The missing link for assessing financial decision-making capacity in individuals with aphasia

Abstract

Letter to the editorDecision-making capacity (DMC) is the ability to "understand information relevant to a decision" and "to retain and integrate this information into the decision making process, and communicate a decision", 1 and involves complex interactions between multiple cognitive domains, including attention, memory, and executive functioning and language. Financial DMC is "the ability to satisfactorily manage one's financial affairs in a manner consistent with personal selfinterest and values". 2 Financial capacity requires the presence of necessary financial skills, and is demonstrated through their financial knowledge and financial judgment (capacity). 3 Financial performance is reflected through the ability to manage one's financial demands. 3 Impairment of one or both of these components can affect financial DMC.The impact that certain cognitive and psychiatric conditions have on financial DMC is well established. 4 A neglected condition that also impacts on financial DMC is aphasia. 5 Aphasia is an "acquired neurogenic language disorder resulting from an injury to the brain, most typically the left hemisphere, that affects all language modalities", 6 which is characterised by impaired ability to communicate. Its incidence ranges from 10% within the general population, to 30% following a stroke. This is important given our ageing population and the fact that the incidence of developing aphasia and having a stroke increases with age.Aphasia poses unique challenges for the assessment of financial DMC. Essential components of the DMC assessment process include the transfer, understanding, and communication of information between the parties. In aphasia, the primary impairment involves difficulties with information processing, which arises from problems in language and in the cognitivecommunication process. This complicates the shared decision-making process, and limits the ability of the aphasic individual to participate and engage. As a result, the DMC assessment becomes difficult if not impossible to complete, and may not be attempted.