Dementia and legal determination of capacity / Demência e avaliação de interdição judicial

ABSTRACT One of the consequences of dementia is the possibility of a guardianship proceeding that will deprive patients of legal capacity in taking decisions and managing their own assets. Objective To assess the legal capacity and guardianship proceedings in patients diagnosed with dementia. Methods Ninety-seven patients diagnosed with dementia and seen at a tertiary hospital were evaluated. Results Of these 97 patients, 60 (62%) were female. The mean age of the patients was 77.9 years; average schooling was 5.5 years. The main diagnosis was Alzheimer’s disease (73%): 16 patients were at a mild stage, eight at a moderate stage and 73 at an advanced stage of dementia. Only 28 patients had been legally declared incapable. Conclusion The large numbers of patients at an advanced stage of dementia, and the relatively few patients legally declared incapable show that legal issues in dementia are problematic.

RESUMO Uma das consequências das demências é a possibilidade da interdição judicial do paciente, retirando-lhe a capacidade jurídica da prática de decisões e administração de bens. Objetivo Avaliar a existência de capacidade jurídica e da interdição judicial em pacientes com diagnóstico de demência. Métodos Foram entrevistados 97 pacientes com diagnóstico prévio de demência atendidos no ambulatório de neurologia do comportamento de um hospital terciário. Resultados Dos 97 pacientes, 60 (62%) eram mulheres. A média de idade dos pacientes foi de 77,9 anos, e de escolaridade foi de 5,5 anos. O principal diagnóstico foi de doença de Alzheimer: 16 estavam em estágio leve, 8 em estágio moderado e 73 em estágio avançado da demência. Somente 28 pacientes apresentavam interdição judicial. Conclusão O elevado número de pacientes em estágio avançado de demência e reduzido número de pacientes com interdição indicou dificuldades em relação às questões legais da demência.

What are the boundaries of legal guardianship in Alzheimer's disease? An evidence-based update in the context of the Brazilian Civil Code

The Brazilian Civil Code, which came into force in 2002, established a functional criterion for guardianship proceedings and introduced the concept of “limited guardianship,” applied to cases in which incapacity to exercise civil rights is partial. With population aging and the growth in the number of older people with cognitive impairments, such as Alzheimer’s disease (AD), the need to invoke legal remedies against elder abuse increased; however, difficulties in assessing capacity still lead to a majority of decisions in favor of plenary guardianship. The present article compiled data on capacity in AD subjects. The varying degrees of decision-making impairment at different stages of AD might be compatible with limited guardianship in milder cases of the disease.