1. Estate Planning and the Neuropsychologist
Dr. Raphael Wald

2. Neuropsychologists in Estate Planning
The effective neuropsychologist should be your greatest weapon in cases involving psychiatric illness and cognitive impairment / dementia.
Today, we will focus our discussion on dementia.

3. Dementia
Many people are confused about the relationship between dementia, Alzheimer’s disease, and other memory disorders.
It is important here to know what the definition of dementia is:
An impairment in memory and at least one other cognitive function (such as attention, executive functioning, spatial reasoning etc.)

4. Dementia
There are many causes of dementia. The most common cause is Alzheimer’s Disease.
This involves the development of abnormal bodies in the brain called plaques and tangles
The next most common cause is vascular dementia
This involves one or more strokes

5. Dementia Other causes of dementia include: Dementia due to head trauma
Dementia pugilistica
Frontotemporal dementia
Parkinson’s disease dementia
Diffuse lewy body disease
Cortical basal ganglionic degeneration
Dementia due to alcohol abuse
Dementia due to Multiple Sclerosis

6. Who Should Diagnose Dementia?
The primary care physician (PCP)
The PCP is most often capable of administering a cursory test of cognitive functioning.
These tests lack sensitivity and specificity.
The most common test used is the mini mental status exam.
However, unless the dementia is obvious or severe, the PCP will have difficulty identifying if a person has dementia and what is causing it.

7. Who Should Diagnose Dementia?
The Neurologist / Psychiatrist
The neurologist also administers cursory tests which gauge a patient’s cognitive functioning
The neurologist also often orders tests such as bloodwork, the Electroencephalogram (EEG), and Magnetic Resonance Imaging (MRI).
Neurologists are trained in noticing more subtle cognitive changes than a primary care physician

8. Who Should Diagnose Dementia?
Neurologists do not typically administer tests which, based on statistics, clearly identify areas of deficit in order to diagnose more subtle forms of dementia.
Further, MRI and EEG cannot diagnose dementia. They provide no information in terms of cognitive function.
Some patients have negative MRIs and have dementia and vice versa.

9. Who Should Diagnose Dementia?
The Neuropsychologist is capable of testing all areas of memory and cognitive functioning.
They use widely accepted tests with stronger sensitivity and specificity in order to compare patients with other people their age, at their level of education.
The neuropsychologist can provide the highest level certainty that a patient has dementia, and provide data and statistics to back up their diagnosis.

10. The Neuropsychologist
The neuropsychologist (non-pediatric neuropsychologist) is an expert in psychiatric illness, dementia, and head injury.
Neuropsychologists also have training in statistics in order to demonstrate how dramatically a patient’s cognitive status has changed as a result of an illness or injury.

11. The Neuropsychologist
The neuropsychologist is also trained to look for medical conditions and clinical signs which point to a likely diagnosis of dementia.
These signs and medical conditions, along with neuropsychological testing, come together like pieces of a puzzle to make a proper diagnosis.
A good neuropsychologist also observes many behavioral subtleties which help in their decision making.

12. The Forensic Neuropsychologist
The neuropsychologist’s training and expertise makes them the best candidate to determine a patient’s legal capacity.
However, many neuropsychologists feel uncomfortable in deposition or court and prefer to avoid providing testimony if possible.
Thus, a good, willing, and personable neuropsychologist is what is most helpful.

13. Estate Planning
In estate planning, the neuropsychologist is called upon in a variety of roles. However, they are utilized most frequently in order to help determine if a patient presently has or had testamentary capacity in order to execute a will.
In general, testamentary capacity involves a fairly low level of cognitive functioning.

14. Estate Planning
Testamentary capacity involves the ability to understand:
Extent of property
People who are beneficiaries
The document being executed
How the distribution of property is affected
No professional is more capable of helping make this determination than the neuropsychologist.

15. Reviewing Records
A neuropsychologist often is asked to review medical records, videotapes, or letters from a patient after they have died in order to help determine if they had capacity at the time of the execution of the will.
Neuropsychological testing records are most useful in this process.

16. Reviewing Records
Medical records are helpful in providing corroborative evidence of decreased capacity through:
Complaints of memory loss or psychiatric illness
MRI
Bloodwork
Cursory cognitive testing
Date of the beginning of illness in order to project the course of an illness

17. Reviewing Records
Videotape and letters / s written by deceased patients can be reviewed as well.
Neuropsychologists are trained to look for observable signs of cognitive impairment including:
Aphasia
Aprosodia
Non-fluency
Apraxia

18. Use Your Expert Witness
The best attorneys I have worked with make use of their expert prior to trial / deposition.
A good, personable neuropsychologist with jury appeal should be able to make your case for you.
It is worth the fee to meet with your neuropsychologist before the trial so that they can help you best understand the case.

19. Questions