Assessment of Mental Capacity

**Patient Particulars** **Name (in NRIC):** Lim Boon Seng **NRIC/FIN/Passport:** S1942357K **Date of Birth:** 22/08/1943 **LPA Reference No:** LPA-2018-094782 **1. Date and Time of Assessment** 03/06/2026 14:30 **2. Specific Decision Being Assessed** Activation of the patient's Lasting Power of Attorney for both personal welfare matters and property and affairs matters, following progressive cognitive decline reported by the appointed donee and the primary caregiver. **3. Assessment Methodology Used** Clinical background: The patient is an 82-year-old retired engineer with a diagnosis of moderate Alzheimer's dementia first made in 2023, currently managed with donepezil 10 mg daily. He has a background of hypertension and type 2 diabetes mellitus, both stable on medication. Caregivers report progressive decline in short-term memory and executive function over the past 12 months, with two recent incidents of becoming lost while attempting to manage his banking matters. Setting and timing: The assessment was conducted in a quiet consultation room at 14:30, the early afternoon window the family identified as the patient's most alert period. The session was kept under 45 minutes to avoid fatigue and sundowning. Communication approach: Simple, short sentences were used. The patient was given ample time to formulate his responses. Key concepts were paraphrased and repeated, and a printed one-page summary of the LPA arrangement was used as a visual aid to support understanding. Cultural or language considerations: The patient is bilingual in English and Hokkien. He was assessed primarily in Hokkien at his preference. An impartial accredited interpreter was present to assist with translation of Mental Capacity Act terminology into Hokkien. Third parties present: The accredited Hokkien interpreter and a clinic nurse were present throughout. The patient's son, who is the appointed donee under the LPA, was excluded from the consultation room during the capacity assessment to avoid undue influence. He was available separately to provide corroborative history. Corroborative history obtained: History was obtained separately from the patient's son and from a domestic helper who has cared for the patient daily for the past three years. Both described worsening short-term memory, difficulty managing household finances, two recent episodes of leaving the stove on, and one episode of becoming lost on a familiar route to the wet market. Cognitive screening tool used and result: Abbreviated Mental Test: 4 out of 10. Mini-Mental State Examination: 16 out of 30, with marked impairment in orientation to time, short-term recall, and serial subtractions. **4. Clinical Findings** Step 1: Impairment of, or disturbance in the functioning of, the mind or brain: The patient has an established diagnosis of moderate Alzheimer's dementia. Clinical examination today is consistent with this diagnosis, with significant impairment in short-term memory, orientation, executive function, and judgment. Step 2: Functional ability to make the specific decision: Ability to understand the information relevant to the decision: The patient was unable to understand the nature and purpose of the Lasting Power of Attorney despite repeated explanations in Hokkien with visual aids. When asked to explain in his own words what an LPA does, he stated that it was "a paper my son brought," and was unable to articulate that it would allow his son to make decisions on his behalf when he is no longer able to do so. Ability to retain the information: Information about the LPA was retained for less than two minutes. The patient was unable to recall the explanation when re-asked after a brief interval, even when the explanation was simplified and repeated three times. Ability to weigh options and consequences: The patient was unable to weigh the implications of activating or not activating the LPA. He could not articulate the consequences of his son being able to make financial decisions on his behalf, nor the consequences of not having such an arrangement in place. Ability to communicate the decision: The patient was able to communicate verbally in Hokkien throughout the assessment. However, his communications were not consistent with a settled decision and varied between agreeing and disagreeing with the same proposition put to him at different points. Other clinical observations: The patient was alert but disoriented to time and place. Mood was euthymic, affect appropriate. Speech was fluent in Hokkien with occasional word-finding difficulty. No psychotic features were elicited. Insight into his cognitive deficits was limited. **5. Reasoning for Conclusions** Clinical reasoning: The patient meets the two-step test under the Mental Capacity Act. He has an established impairment of the mind, namely moderate Alzheimer's dementia, and this impairment renders him unable to understand, retain, and weigh the information relevant to the specific decision of activating his Lasting Power of Attorney. All practicable steps to support his decision-making capacity have been taken, including the use of simple language, visual aids, repetition, native-language interpretation, and assessment during his optimal cognitive window, without success. The conclusion is not based on any unwise decision but on the patient's demonstrable inability to engage with the relevant information. Determination of mental capacity for personal welfare matters: lacks mental capacity in respect of personal welfare matters Determination of mental capacity for property and affairs matters: lacks mental capacity in respect of property and affairs matters Permanence of mental incapacity: likely to be permanent Indication for specialist referral: No specialist referral is indicated. The diagnosis of moderate Alzheimer's dementia is well established, the findings are consistent across cognitive screening and clinical examination, and no fluctuating or atypical features are present that would warrant escalation beyond General Practice scope. **6. Follow-up Plan if Needed** A copy of this assessment will be provided to the appointed donee for the purpose of LPA activation. The patient will continue under the care of the memory clinic with six-monthly review of cognitive function and medication. Caregiver support and dementia education will be reinforced at the next clinic visit. No repeat capacity assessment is indicated unless a new specific decision arises that requires further evaluation.