Date of Award

January 2026

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Mihir Gupta

Abstract

Our population is aging, resulting in an increased proportion of individuals who areconcurrently navigating the treatment of dementia while planning the dissemination of their belongings through legal instruments such as a will or trust. It is inevitable that there will be increased focus on the intersection of capacity law and neurodegenerative disease, possibly manifesting as an increase in lawsuits that challenge the validity of a will, trust, or other legal action, or accuse an individual of exercising undue influence on the cognitively impaired. It is unclear how the courts interpret and integrate information regarding the prescription of Alzheimer’s medication into these cases. Physicians, legal experts, and patients should be aware of what factors contribute to these proceedings in order to best serve the interests of their patients. We performed a systematic review of private law decisions that adjudicated capacity disputes, and characterized the influence of medical information such as Alzheimer’s medications on such capacity disputes. We performed a systematic search of two legal databases, LexisNexis and Westlaw, for private law decisions from 1996 to 2024. Cases were included if they featured the dispute of capacity in the context of Alzheimer’s disease, with mention of Alzheimer’s medication. 75 private law cases were identified, including disputes over wills (n=32, 42.7%), trusts (n=11, 14.7%), deeds (n=8, 10.7%), contracts (n=5, 6.7%), and gifts (n=4, 5.3%). The remaining 15 cases (20%) involved other instruments such as life insurance benefits and retirement accounts. In this cohort, contestants’ win rate for incapacity claims was 48.1%, and 44.1% for undue influence claims. Our study portrays a strikingly different picture than the one illustrated by existing empirical scholarship, according to which contestants’ win rate in capacity litigation ranges from 11.1% to 36.8%. However, there are few studies that investigate outcomes of capacity disputes, and this study marks the largest to date and provides novel insights into this gap in the context of individuals being treated for cognitive impairment. Our study demonstrates the frequent use of medical records and physician testimony as evidence in proceedings that dispute capacity in the context of Alzheimer’s medications, and that of cases that make a determination regarding capacity, 48.1% of these cases result in a finding of lack of capacity. Patients, physicians, and legal professionals should be aware of the outcomes of these cases and the evidence presented in them in order to promote earlier advance care planning.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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