Introduction     Diagnosis of Mild Cognitive Impairment and Alzheimer's Disease Karen L. Bell, M.D.     Treatment Strategies for Dementia and Mild Cognitive Impairment Mary Sano, Ph.D.     Treatment of Depression, Agitation, and Psychosis in Dementia Davangere P. Devanand, M.D.     Recognition of Vascular Dementia, Dementia with Lewy Bodies, and Frontotemporal Dementia Lawrence S. Honig, M.D., Ph.D.     Neuropsychology of Mild Cognitive Impairment, Alzheimer's Disease, Dementia with Lewy Bodies, and Frontotemporal Dementia Penne Sims, Ph.D.     Neuroimaging in Dementia Scott A. Small, M.D.     Genetics of Neurodegenerative Disease: Alzheimer's Disease, Frontotemporal Dementia Jennifer Williamson-Catania, M.S.     Legal and Ethical Issues for Patients with Dementia Daniel G. Fish, Esq.     Avoiding the Courthouse       Agents and Trustees       Health-Care Proxy and Living Will       Cost of Long-Term Care     Posttest         Accreditation     Reference List     Acknowledgements		Legal and Ethical Issues for Patients with Dementia Daniel G. Fish, Esq. Agents and Trustees   Before getting in that automobile, I could have paid 33 cents at a stationery store to purchase a power-of-attorney form, naming someone to make financial decisions for me. I would have signed the document in front of a notary public for an additional $2.50. The elapsed time is under five minutes, and I have just cloned myself in a financial sense.   My agent under the power of attorney can do anything I can do financially, so my financial universe will not come to a screeching halt. Once I am in the intensive-care unit, my agent takes the power-of-attorney form to my financial institutions and can act on my behalf for a total financial cost of $2.83.   Everyone over the age of 18 should have this mechanism in place in case he or she becomes disabled. Once somebody has died, our legal system looks to wills, but dementias and other disabilities that leave someone alive require their own legal approaches. A joint bank account—a checking account, savings account, certificate of deposit, or U.S. savings bond—has a co-owner who has access to the accounts. However, there are assets for which it is not possible to assign a co-owner; a retirement account is the most obvious. Even if you are very careful and set up joint accounts, you will need the power of attorney for the assets you cannot co-own.   I want to be very careful to clarify that I am giving legal information and not legal advice. I can imagine receiving a phone call three years from now: "Hello, Mr. Fish, do you remember when you gave a lecture at Columbia Presbyterian? I took your advice, I named somebody as agent, and he stole my money." The thought makes me break out into a cold sweat.   The power of attorney is a very powerful document, and there is no supervision over the agent, so it should only be given to the most trusted individuals, and it should be done under the supervision of an attorney. Even though you can purchase the document at a stationery store, the legal fees for consulting with an attorney on a document like this are minimal, and I do highly recommend doing that so that things can be looked at carefully.   For a more sophisticated estate with more money involved, a minimum of 1 to 200,000 dollars, you might consider the creation of a living trust. A trust agreement is a very simple document. If I were so lucky as to be leaving tomorrow for a cruise around the world, with no laptop or cell phone, I need to make an agreement with someone to manage my finances while I am away. That manager, or trustee, does not own my assets or pay taxes on them. If my manager dies, they do not go through his or her estate.   A trust agreement is no more than a glorified power of attorney. Under a power of attorney I name an agent to manage my affairs; under a trust agreement, I name a trustee who will manage my affairs for me. If I become disabled I do not need the guardianship because my trustee can manage those assets for me.   An individual's capacity to sign one of these agreements is a moving target that depends on what the person is considering doing. If a client is thinking about signing a last will and testament, the test for capacity is very low: the client simply has to know the approximate value of his or her assets, the size of the estate, and the family members or others whom they would want to inherit their assets. They do not have to have a Mini Mental Status Exam. For a power of attorney or for a trust agreement, we assess contractual ability at a slightly higher level.   We also look at who is likely to complain. If you have a patient who comes to see you with four children who are arguing, "I'm giving more care to Mama than you are; "But I live in California and take care of all of the finances while you're just taking care of her physical needs," this is a warning siren. One should be much more cautious than if you had a patient with a single child. This is a simple practical test.     PREVIOUS | NEXT