“Although we had but a short session today, it was quite enough to established that there remained very significant cognitive problems, despite a very adequate period of sobriety. The marked deficits in short term memory, with preservation of long-term memory, and the exaggeration of pre-existing personality traits and a consistent degree of unawareness of his problem are consistent with a dementing illness, possibly alcohol related.”
“The nature of this cognitive impairment would be informed by future investigations, such as further brain scanning and related studies, but it would seem likely that [P] suffers from a primary degenerative dementia, with greater left than right hemisphere involvement. This could be a frontotemporal dementia, or perhaps a dysexecutive variant of Alzheimer’s Disease. His past history of alcohol abuse is probably an additional contributory factor to his cognitive impairment. In my opinion, his condition probably represents a dual pathology – neurodegeneration and alcohol related cognitive dysfunction – rather than being subsumed under a single diagnostic category, such as ‘alcohol related dementia’. In my view, the history of ischaemic heart disease, the possibility of a cerebrovascular component needs to be borne in mind, though I note an MRI scan in 2016 is reported as showing minimal small vessel disease. In individuals with a history of alcohol abuse, the possibility of Wernicke-Korsakoff syndrome also needs to be considered, but the asymmetric nature of [P’s] cognitive impairment and other features of his clinical history make this a less likely diagnosis. If it is true that [P] has significantly cut down his alcohol intake in recent years, and that his level of alcohol consumption in the weeks prior to my assessment was modest, then it is unlikely that there were acute effects of alcohol consumption on his performance during my test sessions. However, if recent alcohol intake has been significant, this complicates interpretation of his neuropsychological test performance.”
“In view of his major cognitive impairments, it is my opinion that [P] does not have capacity to conduct proceedings. [P] shows evidence of working memory deficits that could affect his comprehension of complex materials. He shows evidence of anterograde (‘short-term’) memory deficits which would affect his ability to retain information in complex proceedings. He shows evidence of executive dysfunction which would affect his ability to weigh up and reason about information in complex proceedings. For simple proceedings, and with advice and support, he does retain some capacity, but this would be limited to that context.”
“In my opinion [P] lacks the necessary mental capacity to conduct these proceedings. He would be unable to retain and use / weigh relevant information for decisions that would be required during proceedings due to an impairment of mind.”
“...is whether the party to legal proceedings is capable of understanding, with the assistance of such proper explanation from legal advisors and experts in other disciplines as the case may require, the issues on which his consent or decision is likely to be necessary in the course of those proceedings. If he has capacity to understand that which he needs to understand in order to pursue or defend a claim, I can see no reason why the law, whether substantive or procedure, should require the imposition of a next friend or guardian ad litem (or, as such person is now described in the Civil Procedure Rules, a litigation friend).”
“... the ability to recognise a problem, obtain and receive, understand relevant information, including advice, the ability to weigh the information (including that derived from advice) in the balance in reaching a decision, and the ability to communicate that decision.”
“I have no doubt that the plaintiff is quite incapable of managing unaided a large sum of money such as the sort of sum that would be appropriate compensation for her injuries. Few people have the capacity to manage all their affairs unaided... It may be that she would have chosen, and would choose now, not to take advice, but that is not the question. The question is: is she capable of doing so? To have that capacity she requires first the insight and understanding of the fact that she has a problem in respect of which she needs advice... Secondly, having identified the problem, it will be necessary for her to seek an appropriate adviser and to instruct him with sufficient clarity to enable him to understand the problem and advise her appropriately... Finally, she needs sufficient mental capacity to understand and to make decisions based upon, or otherwise give effect to, such advice as she may receive.”
“... the ability to recognise a problem, obtain and receive, understand relevant information, including advice, the ability to weigh the information (including that derived from advice) in the balance in reaching a decision, and the ability to communicate that decision.”
“To have that capacity she requires first the insight and understanding of the fact that she has a problem in respect of which she needs advice... Secondly, having identified the problem, it will be necessary for her to seek an appropriate adviser and to instruct him with sufficient clarity to enable him to understand the problem and advise her appropriately... Finally, she needs sufficient mental capacity to understand and to make decisions based upon, or otherwise give effect to, such advice as she may receive.”
“People with executive functioning deficits and deficits in their short-term memory may be okay, but they may have difficulty in electing the right bits of information and using them in the right context. There are glaringly obvious occasions when [P] has not been able to bring to mind information that it is important to know in the moment to make the relevant decision.”