title: How are the interests of incapacitated research participants protected through legislation? An Italian study on legal agency for dementia patients.
abstract: BACKGROUND
  Patients with dementia may have limited capacity to give informed consent to participate in clinical research. One possible way to safeguard the patients' interests in research is the involvement of a proxy in the recruitment process. In Italy, the system of proxy is determined by the courts. In this study we evaluate the timing for appointment of a legal proxy in Italy and identify predictive variables of appointment.
  
  
  RESULTS
  Subjects were recruited among the outpatients seeking medical advice for cognitive complaints at the Centre for Research and Treatment of Cognitive Dysfunctions, University of Milan, "Luigi Sacco" Hospital. The Centre was participating to the AdCare Study, a no-profit randomised clinical trial coordinated by the Italian National Institute of Health. The requirement that informed consent be given by a legal representative dramatically slowed down the recruitment process in AdCare, which was prematurely interrupted. The Centre for Research and Treatment of Cognitive Dysfunctions collected data on the timing required to appoint the legal representatives. Patients diagnosed with dementia and their caregivers were provided information on the Italian law on legal agency (law 6/2004). At each scheduled check-up the caregiver was asked whether she/he had applied to appoint a legal proxy for the patient and the time interval between the presentation of the law, the registration of the application at the law court chancellery and the sentence of appointment was registered. The study involved 169 demented patients. Seventy-eight patients (46.2%) applied to appoint a legal proxy. These subjects were usually younger, had been suffering from dementia for a longer time, had less than two children and made more use of memantine. The mean interval time between the presentation of the law and the patients' application to the law court chancellery was two months. The mean interval time between the patient's application to the law court chancellery and the sentence of appointment was four months.
  
  
  CONCLUSIONS
  In Italy the requirement that legal representatives be appointed by the courts slows down subjects' participation in research. Other procedures for legal agency of the incapacitated patients may be adopted, taking as examples other EU countries' systems.
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
authors.forename: Sabina
authors.initials: S
authors.lastname: Gainotti
authors.forename: Susanna
authors.initials: S
authors.lastname: Fusari Imperatori
authors.forename: Stefania
authors.initials: S
authors.lastname: Spila-Alegiani
authors.forename: Laura
authors.initials: L
authors.lastname: Maggiore
authors.forename: Francesca
authors.initials: F
authors.lastname: Galeotti
authors.forename: Nicola
authors.initials: N
authors.lastname: Vanacore
authors.forename: Carlo
authors.initials: C
authors.lastname: Petrini
authors.forename: Roberto
authors.initials: R
authors.lastname: Raschetti
authors.forename: Claudio
authors.initials: C
authors.lastname: Mariani
authors.forename: Francesca
authors.initials: F
authors.lastname: Clerici
mesh_terms: D003704:Dementia / Q000628:therapy*; D006805:Human Experimentation / Q000331:legislation & jurisprudence*; D006801:Humans; D007558:Italy