | 12.00 (1.22) | 4 | 0.000 |
CAT-V Cutoff | AUC | Sensitivity % | Specificity % | 95% CI | p-Value | |
---|---|---|---|---|---|---|
Age Categories | PwtD vs. PwADD | |||||
51–65 years | 8.00 | 0.974 | 93.2 | 100 | 0.943–1.000 | <0.001 |
66–75 years | 10.5 | 0.920 | 73.3. | 97.1 | 0.877–0.962 | <0.001 |
76–85 years | 7.5 | 0.834 | 92.2 | 64.7 | 0.758–0.911 | <0.001 |
86–95 years | 9.5 | 1.000 | 100 | 100 | 1.000–1.000 | 0.004 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Poptsi, E.; Moraitou, D.; Tsatali, M.; Papaliagkas, V.; Tzanakaki-Melissari, M.; Kyriakoulaki, E.; Kounti, F.; Markou, N.; Liapi, D.; Batsila, G.; et al. Examining Voting Capacity in Older Adults with and without Cognitive Decline. Brain Sci. 2022, 12, 1614. https://doi.org/10.3390/brainsci12121614
Poptsi E, Moraitou D, Tsatali M, Papaliagkas V, Tzanakaki-Melissari M, Kyriakoulaki E, Kounti F, Markou N, Liapi D, Batsila G, et al. Examining Voting Capacity in Older Adults with and without Cognitive Decline. Brain Sciences. 2022; 12(12):1614. https://doi.org/10.3390/brainsci12121614
Chicago/Turabian StylePoptsi, Eleni, Despina Moraitou, Marianna Tsatali, Vasileios Papaliagkas, Maria Tzanakaki-Melissari, Elia Kyriakoulaki, Fotini Kounti, Nefeli Markou, Despina Liapi, Georgia Batsila, and et al. 2022. "Examining Voting Capacity in Older Adults with and without Cognitive Decline" Brain Sciences 12, no. 12: 1614. https://doi.org/10.3390/brainsci12121614