Treatment preferences do not vary by cognitive function in older patients, study finds

Older patients with mild cognitive impairment (MCI) have similar treatment preferences to those with normal cognition, a recent study found.

Researchers conducted a cross-sectional survey at two U.S. academic medical centers from February to December 2019 to determine whether patients with MCI had different treatment preferences than those without. Study participants were dyads of older outpatients with MCI and normal cognition and patient-designated surrogates. The survey used the modified Life-Support Preferences-Predictions Questionnaire score to measure patients' preferences for life-sustaining treatment in six health scenarios: current health, emphysema, stroke, metastatic colon cancer, heart attack with heart failure, and dementia. The results were published May 7 by the Journal of General Internal Medicine.

The survey response rate was 73.4%, and 127 of 136 recruited dyads (93.4%) completed the survey. Of these, 66 had MCI and 61 had normal cognition. Patients with MCI were 42.4% Black and 60.6% female and had a median age of 74.0 years, while patients with normal cognition were 47.5% Black and 62.3% female and had a median age of 71.0 years. Those with MCI had lower cognitive performance, higher functional dependence due to cognitive impairment, greater indication of depression, and longer relationships with their surrogates than those without.

Patients with MCI and patients with normal cognition did not differ significantly in the median number of life-sustaining treatments rejected across health scenarios (4.5 vs. 6.0; P=0.55). Eighty percent of patients in each group expressed a desire for life-sustaining treatments in their current health state (P=0.99). The researchers adjusted for patient and surrogate factors and found that the difference in mean counts of rejected treatments between patients with MCI and those with normal cognition was not statistically significant (adjusted ratio, 1.08; 95% CI, 0.80 to 1.44; P=0.63).

The researchers noted that their results may not be generalizable to other populations and that treatment scenarios were hypothetical, among other limitations. They concluded that in their study, older patients with MCI did not appear to want less treatment than patients with normal cognition. “These findings suggest that other provider and system factors rather than patient and surrogate treatment preferences might contribute to patients with MCI getting less guideline-concordant care than patients with [normal cognition],” the authors wrote.