From mild cognitive impairment to moderate Alzheimer's disease: Associations between decision-making capacity and awareness

BackgroundEvidence on how distinct stages of mild cognitive impairment (MCI) and Alzheimer's disease (AD) affect decisional capacity and disease awareness remains limited.ObjectiveWe aim to examine the impairment of decision-making capacity, hypothesizing that people with MCI would demonstrate greater capacity and awareness than those with AD. We also aim to explore associations with cognitive and clinical variables.MethodsWe conducted a cross-sectional study including 137 participants: MCI (n = 37), mild AD (n = 50), and moderate AD (n = 50). Standardized assessments were used to evaluate domains of decision-making capacity and awareness of the illness.ResultsPeople with MCI performed significantly better in understanding, appreciation, and reasoning domains, while expression of choice was preserved across all groups. Disease awareness was higher in MCI, whereas AD participants showed marked deficits, particularly in cognitive and functional domains. Differences in socioemotional awareness were less consistent.ConclusionsOur findings indicate a decline, from MCI to moderate AD, in decisional capacity and awareness, with expression of choice remaining relatively intact. These results have important ethical and clinical implications for shared decision-making and dementia care.