Evaluating Decisional Capacity in Older Adults and Individuals with Alzheimer's Disease

Individuals with Alzheimer's disease (AD) and some older adults are at risk of impaired decisional capacity for enrollment in clinical research trials. The MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), a semi-structured interview that was developed to help investigators evaluate four commonly recognized dimensions of competence (understanding, appreciation, reasoning, and choice), remains among the best and most widely used tools to assess decisional capacity. However, the gold standard remains expert judgment.