Do people with dementia always lack capacity True or false?

A diagnosis of dementia does not automatically remove a person's decision-making ability. This authoritative guide addresses the question, do people with dementia always lack capacity True or false, by explaining the nuances of mental capacity and emphasizing that abilities can fluctuate and depend on the situation.

Quick Summary

False, people with dementia do not always lack capacity; their ability to make decisions can fluctuate and often depends on the specific task, the stage of the illness, and their overall health at that moment.

Key Points

• Dementia Does Not Mean Incapacity: A diagnosis of dementia does not automatically mean a person lacks mental capacity; capacity is assessed individually for specific decisions at a specific time.

• Capacity Can Fluctuate: A person's ability to make decisions can vary from day to day or even hour to hour due to factors like fatigue, illness, or time of day.

• Capacity is Task-Specific: An individual may retain capacity for simple decisions (e.g., what to eat) while losing it for more complex matters (e.g., financial investments).

• Professional Assessment is Needed: Only qualified medical professionals can assess mental capacity, which is based on a person's ability to understand, retain, weigh, and communicate a decision.

• Early Legal Planning is Critical: In the early stages of dementia, creating legal documents like a Power of Attorney and an Advance Directive empowers individuals to ensure their wishes are honored in the future.

• Support Autonomy Whenever Possible: Caregivers and family members should focus on supporting decision-making, using strategies like simplifying choices, rather than taking control away.

Understanding Mental Capacity: A Closer Look

Many people incorrectly believe that a dementia diagnosis is an instant and complete loss of mental capacity. The truth is far more complex and compassionate. Mental capacity is not an all-or-nothing concept, and it is assessed on a decision-by-decision basis. A person's ability to understand, weigh, and communicate a decision can be influenced by many factors, including the type and stage of dementia, their current health, and their environment.

Capacity vs. Competency: The Key Distinction

To understand this issue, it's essential to differentiate between two key terms: capacity and competency. While often used interchangeably in everyday language, they have distinct legal and medical meanings.

• Capacity: This is a medical and functional assessment made by a clinician. It refers to a person's ability to make a specific decision at a specific point in time. It is task-specific, meaning someone can have the capacity to make small decisions (e.g., what to wear) but lack the capacity for complex ones (e.g., large financial transactions). Capacity can also fluctuate, being stronger at certain times of the day or when a person is feeling well.
• Competency: This is a legal determination made by a court of law. A judge declares a person incompetent for legal purposes, which is a broader, more global assessment than capacity. This typically only occurs in advanced stages of the illness and is not an automatic outcome of a dementia diagnosis.

The Fluctuating Nature of Decision-Making

One of the most important aspects to remember is that capacity in people with dementia can fluctuate. Several factors can influence a person's cognitive function on a daily or even hourly basis:

• Time of day: Many people with dementia experience 'sundowning,' a phenomenon where confusion and agitation worsen in the late afternoon and evening. This means a person might have good decision-making ability in the morning but not in the evening.
• Overall health: Illnesses, infections, or fatigue can significantly impact a person's mental clarity. Treating an underlying infection, for example, might temporarily restore some capacity.
• Environment: A calm, familiar environment can help preserve capacity, while a noisy or unfamiliar setting can increase confusion and stress.
• Medication: Some medications can affect cognitive function. Adjusting medication can sometimes lead to an improvement in capacity.

How is Mental Capacity Assessed?

Assessing mental capacity is a structured process that should only be performed by a qualified professional, like a physician, geriatrician, or neuropsychologist. The assessment is not a simple test but a conversation that evaluates a person's ability to engage with and understand information related to a specific decision. Typically, four criteria are considered:

• Understand relevant information: Can the person comprehend the information needed to make the decision?
• Retain that information: Can they hold onto the information long enough to make a decision?
• Weigh the information: Can the person consider the different options and consequences?
• Communicate the decision: Can they express their decision in any way, whether verbally, through gestures, or by other means?

It's also important to remember that making an unwise decision does not automatically mean a person lacks capacity, as everyone has the right to make choices that others might not agree with.

Planning for the Future: Advance Decisions and Legal Tools

Because dementia is progressive, proactive planning is essential. Early in the diagnosis, while capacity is still strong, individuals can make legal arrangements that ensure their wishes are respected as the condition advances.

1. Granting a Power of Attorney (POA): A POA allows a trusted individual to make financial or healthcare decisions on your behalf if you become unable to do so. This is a critical step for protecting both a person's autonomy and their assets.
2. Creating an Advance Health Care Directive (Living Will): This document outlines a person's preferences for future medical treatment, especially regarding life-sustaining treatments. It ensures their end-of-life wishes are known and followed.
3. Appointing a Successor In the Power of Attorney document, it is wise to name a successor agent, should the primary one become unable to act. This provides an extra layer of protection.
4. Discussing Your Wishes: Communicate your desires clearly and repeatedly with your chosen agent and family members. This proactive approach helps avoid conflict and ensures your values are at the forefront of future decisions.

For more detailed information on legal planning, the Alzheimer's Association offers a comprehensive guide on planning ahead for legal matters related to dementia.

A Comparison of Capacity in Early vs. Advanced Dementia

Feature	Early-Stage Dementia	Advanced-Stage Dementia
Decision Scope	Often retains capacity for many decisions, especially familiar or simple ones.	Capacity is significantly diminished or lost for most decisions.
Fluctuation	Capacity may be more stable but can still be affected by fatigue or illness.	Fluctuations may be more pronounced or unpredictable.
Communication	Can typically express decisions, though they might need more time or clarification.	Communication is often limited, making it difficult to express preferences clearly.
Planning	Best time for proactive legal and financial planning (e.g., POA).	Decisions are made by a designated agent or in the person's 'best interests.'
Support Needed	Support focuses on providing information clearly and patiently, not making decisions for them.	Support involves making decisions on their behalf, respecting their known wishes.

Conclusion

The idea that people with dementia always lack capacity is a misleading oversimplification. Capacity is a dynamic, task-specific ability that must be assessed individually and with great care. By understanding the distinction between capacity and competency, appreciating the fluctuating nature of cognitive abilities, and engaging in early, thoughtful planning, families can respect the autonomy of their loved ones for as long as possible. The focus should be on supporting their decision-making, not taking it away prematurely.

Frequently Asked Questions

Does a person with an early dementia diagnosis still have legal rights?

Yes, absolutely. A person with an early dementia diagnosis is presumed to have full legal capacity until proven otherwise. They retain the right to make their own decisions, manage their finances, and participate in legal matters, as long as they can demonstrate the capacity for the specific decision.

What is the difference between capacity and competency in the context of dementia?

Capacity is a medical and functional assessment of a person's ability to make a specific decision at a specific time. Competency is a legal judgment made by a court that declares a person unable to manage their affairs, which is a broader determination and not an automatic outcome of dementia.

Can a person with dementia still make a will?

Yes, a person with dementia can make or change a will as long as they possess 'testamentary capacity' at that specific time. This requires them to understand what a will is, the nature and extent of their property, and who the potential beneficiaries are.

What should I do if I suspect my loved one is losing capacity?

If you have concerns, it's best to consult with a medical professional who can formally assess capacity. It is also wise to encourage early legal planning, such as establishing a Power of Attorney, while your loved one can still participate in the decision-making process.

How can caregivers help support decision-making for someone with dementia?

Caregivers can help by simplifying complex decisions, offering limited choices (e.g., 'Would you like to wear the blue shirt or the green shirt?'), and providing information in a clear and calm manner. Listening patiently and respecting their preferences is also crucial.

What is 'fluctuating capacity' in relation to dementia?

Fluctuating capacity refers to a person's cognitive abilities and decision-making skills changing over time, sometimes improving and sometimes declining. Factors like time of day, stress, and overall health can cause these fluctuations.

Is an 'unwise' decision proof of lacking capacity?

No. A person's capacity is not measured by whether others agree with their decision. The legal framework protects an individual's right to make choices that may seem foolish to others, as long as they have the mental capacity to understand and weigh the consequences.