Cognitive Correlates of Impaired Testamentary Capacity in Alzheimer's Dementia

'Evaluation of testamentary capacity: A systematic review'

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.

Testamentary capacity assessment in dementia using artificial intelligence: prospects and challenges

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.