Complex Capacity Assessments: A Case Series of Patients with Huntington's Disease

Author : Dr. L Potter

Abstract :Objectives: Huntington’s Disease (HD) is an inherited neurodegenerative disorder known to cause neuropsychiatric deficits including cognitive impairment. These deficits have been associated with reduced decision-making capacity. This case series examines the impact of these within the practical context of court judgment. Approach: Three patients with HD were referred to the author by the UK Court of Protection for assessment of capacity. Assessments were carried out based on the Macarthur Competence Assessment Tool for treatment (MacCAT-T), as well as appropriate cognitive testing (ACE-III, MoCA, Frontal Assessment Battery). Findings: All patients were found to lack capacity by the assessor, findings which were upheld by the court. Capacity was impaired due to a combination of impaired retention, understanding and weighing information. Communication was preserved. All three showed evidence of cognitive impairment including executive dysfunction. There was no evidence of other psychiatric symptoms, such as mood disorder or psychosis, in any of the patients. Implications: This case series supports the finding that lack of capacity in HD is associated with cognitive impairment, particularly executive dysfunction, in the absence of other neuropsychiatric symptoms. Anosognosia (unawareness of symptoms) was present in all patients, and correlated with executive dysfunction. Use of a semistructured interview tool (MacCAT-T) may be helpful in giving Courts confidence in the validity of a capacity assessment carried out by a clinician, particularly as the abilities assessed correspond to capacity as defined by UK law. 22 Proceedings of International Conference - 202

Keywords :Cognitive Impairment and Legal Capacity in Huntington’s Disease: A Case Series

Conference Name :International Conference on Neuroscience, Psychiatry and Biological Psychiatry (ICNPBP-25)

Conference Place Kyoto, Japan

Conference Date 24th Jul 2025