ABSTRACT
Assessment of cognitive capacity to make important decisions or perform activities of daily living is an important professional responsibility for many neuropsychologists who evaluate older adults. Use of a conceptual framework for the assessment of decisional capacity can facilitate neuropsychological assessment of the four fundamental cognitive abilities that are involved in decisional capacity: understanding, appreciation, reasoning or formulating, and communicating a choice. Such capacity assessments are often part of a broader neuropsychological evaluation. The goal of this chapter is to provide neuropsychologists pragmatic guidance for capacity assessments, including a conceptual approach, an understanding of cognitive and functional issues, and information about assessment tools and report writing. Although neuropsychologists are asked to address a variety of capacity-related questions, this chapter focuses on the capacity to make medical decisions and the capacity to manage finances. The assessment processes illustrated for these decisions and abilities can be applied to other questions of capacity. Effective clinicians perform appropriate evaluations and arrive at sound decisions that balance respect for the examinee's autonomy with preservation of their safety and wellbeing.
