Evaluating decision-making is complicated. Often individuals are under the impression that a “score” on a cognitive screening tool, such as a Folstein MMSE, is a definitive marker. Unfortunately, decision-making competency is not this black and white. Standardized measures are important to use as they are a way to compare others who may fall below or above a “normal” range. However scores can be misleading. Someone who scores 23/30 on the MMSE, which is below normal, may be able to make decisions for themselves because of their strong judgment, insight, critical thinking and organization skills which this test does not measure while someone who scores 27/30 (normal range) is unable to make decisions because of poor judgment, insight and problem solving. As a cognitive capacity evaluator I do use screening tools as part of my assessment but I cannot rely on these scores alone.
I rely on a combination of factors which include an in-depth interview with my clients, their family, and other professionals with whom they may have contact, a review of medical records and tests, and formalized screening tools. I consider all of this information in determining whether or not someone is deemed competent to make decisions.
It is important to evaluate the following:
It is only after careful consideration of all of the above that competency can be determined. If you are concerned that someone you love is suffering from cognitive deficits, use the Cognitive Worksheets available at www.ericksonresource.com/worksheets to track the symptoms so that you can share them with a physician or other health care professionals.
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