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Tsiakiri A, Trypsiani I, Christidi F, Trypsianis G, Bakirtzis C, Vlotinou P, Tsiptsios D, Voskou P, Papageorgiou S, Aggelousis N, Vadikolias K, Serdari A. The testamentary capacity in acute stroke. A cross-sectional study. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-11. [PMID: 38447221 DOI: 10.1080/23279095.2024.2324126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Succession law, which governs the creation and validity of wills, is closely tied to testamentary capacity (TC), the cognitive competence required for a valid will. This study explores TC in acute stroke patients and its connections to demographic and clinical characteristics. The research included first-time stroke patients admitted within 24 hours of symptom onset, meeting specific criteria. Data were collected, and assessment tools like the Addenbrooke's Cognitive Examination III (ACE-III) and Testamentary Capacity Assessment Tool (TCAT) were used. The study found that TCAT scores were not significantly affected by age or gender but positively correlated with education, the Barthel Index and ACE-III scores. They were negatively associated with National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) scores. Specific cognitive domains, particularly memory and attention, were independent determinants of TCAT scores. This research introduces TCAT as a valuable tool for evaluating testamentary capacity in stroke patients and highlights the multifaceted nature of TC, emphasizing the need for a nuanced approach. As the population ages and complex medical conditions become more prevalent, understanding the interplay between cognitive functioning and testamentary capacity becomes increasingly crucial for both legal and medical professionals.
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Affiliation(s)
- Anna Tsiakiri
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioanna Trypsiani
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Gregory Trypsianis
- Laboratory of Medical Statistics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christos Bakirtzis
- B' Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Pinelopi Vlotinou
- Department of Occupational Therapy, University of West Attica, Athens, Greece
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagiota Voskou
- Cognitive Disorders/Dementia Unit, 2nd Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Sokratis Papageorgiou
- Cognitive Disorders/Dementia Unit, 2nd Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | | | - Aspasia Serdari
- Department of Child and Adolescent, Democritus University of Thrace, Alexandroupolis, Greece
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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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Martin RC, Gerstenecker A, Hebert K, Triebel K, Marson D. Assessment of Testamentary Capacity in Older Adults: Description and Initial Validation of a Standardized Interview Instrument. Arch Clin Neuropsychol 2022; 37:1133-1147. [PMID: 35596954 DOI: 10.1093/arclin/acac028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Testamentary capacity (TC) is a legal construct, which concerns a person's mental capacity to make or amend a will. Although expert clinicians are frequently asked to assess TC in forensic settings, there are few instruments and little empirical research to inform and guide their assessments. The present study describes the development and psychometric properties of a standardized assessment measure of TC (Testamentary Capacity Instrument-TCI), and investigates its reliability and validity. METHODS The TCI is an interview-based, psychometric measure, which assesses a testator's knowledge of four conceptual elements, which together comprise the legal basis for TC in the Anglo-American legal system: (1) what a will is, (2) nature and extent of assets/property, (3) possible heirs/claimants to property, and (4) plan to distribute assets to heirs after death. Cronbach's alpha and percentage exact agreement were used to examine TCI element reliabilities. Using independent samples t-tests, MANOVA and MANCOVA, we investigated validity by comparing TCI element performance of cognitively intact older adults (n = 22) and older adults with ad dementia (n = 20). RESULTS The TCI elements showed good internal consistency and good inter-rater reliability. The ad group performed significantly below the control group on all four TCI elements, with effect sizes exceeding 1.2, suggesting that the TCI has content and construct validity. CONCLUSIONS Relative to cognitively intact older adults, older adults with ad dementia showed significant impairment on all four TCI conceptual elements. The TCI has promise as a standardized quantitative measure of TC to support clinical assessment of TC in forensic settings.
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Affiliation(s)
- Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Adam Gerstenecker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Katina Hebert
- Birmingham Veterans Administration Medical Center, Birmingham, AL 35233, USA
| | - Kristen Triebel
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Daniel Marson
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Kenepp A, Johnson E, Lee GJ, Sunderaraman P, Denburg NL, Nguyen CM. A Comprehensive Approach to Assessment of Testamentary Capacity. Front Psychol 2021; 12:789494. [PMID: 35002883 PMCID: PMC8733255 DOI: 10.3389/fpsyg.2021.789494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022] Open
Abstract
The growing aging population raises important implications for legal and clinical systems, including testamentary capacity (TC) assessment. Yet, there are limited comprehensive and standardized assessment measures for TC readily available for clinical use. A review of current assessment methods and standardized approaches for TC assessment is provided. Although several guidelines regarding TC assessment have been proposed in prior literature, existing standardized approaches do not appear to meet full criteria for TC. A comprehensive approach to assessment of testamentary capacity is proposed.
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Affiliation(s)
- Amanda Kenepp
- Department of Psychology, Queens College and The Graduate Center (CUNY), New York, NY, United States
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Ellen Johnson
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Grace J. Lee
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Preeti Sunderaraman
- Department of Neurology & The Framingham Heart Study - Brain Aging Program, Boston University School of Medicine, Boston, MA, United States
| | - Natalie L. Denburg
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa, IA, United States
| | - Christopher M. Nguyen
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
- *Correspondence: Christopher M. Nguyen,
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Bolognini N, Gramegna C, Esposito A, Aiello EN, Difonzo T, Zago S. The Testamentary Capacity Assessment Tool (TCAT): validation and normative data. Neurol Sci 2021; 43:2831-2838. [PMID: 34787752 DOI: 10.1007/s10072-021-05736-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is an increasing need for objective and standardized assessment of testamentary capacity (TC) in dementia. A new instrument, the Testamentary Capacity Assessment Tool (TCAT), has been recently developed; however, the lack of validation and normative data regarding this cognitive screening test has limited its adoption in forensic and clinical settings. The present study collects normative data for the TCAT and assesses its convergent validity with standardized cognitive tests and the capacity to define what a 'testament' is. METHODS The study involved 323 neurologically healthy adults (123 males, 200 females) of different ages (31-93 years) and different educational levels (4-25 years). The TCAT was administered along with the Beck Depression Inventory-II (BDI-II), the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), the Frontal Assessment Battery (FAB) and the Testament Definition Scale (TDS). RESULTS Multiple regression analyses revealed a significant effect for gender, age and education on TCAT scores. Correlation analyses showed significant associations between the TCAT and the MMSE, MoCA, FAB and BDI-II. A positive correlation between the TCAT and TDS was also found, proving good convergent validity of the TCAT with respect to TC. Finally, cut-off scores and Equivalent Scores (ES) were computed. DISCUSSION The present study provides normative data for using the TCAT as an adjuvant cognitive screening test in the neuropsychological evaluation of TC. Our findings shall be of interest for the adoption of the TCAT also in clinical practice, since it evaluates cognitive functions (e.g., autobiographic memory, Theory of Mind) not measured by traditional screening tests.
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Affiliation(s)
- Nadia Bolognini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy. .,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy.
| | - Chiara Gramegna
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Edoardo Nicolò Aiello
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Teresa Difonzo
- U.O.C. Di Neurologia, IRCCS Fondazione Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefano Zago
- U.O.C. Di Neurologia, IRCCS Fondazione Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Zago S, Bolognini N. Neuropsychological autopsy of testamentary capacity: Methodology and issues in the elderly. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:570-583. [PMID: 32687452 DOI: 10.1080/23279095.2020.1791869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The forensic assessment of testamentary capacity is a topical issue given the prevalence of dementia illnesses and the increase in the complexity of modern financial and family structures. Although a contemporaneous assessment would be desirable, the majority of situations require a retrospective assessment of the mental state a deceased individual. Neuropsychologists, independently or as part of a board of consultants, are, therefore, frequently requested to give an expert opinion of the competence of cognitively impaired elderly testators.This paper offers a guide for carrying out a neuropsychological autopsy, namely the process of posthumous evaluation, for determining testamentary capacity. Taking into account the recent literature on the assessment of testamentary capacity, we propose a three-phase procedure for carrying out the neuropsychological autopsy in the forensic context. The neuropsychological autopsy of testamentary capacity is based on the meticulous, chronologically structured evaluation of any medical documents, available psychometric data, along with the critical examination of any source of information about the cognitive level of functioning of the deceased person at the time of the will.
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Affiliation(s)
- Stefano Zago
- U.O.C. di Neurologia, IRCCS Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Nadia Bolognini
- Dipartimento di Psicologia, Università degli Studi Milano-Bicocca di Milano, Milano, Italy.,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milano, Italy
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