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Background <p>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.</p> Methods <p>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.</p> Results <p>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.</p> Conclusions <p>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.</p> Clinical trial number <p>Not applicable.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月1日

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  • Xing Wu,
  • Wenqian Zhao,
  • Yutong Huang,
  • Xinyu Yao,
  • Yayi Zhao

摘要

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Clinical trial number

Not applicable.