[DIAGNOSIS OF MAJOR NEUROCOGNITIVE DISORDER (DEMENTIA) DUE TO ALZHEIMER`S DISEASE FOR THE NOMINATION OF A GUARDIAN]

Brief medical certificates are central in legal proceedings for guardianship appointments. They have been increasingly criticized, especially for relying upon medical diagnoses, ignoring functioning, decision-making capacity, needs, and preferences of the individual. Changes in social and legal conceptions led in 2016 to the approval of the 18th amendment to the Legal Capacity and Guardianship Law, with less restrictive alternatives to guardianship, and the necessity to hear the person and his preferences. In parallel there have been changes in the understanding and definition of mental disorders. The American Psychiatric Association's DSM-5 of 2013 suggests in its diagnostic criteria and text, explicitly or implicitly, a diagnostic approach for Neurocognitive Disorders that includes: a. an auxiliary table containing six defined cognitive domains and twenty two subdomains, examples of symptoms or observations and assessments, b. a three-step evaluation process: step one, determining a neurocognitive disorder (major or mild) through careful questioning of one to three sources and person and situation appropriate cognitive tests chosen from three groups with various complexities and thresholds or a documented clinical evaluation, and in addition, assessment of independence in everyday activities is required. Step two examines etiology and step three, behavioral symptomatology, and current severity based on instrumental and basic activities of daily living. The approach offers a reliable and precise diagnosis and a multi-level evaluation. We report a case ruled at a Family Court, concerning an elderly person for whom a guardian was sought for an Alzheimer`s dementia diagnosis based on one brief cognitive score. The court, denying the request, preferred several descriptions of instrumental (mostly financial) and basic activities of daily living and hearing the person directly, his arguments and preferences over the mere diagnosis and test score. Implementation of the above approach would have prevented the unnecessary legal proceeding. The approach might serve as a solid, not complicated, platform for clinical assessment of a person on several levels - diagnosis, cognition, mental state and functioning. Coupled with needs and expressed preferences, this platform would help the court in legal proceedings for guardianship in a person with cognitive deterioration.