Dysphasia after stroke and legal capacity

Abstract

AbstractBackgroundAlthough after stroke dysphasia or aphasia is not equal to incapacity, the legal capacity of patients can be doubted. The patients’ ability to fully comprehend the given information and make decisions may be impaired. Stroke is sudden, life threatening and likely to affect capacity even in the absence of dysphasia. There are currently no published guidelines in the management of legal issues for patients and professionals.MethodA literature review in the Pubmed database has been made, using the key‐words: stroke, legal capacity, decision‐makingResultBrain injury after stroke may impair appreciation of decisions’ consequences and/or communicating decisions effectively, while the capacity to reason remains. Stroke may affect various brain areas, i.e. prefrontal cortex involved in decision‐making (ventromedial prefrontal cortex damage may lead to impulsive decision‐making). A right‐brain stroke may cause poor executive function, lack of initiation or neglect. Left‐hemisphere strokes may lead to aphasia and reduced capacity evaluation. The dysphasic may understand more than he can express, or vice versa.Difficulties further compounding communication problems include: reading and writing; numeracy; inattention/concentration; fatigue; emotional control (lability); perseveration; intellectual functioning. Receptive aphasia can impair understanding medical options, while expressive aphasia may prevent communicating relative decisions.Patients may also be susceptible to undue influence regarding testamentary and financial capacity due to communication deficits and varying levels of dependence. Depression following stroke can further impair capacity.ConclusionThe patient may have a communication rather than a capacity deficit. Judging a patient’s ability to weigh information is often the most difficult aspect of legal capacity assessment. There is little literature or high court jurisdiction regarding whether dysphasia after stroke impairs patients’ capacity. Evaluation of the prerequisites for legal capacity requires a multi‐professional cooperation.