Cognitive Disorders/Dementia Unit, 2nd Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece.
Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece.
J Alzheimers Dis. 2018;61(3):985-994. doi: 10.3233/JAD-170297.
In current practice, it is common for the medical practitioner to assess a person's testamentary capacity (TC) and give evidence to the Courts about a potential will contest. TC is an advanced cognitive activity that is both situation- and task-specific.
The aim of the present study was the development of a brief, specialized instrument for TC assessment in patients with dementia.
We developed a short tool consisting of four subtests, assessing the person's core functions which are required for TC: memory (orientation, autobiographical memory and realistic perception of beneficiaries), absence of serious psychopathology, knowledge of financial parameters (value of assets, everyday life products, bills), and intention (vignettes, theory of mind). For its validation, we examined 64 outpatients from the Cognitive Disorders/Dementia Unit, 2nd Department of Behavioral Neurology, University of Athens. The decision of the expert served as the gold standard for the evaluation of TC.
Of the 64 participants, 39 were judged by the expert as capable of TC and the remaining 25 as incapable. For the total scale (maximum score of 48), the best combination of sensitivity (82.6%) and specificity (100%) was obtained for a cut-off score of 32/33. Cronbach's alpha showed high levels of internal reliability for the scale (α= 0.86) and the point-biserial correlation coefficients showed high levels of criterion-related validity (rbp = 0.797, p < 0.001).
The new instrument appears to be a reliable screening tool for the evaluation of TC in dementia, which can be used by both the expert and the non-expert. Further research is needed to confirm these promising findings.
在当前的实践中，医疗从业者评估一个人的遗嘱能力（TC）并向法院提供有关潜在遗嘱争议的证据是很常见的。TC 是一种高级认知活动，具有情境和任务特异性。
本研究旨在开发一种用于痴呆患者 TC 评估的简短、专业工具。
我们开发了一种由四个子测试组成的简短工具，评估患者进行 TC 所需的核心功能：记忆（定向、自传体记忆和对受益人的现实感知）、无严重精神病理学、对财务参数的了解（资产价值、日常用品、账单）和意图（情景、心理理论）。为了验证其有效性，我们检查了来自雅典大学行为神经病学第二系认知障碍/痴呆科的 64 名门诊患者。专家的决定被视为评估 TC 的金标准。
在 64 名参与者中，有 39 名被专家判断为具有 TC 能力，其余 25 名被判断为不具有 TC 能力。对于总评分（最高 48 分），对于 32/33 的截断分数，获得了最佳的敏感性（82.6%）和特异性（100%）组合。该量表的克朗巴赫α系数显示出高度的内部可靠性（α=0.86），点双列相关系数显示出高度的效标关联效度（rbp=0.797，p<0.001）。
新工具似乎是一种用于评估痴呆患者 TC 的可靠筛选工具，既可以由专家也可以由非专家使用。需要进一步的研究来证实这些有希望的发现。
