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Aravind H, Taylor M, Gill N. 'Evaluation of testamentary capacity: A systematic review'. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 93:101969. [PMID: 38422563 DOI: 10.1016/j.ijlp.2024.101969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/29/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To systematically review the literature on methods for the standardized and objective assessment of Testamentary Capacity (TC), to identify the best evidence-based and clinically pragmatic method to assess TC. Doubts concerning TC can have far-reaching legal and financial implications. METHOD A systematic search of the literature was conducted, using PRISMA guidelines, to identify studies which describe methods or tools for the assessment of TC. RESULTS The Testamentary Definition Scale (TDS); the Testamentary Capacity Assessment Tool (TCAT); and the Testamentary Capacity Instrument (TCI) all have good psychometric properties, but TDS only partially assesses TC, and the TCI is designed for research rather than day-to-day clinical practice. CONCLUSION The TCAT could usefully supplement the clinical assessment of TC, coupled with a standardized examination of cognition. There is room to develop an all-encompassing TC assessment tool. Currently, the clinical judgement of a medical professional, taking account of the medical, legal, ethical issues informing a capacity or competency decision, remains the gold standard for assessing TC.
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Affiliation(s)
- Himaja Aravind
- Mental Health and Specialist Services, Gold Coast Health, Gold Coast, QLD, Australia
| | - Mark Taylor
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia.
| | - Neeraj Gill
- Mental Health and Specialist Services, Gold Coast Health, Gold Coast, QLD, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia; Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
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Economou A, Kontos J. Testamentary capacity assessment in dementia using artificial intelligence: prospects and challenges. Front Psychiatry 2023; 14:1137792. [PMID: 37324813 PMCID: PMC10264688 DOI: 10.3389/fpsyt.2023.1137792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Testamentary capacity (TC), a set of capacities involved in making a valid Will, has become prominent in capacity evaluations due to the demographic increase in older persons and associated increase in cognitive impairment. The assessment of contemporaneous TC follows the criteria derived from the Banks v Goodfellow case, which do not bind capacity solely on the basis of presence of a cognitive disorder. Although effort is being made for establishing more objective criteria for TC judgment, variations in situational complexity call for incorporating the different circumstances of the testator in capacity assessment. Artificial intelligence (AI) technologies such as statistical machine learning have been used in forensic psychiatry mainly for the prediction of aggressive behavior and recidivism but little has been done in the area of capacity assessment. However, the statistical machine learning model responses are difficult to interpret and explain, which presents problems with regard to the new General Data Protection Regulation (GDPR) of the European Union. In this Perspective we present a framework for an AI decision support tool for TC assessment. The framework is based on AI decision support and explainable AI (XAI) technology.
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Affiliation(s)
- Alexandra Economou
- Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
| | - John Kontos
- Department of History and Philosophy of Science, National and Kapodistrian University of Athens, Athens, Greece
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Topical Issues in Contemporaneous Assessment of Testamentary Capacity. PSYCHOLOGICAL INJURY & LAW 2022. [DOI: 10.1007/s12207-022-09466-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Gerstenecker A, Martin RC, Hebert K, Triebel K, Marson DC. Cognitive Correlates of Impaired Testamentary Capacity in Alzheimer's Dementia. Arch Clin Neuropsychol 2022; 37:1148-1157. [PMID: 35731016 DOI: 10.1093/arclin/acac034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Testamentary capacity (TC) is a legal construct about the ability to make or change a will. Although studies of financial and medical capacities have noted a strong association between capacity and cognition, no study has examined the cognitive correlates of TC in Alzheimer's disease (ad). METHODS Study participants were 22 cognitively healthy controls and 20 persons with mild to moderate ad who were administered a neuropsychological battery and the Testamentary Capacity Instrument (TCI), a new performance-based measure of TC. Both TCI Element and TCI Total scores were calculated. TCI Total scores were calculated for the purposes of expanding correlational analyses (i.e., Pearson's product-moment) and are not intended for forensic TC evaluations. Final predictors were identified using linear and logistic regression modeling. RESULTS All ad participants but one obtained TCI Totals that fell >2.5 standard deviations below the control group mean. Initial cognitive correlates of TCI performance were measures of general cognition, language, verbal memory, executive function, and processing speed. The four cognitive variables showing the highest t values and correlating with TCI Total score > 0.7 were entered into logistic and linear regression models. Final predictor models consisted of measures of verbal memory, executive function, and semantic knowledge and demonstrated shared variance of 0.71 (linear) and 0.82 (logistic). CONCLUSIONS A diagnosis of ad dementia is associated with clinical impairment in TC and associated cognitive abilities and indicates that a legal assessment of TC is warranted. Second, the results offer insight into the cognitive basis of TC in persons with Alzheimer's dementia.
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Affiliation(s)
- Adam Gerstenecker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL, USA.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL, USA.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Katina Hebert
- Tuscaloosa Veteran's Administration, Tuscaloosa, AL, USA
| | - Kristen Triebel
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL, USA.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel C Marson
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL, USA.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL, USA
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