From the Guidelines
Individuals with impaired short-term memory can often retain the capacity for informed medical decision-making, as decision-making capacity is decision-specific and not necessarily impaired by memory deficits. The ability to make medical decisions requires understanding relevant information, appreciating the situation and its consequences, reasoning about treatment options, and communicating a choice 1. Many individuals with short-term memory deficits can still engage in these processes effectively, especially for decisions made in the moment with proper support. Healthcare providers should assess decision-making capacity specifically rather than assuming incapacity based solely on memory impairment, as cognitive impairment is a spectrum and judgments about patients’ decision-making capacity are now recognized to be decision-specific 1.
Some key points to consider when assessing decision-making capacity in individuals with impaired short-term memory include:
- Understanding relevant information: providing written information, using plain language, and multimodal presentation of information can help 1
- Appreciating the situation and its consequences: involving trusted family members, using decision aids, and scheduling important discussions during the person's best time of day can be beneficial 1
- Reasoning about treatment options: breaking complex decisions into smaller components and providing corrective feedback can assist 1
- Communicating a choice: executing previously expressed wishes about care can be relatively straightforward, and decision-makers can extrapolate from what is known about the patient's prior general values and beliefs to try and judge how patients would have chosen 1
Overall, the key is individualized assessment, as memory impairment exists on a spectrum and doesn't automatically preclude the ability to make informed medical choices 1. Supportive strategies can help, and some individuals may benefit from advance directives created when their capacity was intact. Healthcare providers should prioritize individualized assessment and supportive strategies to facilitate informed medical decision-making in individuals with impaired short-term memory.
From the Research
Impaired Short-Term Memory and Informed Medical Decision-Making
- Individuals with impaired short-term memory may face challenges in retaining information necessary for informed medical decision-making 2, 3.
- Research suggests that short-term memory deficits can impact cognitive performance, including attention and decision-making abilities 3, 4.
- However, the relationship between short-term memory impairment and informed medical decision-making capacity is complex and may depend on various factors, including the severity of the impairment and the individual's overall cognitive function 5, 6.
Cognitive Deficits and Decision-Making
- Studies have shown that individuals with mild traumatic brain injury (mTBI) exhibit deficits in sustained visual attention, short-term memory, and decision-making 3.
- Similarly, older adults with subjective short-term memory difficulties are at higher risk of developing dementia and cognitive impairment 5.
- Biochemical indicators, such as ghrelin, leptin, and cortisol levels, may also be associated with cognitive decline and memory loss in older adults 6.
Retaining Decision-Making Capacity
- Despite impaired short-term memory, individuals may still be able to retain some capacity for informed medical decision-making, particularly if they have access to support and accommodations 2, 4.
- Further research is needed to fully understand the relationship between short-term memory impairment and informed medical decision-making capacity, as well as to develop effective strategies for supporting individuals with cognitive deficits 3, 5, 6.