The document discusses the aging crisis of mental health and dementia in prisons. It notes that doing nothing about this social problem of dementia in prisons would be too costly and inhumane. Prisons are facing challenges in caring for those with activities of daily living needs related to dementia.
An exploration of the pros and cons of dementia screening/case-finding, in the context of the UK government's dementia strategy in 2013.
Presented to Thames Valley Faculty on 30 April 2013
1. Dementia is defined as a progressive decline in intellectual functioning that interferes with daily life. It is caused by over 60 disorders and is marked by declines in memory, spatial skills, task performance, language, thinking, and math skills.
2. There are two main types of dementia - reversible and irreversible. Reversible dementias can potentially be cured by treating underlying causes, while irreversible dementias like Alzheimer's disease currently have no cure.
3. Delirium is a disturbance of consciousness and cognition that develops over a short period of time, while dementia is a longer-term progressive decline. Delirium has many potential causes and treatments involve treating the underlying medical condition.
This document provides an overview of Alzheimer's disease (AD), including its diagnosis, management, and differential diagnosis. Some key points:
- AD is the most common cause of dementia. It causes progressive cognitive decline and impairment in daily living activities.
- The diagnosis is based on history and exams. Early diagnosis allows time for planning and treatment before severe deterioration.
- AD was first described by Alois Alzheimer in 1906 from the autopsy of a patient. It has since been further characterized and defined by diagnostic criteria.
- Risk factors include increasing age, family history, and genetic factors. The prevalence and incidence increases substantially with age over 65.
The document provides an overview of the neurological method for evaluating patients with neurological symptoms. It involves identifying the anatomical location and pathophysiology of lesions causing symptoms to generate a differential diagnosis and appropriate tests. A thorough history and neurological exam are most important to narrow the differential diagnosis and minimize unnecessary testing. The exam considers higher brain functions, cranial nerves, motor and sensory systems, and more to localize lesions in areas like the cortex, basal ganglia, cerebellum, or peripheral nerves. Potential pathophysiologies include vascular, infectious, neoplastic, degenerative, traumatic or toxic-metabolic causes. Appropriate application of this method provides an orderly approach even for complex cases.
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
During your journey through this slide deck of the geriatric populations 3 D’s, you will experience: the difference between geriatric dementia, geriatric delirium and geriatric depression; the global impact of dementia and the importance of a quality diagnosis; and the dementia assessment, management and treatment options.
The links in this slide deck lead you to expert geriatric teaching tools and videos that you will value and love.
According to the World Alzheimer Report if dementia care were a country, it would be the world’s 18th largest economy. The worldwide costs of dementia exceeded 1% of global GDP in 2010, at US$604 billion. If dementia were a company, it would be the world’s largest by annual revenue exceeding Wal-Mart (US$414 billion) and Exxon Mobil (US$311 billion). Geriatric populations are increasing and Alzheimer’s in the USA will ALMOST TRIPLE BY 2050. Let’s stay informed!
Learn it-Live it-Love it-Your path for a more informed life!
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
This document provides an overview of neurocognitive disorders including delirium and dementia. It begins with an introduction noting the aging population and prevalence of these conditions. It then discusses delirium as an acute decline in consciousness and cognition often caused by medical conditions or substances. Dementia is defined as progressive cognitive decline without altered consciousness. Common causes of dementia like Alzheimer's and vascular dementia are explained. The document provides details on assessing, diagnosing, treating and managing delirium and dementia. It concludes with take home messages about the importance of recognizing these conditions in elderly patients.
The document discusses dementia, including its various types, symptoms, diagnostic criteria, assessment methods, and treatment options. It defines dementia as the loss of cognitive and intellectual function without impairment of perception or consciousness. The five major types of dementia are Alzheimer's disease, cerebrovascular disease, Lewy body disease, frontotemporal dementia, and Parkinson's disease with dementia. Assessment involves interviews, examinations, and tests to evaluate cognition, function, and rule out other conditions. Treatment focuses on enhancing quality of life and includes both non-pharmacological and pharmacological approaches.
An exploration of the pros and cons of dementia screening/case-finding, in the context of the UK government's dementia strategy in 2013.
Presented to Thames Valley Faculty on 30 April 2013
1. Dementia is defined as a progressive decline in intellectual functioning that interferes with daily life. It is caused by over 60 disorders and is marked by declines in memory, spatial skills, task performance, language, thinking, and math skills.
2. There are two main types of dementia - reversible and irreversible. Reversible dementias can potentially be cured by treating underlying causes, while irreversible dementias like Alzheimer's disease currently have no cure.
3. Delirium is a disturbance of consciousness and cognition that develops over a short period of time, while dementia is a longer-term progressive decline. Delirium has many potential causes and treatments involve treating the underlying medical condition.
This document provides an overview of Alzheimer's disease (AD), including its diagnosis, management, and differential diagnosis. Some key points:
- AD is the most common cause of dementia. It causes progressive cognitive decline and impairment in daily living activities.
- The diagnosis is based on history and exams. Early diagnosis allows time for planning and treatment before severe deterioration.
- AD was first described by Alois Alzheimer in 1906 from the autopsy of a patient. It has since been further characterized and defined by diagnostic criteria.
- Risk factors include increasing age, family history, and genetic factors. The prevalence and incidence increases substantially with age over 65.
The document provides an overview of the neurological method for evaluating patients with neurological symptoms. It involves identifying the anatomical location and pathophysiology of lesions causing symptoms to generate a differential diagnosis and appropriate tests. A thorough history and neurological exam are most important to narrow the differential diagnosis and minimize unnecessary testing. The exam considers higher brain functions, cranial nerves, motor and sensory systems, and more to localize lesions in areas like the cortex, basal ganglia, cerebellum, or peripheral nerves. Potential pathophysiologies include vascular, infectious, neoplastic, degenerative, traumatic or toxic-metabolic causes. Appropriate application of this method provides an orderly approach even for complex cases.
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
During your journey through this slide deck of the geriatric populations 3 D’s, you will experience: the difference between geriatric dementia, geriatric delirium and geriatric depression; the global impact of dementia and the importance of a quality diagnosis; and the dementia assessment, management and treatment options.
The links in this slide deck lead you to expert geriatric teaching tools and videos that you will value and love.
According to the World Alzheimer Report if dementia care were a country, it would be the world’s 18th largest economy. The worldwide costs of dementia exceeded 1% of global GDP in 2010, at US$604 billion. If dementia were a company, it would be the world’s largest by annual revenue exceeding Wal-Mart (US$414 billion) and Exxon Mobil (US$311 billion). Geriatric populations are increasing and Alzheimer’s in the USA will ALMOST TRIPLE BY 2050. Let’s stay informed!
Learn it-Live it-Love it-Your path for a more informed life!
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
This document provides an overview of neurocognitive disorders including delirium and dementia. It begins with an introduction noting the aging population and prevalence of these conditions. It then discusses delirium as an acute decline in consciousness and cognition often caused by medical conditions or substances. Dementia is defined as progressive cognitive decline without altered consciousness. Common causes of dementia like Alzheimer's and vascular dementia are explained. The document provides details on assessing, diagnosing, treating and managing delirium and dementia. It concludes with take home messages about the importance of recognizing these conditions in elderly patients.
The document discusses dementia, including its various types, symptoms, diagnostic criteria, assessment methods, and treatment options. It defines dementia as the loss of cognitive and intellectual function without impairment of perception or consciousness. The five major types of dementia are Alzheimer's disease, cerebrovascular disease, Lewy body disease, frontotemporal dementia, and Parkinson's disease with dementia. Assessment involves interviews, examinations, and tests to evaluate cognition, function, and rule out other conditions. Treatment focuses on enhancing quality of life and includes both non-pharmacological and pharmacological approaches.
The document discusses types of dementia like Alzheimer's disease and provides details about its pathophysiology and diagnostic criteria. It notes the growing prevalence of dementia worldwide and defines the condition. It describes the amyloid cascade hypothesis of Alzheimer's and discusses current and potential future treatments like cholinesterase inhibitors and memantine.
This document summarizes various types of dementia and their characteristics. It discusses Alzheimer's disease and other dementias such as vascular dementia, frontotemporal dementia, dementia with Lewy bodies, Parkinson's disease dementia, and prion diseases. For each type, it describes clinical presentation, risk factors, neuropathology, diagnosis, and treatment options. The document provides a comprehensive overview of the classification, causes, symptoms, evaluations, and management strategies for the major forms of acquired cognitive impairment and dementia.
The document discusses cognitive disorders and different types and stages of dementia. It defines cognition and lists different cognitive domains. It then summarizes classification systems for cognitive disorders from DSM-IV, DSM-5, and ICD-10. The stages of cognitive decline are discussed, from subjective cognitive impairment to mild cognitive impairment to dementia. The main types and causes of dementia are outlined. Assessment, risk factors, features and differentiation of different dementias like Alzheimer's and vascular dementia are summarized.
Diagnosis And Treatment Of Mental Disorders In Correctional Facilitiessaragardner
The document discusses two main issues regarding the treatment of mentally ill inmates in prisons: 1) accurate diagnosis of inmates' mental health issues upon entering the prison system, and 2) providing ongoing treatment programs for inmates with long-term mental disorders. Regarding accurate diagnosis, the document notes screening tools may be invalid and prison staff lack time and training. For ongoing treatment, the document argues current conditions like solitary confinement exacerbate issues, and most inmates lack access to mental healthcare and trained staff while incarcerated. Overall, the document calls for reforms to improve diagnosis and treatment of mental illness among prison populations.
This document discusses addiction treatment in older adults. It notes that substance abuse among those aged 60 and older is a growing problem. Effective treatment requires addressing issues unique to seniors, such as medical comorbidities, cognitive decline, and social isolation. Approaches include age-specific group therapy focusing on coping skills, rebuilding social support networks, and addressing depression or grief. Treatment must be provided with sensitivity to geriatric issues by clinicians experienced in working with older populations.
Geriatric Population the 3 D's Geriatric Dementia, Delirium and Depression 2015Michelle Peck
Michelle Peck | Legal Nurse Consultant | Adult & Geriatric Nurse Practitioner | Health Care | Consultant | Professional Speaker | Educator | Researcher
Enjoy your journey through this slide deck!
During your journey through Geriatric Dementia, Delirium and Depression, you will experience how to:
• Differentiate delirium, depression & dementia.
• Describe the etiology & signs and symptoms of delirium, depression, and dementia.
• Identify risk factors for delirium, depression, and dementia.
• Identify types of medications that may cause depression.
• Communicate and care for people experiencing delirium.
• Explain non-pharmacologic interventions for treating dementia.
In order to minimize risk and customize interventions, we have to know where and how our clients are living.
The picture on the first slide is from geriatric simulation lab, where nursing students practice administering geriatric assessment scales to identify areas of risk. What risks and hazards can you see in this picture?
What you can't see is that the V8 Splash bottle is actually whiskey, medications and incontinence briefs are scattered all over the floor and our client is using oxygen via nasal cannula while smoking. Would picking up the trash and organizing the house fix the problem? Fifty percent of the students verbalized wanting to clean up during their assessment visit and some asked if they could tidy up upsetting the client.
Every problem deserves a viable solution. A comprehensive geriatric assessment is in order and interventions need to follow by assembling the geriatric team.
Our client's assessment findings were all high risk.
View the geriatric assessment scales with how to administer articles & videos at http://consultgerirn.org/resources.
What do we do next? We need to assemble the geriatric team to intervene.
View assembling the geriatric team "Assessments and Referrals" at http://www.environmentalgeriatrics.org/cme/extra/noCredit.html.
Hopefully at minimum the discharging physician ordered the home health care services necessary to bridge our client's hospital to home care.
If the geriatric assessment scales were performed prior to hospital discharge the physician should have recognized that with all her high risk findings she should not have been discharged home alone. At minimum she requires 24 hour supervision for safety.
The students all felt our client was confused and attributed it to her whiskey drinking, but after performing her Mini Cog they realized she was screening positive for dementia. How many clients slip through the cracks because of lack of assessment?
Our client confabulated and was quite convincing until the students saw her clock draw. Now they knew environmental observations were much more important than client self-report.
A picture is worth a thousand words. We fail our clients until we learn the assessment skills required to paint an accurate picture.
The document discusses the path of mentally ill offenders through the criminal justice system from arrest to release. It notes that many police officers receive little training in dealing with mentally ill individuals and that arrests can sometimes escalate situations. For those booked into jails and prisons, mental health treatment is often lacking. Over time, deinstitutionalization led to fewer psychiatric hospital beds, resulting in many mentally ill individuals becoming incarcerated instead of treated. The document recommends improving mental health treatment for inmates and increasing diversion programs to help address this issue.
This document discusses co-occurring disorders (COD), which are when a person has both a substance use disorder and a mental health disorder. Some key points:
- Around 50-75% of people receiving treatment for a substance use disorder also have at least one mental health disorder. Around 25-50% of people with a mental health disorder also have a substance use disorder.
- Common mental health disorders that co-occur with substance use disorders include mood disorders like depression and bipolar disorder, anxiety disorders, schizophrenia, and personality disorders.
- Integrated treatment that addresses both disorders simultaneously tends to be more effective than treating them separately. Screening and assessment tools can help identify CODs.
This document discusses co-occurring disorders (COD), which are when a person has both a substance use disorder and a mental health disorder. Some key points:
- Around 50-75% of people receiving treatment for a substance use disorder also have at least one mental health disorder. Around 25-50% of people with a mental health disorder also have a substance use disorder.
- Common mental health disorders that co-occur with substance use disorders include mood disorders like depression and bipolar disorder, anxiety disorders, schizophrenia, and personality disorders.
- Integrated treatment that addresses both disorders simultaneously tends to be more effective than treating them separately. Screening and assessment tools can help identify CODs.
Presentation delivered by Dr. Carol Manning at the live webinar hosted by AlzPossible at www.alzpossible.org on the 17th of March, 2014.
www.alzpossible.org
This document discusses functional cognitive disorder (FCD), which refers to cognitive difficulties that are caused by functional rather than organic factors. Some key points:
- FCD is common in clinical practice but may be underdiagnosed. It involves internal inconsistency in cognitive abilities and symptoms cannot be better explained by other disorders.
- FCD can resemble mild cognitive impairment (MCI) or the prodromal stage of dementia. However, individuals with FCD are more likely to have stable cognition over time and less likely to develop dementia.
- Making an FCD diagnosis can help tailor interventions and manage patient expectations. However, FCD can be difficult to diagnose due to similarities with early neurodegenerative conditions
The document discusses the 3 D's of geriatric care - delirium, dementia, and depression. It provides information on recognizing, differentiating, and diagnosing each condition. For delirium, it describes potential causes and emphasizes the importance of recognizing it as it can be medical emergency. For dementia, it outlines diagnostic criteria for Alzheimer's disease and discusses assessment tools. Treatment goals for dementia include maintaining independence and cognitive ability. Non-pharmacological interventions for dementia focus on person-centered care.
Dementia is a chronic progressive mental disorder that affects functions like memory, thinking, and judgement. Alzheimer's disease is the most common form of dementia. It has an insidious onset and progresses slowly over several years, resulting in deterioration of cognition, function, and behavior. Current management focuses on treating cognitive, behavioral, and psychological symptoms, though there is no cure for Alzheimer's disease.
Dementia is a progressive decline in cognitive function that interferes with daily life. It has many potential causes but the most common is Alzheimer's disease. Dementia is characterized by declines in memory, spatial awareness, task performance, language, abstract thinking and mathematical skills. It can be reversible or irreversible. Delirium is a temporary disturbance in consciousness and cognition that develops over a short period of time, often due to an underlying medical condition. Complications of dementia include delusions, hallucinations, depression, aggression, dangerous behaviors and sundowning. Treatment focuses on managing symptoms, ensuring safety, and supporting patients and their caregivers.
Cognitive & neurologic, delirium & dementia spring 2014 abridgedShepard Joy
This document provides an overview of delirium and dementia in older adults. It begins with objectives and key terms related to cognition and neurologic function. It then discusses normal age-related cognitive changes, effects of aging on the neurologic system, and intellectual function. Symptoms of impaired cognition that should be investigated are outlined. The differences between delirium and dementia are explained, with delirium defined as a temporary acute state of confusion compared to the chronic nature of dementia. Risk factors, causes, and nursing care approaches for delirium are also summarized.
Aging is associated with cognitive decline, and older subjects can have demonstrable cognitive impairment without crossing the threshold for dementia.
This condition has been termed “mild cognitive impairment” (MCI), and these patients have an increased risk of developing dementia, especially Alzheimer disease (AD).
Studies conducted in referral clinics have shown that patients with MCI progress to AD at a rate of 10% to 15% per year, and 80% of these patients have converted to AD after approximately 6 years of follow-up.
The identification and classification of MCI can be a major challenge.
The document summarizes a senior project to build brand awareness for a ski apparel company called "Ski the East" through developing an ambassador loyalty program. The project involved researching the brand's positioning using the 5 Ps of marketing, identifying 31 east coast colleges and universities with ski clubs to target, creating an application and perks for an ambassador program, and launching the initial collegiate program with plans to expand it to high schools and ski clubs. The student learned the importance of thorough research before launching and representing the brand's vibe in their work.
The document discusses types of dementia like Alzheimer's disease and provides details about its pathophysiology and diagnostic criteria. It notes the growing prevalence of dementia worldwide and defines the condition. It describes the amyloid cascade hypothesis of Alzheimer's and discusses current and potential future treatments like cholinesterase inhibitors and memantine.
This document summarizes various types of dementia and their characteristics. It discusses Alzheimer's disease and other dementias such as vascular dementia, frontotemporal dementia, dementia with Lewy bodies, Parkinson's disease dementia, and prion diseases. For each type, it describes clinical presentation, risk factors, neuropathology, diagnosis, and treatment options. The document provides a comprehensive overview of the classification, causes, symptoms, evaluations, and management strategies for the major forms of acquired cognitive impairment and dementia.
The document discusses cognitive disorders and different types and stages of dementia. It defines cognition and lists different cognitive domains. It then summarizes classification systems for cognitive disorders from DSM-IV, DSM-5, and ICD-10. The stages of cognitive decline are discussed, from subjective cognitive impairment to mild cognitive impairment to dementia. The main types and causes of dementia are outlined. Assessment, risk factors, features and differentiation of different dementias like Alzheimer's and vascular dementia are summarized.
Diagnosis And Treatment Of Mental Disorders In Correctional Facilitiessaragardner
The document discusses two main issues regarding the treatment of mentally ill inmates in prisons: 1) accurate diagnosis of inmates' mental health issues upon entering the prison system, and 2) providing ongoing treatment programs for inmates with long-term mental disorders. Regarding accurate diagnosis, the document notes screening tools may be invalid and prison staff lack time and training. For ongoing treatment, the document argues current conditions like solitary confinement exacerbate issues, and most inmates lack access to mental healthcare and trained staff while incarcerated. Overall, the document calls for reforms to improve diagnosis and treatment of mental illness among prison populations.
This document discusses addiction treatment in older adults. It notes that substance abuse among those aged 60 and older is a growing problem. Effective treatment requires addressing issues unique to seniors, such as medical comorbidities, cognitive decline, and social isolation. Approaches include age-specific group therapy focusing on coping skills, rebuilding social support networks, and addressing depression or grief. Treatment must be provided with sensitivity to geriatric issues by clinicians experienced in working with older populations.
Geriatric Population the 3 D's Geriatric Dementia, Delirium and Depression 2015Michelle Peck
Michelle Peck | Legal Nurse Consultant | Adult & Geriatric Nurse Practitioner | Health Care | Consultant | Professional Speaker | Educator | Researcher
Enjoy your journey through this slide deck!
During your journey through Geriatric Dementia, Delirium and Depression, you will experience how to:
• Differentiate delirium, depression & dementia.
• Describe the etiology & signs and symptoms of delirium, depression, and dementia.
• Identify risk factors for delirium, depression, and dementia.
• Identify types of medications that may cause depression.
• Communicate and care for people experiencing delirium.
• Explain non-pharmacologic interventions for treating dementia.
In order to minimize risk and customize interventions, we have to know where and how our clients are living.
The picture on the first slide is from geriatric simulation lab, where nursing students practice administering geriatric assessment scales to identify areas of risk. What risks and hazards can you see in this picture?
What you can't see is that the V8 Splash bottle is actually whiskey, medications and incontinence briefs are scattered all over the floor and our client is using oxygen via nasal cannula while smoking. Would picking up the trash and organizing the house fix the problem? Fifty percent of the students verbalized wanting to clean up during their assessment visit and some asked if they could tidy up upsetting the client.
Every problem deserves a viable solution. A comprehensive geriatric assessment is in order and interventions need to follow by assembling the geriatric team.
Our client's assessment findings were all high risk.
View the geriatric assessment scales with how to administer articles & videos at http://consultgerirn.org/resources.
What do we do next? We need to assemble the geriatric team to intervene.
View assembling the geriatric team "Assessments and Referrals" at http://www.environmentalgeriatrics.org/cme/extra/noCredit.html.
Hopefully at minimum the discharging physician ordered the home health care services necessary to bridge our client's hospital to home care.
If the geriatric assessment scales were performed prior to hospital discharge the physician should have recognized that with all her high risk findings she should not have been discharged home alone. At minimum she requires 24 hour supervision for safety.
The students all felt our client was confused and attributed it to her whiskey drinking, but after performing her Mini Cog they realized she was screening positive for dementia. How many clients slip through the cracks because of lack of assessment?
Our client confabulated and was quite convincing until the students saw her clock draw. Now they knew environmental observations were much more important than client self-report.
A picture is worth a thousand words. We fail our clients until we learn the assessment skills required to paint an accurate picture.
The document discusses the path of mentally ill offenders through the criminal justice system from arrest to release. It notes that many police officers receive little training in dealing with mentally ill individuals and that arrests can sometimes escalate situations. For those booked into jails and prisons, mental health treatment is often lacking. Over time, deinstitutionalization led to fewer psychiatric hospital beds, resulting in many mentally ill individuals becoming incarcerated instead of treated. The document recommends improving mental health treatment for inmates and increasing diversion programs to help address this issue.
This document discusses co-occurring disorders (COD), which are when a person has both a substance use disorder and a mental health disorder. Some key points:
- Around 50-75% of people receiving treatment for a substance use disorder also have at least one mental health disorder. Around 25-50% of people with a mental health disorder also have a substance use disorder.
- Common mental health disorders that co-occur with substance use disorders include mood disorders like depression and bipolar disorder, anxiety disorders, schizophrenia, and personality disorders.
- Integrated treatment that addresses both disorders simultaneously tends to be more effective than treating them separately. Screening and assessment tools can help identify CODs.
This document discusses co-occurring disorders (COD), which are when a person has both a substance use disorder and a mental health disorder. Some key points:
- Around 50-75% of people receiving treatment for a substance use disorder also have at least one mental health disorder. Around 25-50% of people with a mental health disorder also have a substance use disorder.
- Common mental health disorders that co-occur with substance use disorders include mood disorders like depression and bipolar disorder, anxiety disorders, schizophrenia, and personality disorders.
- Integrated treatment that addresses both disorders simultaneously tends to be more effective than treating them separately. Screening and assessment tools can help identify CODs.
Presentation delivered by Dr. Carol Manning at the live webinar hosted by AlzPossible at www.alzpossible.org on the 17th of March, 2014.
www.alzpossible.org
This document discusses functional cognitive disorder (FCD), which refers to cognitive difficulties that are caused by functional rather than organic factors. Some key points:
- FCD is common in clinical practice but may be underdiagnosed. It involves internal inconsistency in cognitive abilities and symptoms cannot be better explained by other disorders.
- FCD can resemble mild cognitive impairment (MCI) or the prodromal stage of dementia. However, individuals with FCD are more likely to have stable cognition over time and less likely to develop dementia.
- Making an FCD diagnosis can help tailor interventions and manage patient expectations. However, FCD can be difficult to diagnose due to similarities with early neurodegenerative conditions
The document discusses the 3 D's of geriatric care - delirium, dementia, and depression. It provides information on recognizing, differentiating, and diagnosing each condition. For delirium, it describes potential causes and emphasizes the importance of recognizing it as it can be medical emergency. For dementia, it outlines diagnostic criteria for Alzheimer's disease and discusses assessment tools. Treatment goals for dementia include maintaining independence and cognitive ability. Non-pharmacological interventions for dementia focus on person-centered care.
Dementia is a chronic progressive mental disorder that affects functions like memory, thinking, and judgement. Alzheimer's disease is the most common form of dementia. It has an insidious onset and progresses slowly over several years, resulting in deterioration of cognition, function, and behavior. Current management focuses on treating cognitive, behavioral, and psychological symptoms, though there is no cure for Alzheimer's disease.
Dementia is a progressive decline in cognitive function that interferes with daily life. It has many potential causes but the most common is Alzheimer's disease. Dementia is characterized by declines in memory, spatial awareness, task performance, language, abstract thinking and mathematical skills. It can be reversible or irreversible. Delirium is a temporary disturbance in consciousness and cognition that develops over a short period of time, often due to an underlying medical condition. Complications of dementia include delusions, hallucinations, depression, aggression, dangerous behaviors and sundowning. Treatment focuses on managing symptoms, ensuring safety, and supporting patients and their caregivers.
Cognitive & neurologic, delirium & dementia spring 2014 abridgedShepard Joy
This document provides an overview of delirium and dementia in older adults. It begins with objectives and key terms related to cognition and neurologic function. It then discusses normal age-related cognitive changes, effects of aging on the neurologic system, and intellectual function. Symptoms of impaired cognition that should be investigated are outlined. The differences between delirium and dementia are explained, with delirium defined as a temporary acute state of confusion compared to the chronic nature of dementia. Risk factors, causes, and nursing care approaches for delirium are also summarized.
Aging is associated with cognitive decline, and older subjects can have demonstrable cognitive impairment without crossing the threshold for dementia.
This condition has been termed “mild cognitive impairment” (MCI), and these patients have an increased risk of developing dementia, especially Alzheimer disease (AD).
Studies conducted in referral clinics have shown that patients with MCI progress to AD at a rate of 10% to 15% per year, and 80% of these patients have converted to AD after approximately 6 years of follow-up.
The identification and classification of MCI can be a major challenge.
The document summarizes a senior project to build brand awareness for a ski apparel company called "Ski the East" through developing an ambassador loyalty program. The project involved researching the brand's positioning using the 5 Ps of marketing, identifying 31 east coast colleges and universities with ski clubs to target, creating an application and perks for an ambassador program, and launching the initial collegiate program with plans to expand it to high schools and ski clubs. The student learned the importance of thorough research before launching and representing the brand's vibe in their work.
Este documento describe el tratamiento psicológico de niños víctimas de abuso sexual. Explica las consecuencias del abuso a corto y largo plazo, así como diferentes tipos de intervención según el tipo y gravedad del abuso. El tratamiento debe diseñarse considerando factores individuales del niño y si involucra a la familia. Se mencionan técnicas como conversaciones, juego, arte y música para ayudar a los niños.
HTML es un lenguaje de marcado que se utiliza para crear páginas web y establecer su estructura y contenido mediante etiquetas. Incluye comandos para formato de texto, listas, encabezados y otros elementos. Los programas más usados para editar HTML incluyen CoffeeCup Free Editor, Notepad y TextWrangler. Los navegadores como Chrome, Firefox y Safari interpretan los archivos HTML para mostrar las páginas web.
The Prevent strategy aims to (1) stop people becoming terrorists or supporting terrorism by intervening early, (2) encourage individuals and communities to challenge extremist ideology, and (3) place a duty on schools to protect students from being drawn into terrorism. Schools must ensure a curriculum that promotes spiritual and cultural development, assess risks, ensure safeguarding partnerships, train staff, and keep students safe online. Ofsted will evaluate schools' approaches to keeping students safe from radicalization. The Channel program provides early support for those vulnerable to radicalization to build resilience against violent extremism. The school underwent Prevent training to recognize potentially vulnerable students and make appropriate referrals.
The document discusses research conducted on views about veganism. A survey was administered asking about knowledge of veganism and opinions on a vegan diet. Most respondents knew what veganism is but had not considered it due to not wanting to give up foods like meat and dairy. Opinions on a vegan diet were mixed, with some seeing it as bland or restrictive but beneficial for health. Reasons people become vegan included health reasons or concerns about animal treatment. Most vegan friends of respondents were vegan for health reasons. Secondary research summarized information from vegan advocacy websites about the ethics, health, and environmental benefits of veganism. Quotes from various sources on these topics were also presented.
El documento proporciona instrucciones sobre cómo crear páginas web usando HTML. Explica los comandos básicos de HTML como <html> para indicar el inicio y fin de una página, <h1-6> para el tamaño del texto, y <img> para insertar imágenes. También incluye direcciones de sitios para descargar imágenes y GIF, capturas de pantalla de videos sobre HTML, y definiciones de términos técnicos comunes.
HTML es un lenguaje de marcado que se usa para crear páginas web. Utiliza etiquetas para establecer la estructura y contenido de una página, incluyendo texto, objetos e imágenes. Algunos editores populares de HTML son CoffeeCup Free Editor, TextWrangler y Notepad. Los navegadores como Chrome, Firefox y Safari interpretan archivos HTML para mostrar páginas web.
Las Fuerzas Armadas del Ecuador forman soldados en varias ramas incluyendo infantería, caballería, artillería, ingeniería, comunicaciones, aviación, inteligencia, sanidad y administración general.
El documento describe la historia de la contaminación ambiental a través de los siglos. Menciona que la contaminación del aire ha existido desde tiempos antiguos, pero se hizo más prominente durante la revolución industrial cuando se quemaron grandes cantidades de carbón. También señala que la contaminación del agua y del suelo se han vuelto problemas importantes y de alcance global en la era moderna.
Sara Giraldo García es una técnica en sistemas. Tiene experiencia trabajando con tecnologías de la información y sistemas computacionales. Brinda servicios de soporte técnico y resolución de problemas relacionados con hardware y software.
El documento describe el síndrome de Reiter, una artritis reactiva que se desarrolla después de una infección intestinal o genital. Se caracteriza por la triada de artritis, uretritis y conjuntivitis. Está vinculado a bacterias como Shigella, Salmonella y Chlamydia trachomatis y es más común en hombres de 18 a 40 años que son portadores del antígeno HLA-B27. El tratamiento incluye antiinflamatorios no esteroideos y, en algunos casos, antimicrobianos, sulfasalazina o fá
El píxel es la unidad mínima de una imagen digital. Cada píxel se codifica mediante bits y su número y tamaño definen la resolución de la imagen, mientras que la profundidad de color determina la cantidad de colores que puede representar. Los píxeles defectuosos como los píxeles muertos, calientes o atascados aparecen de color constante.
Huntington's disease is a condition that stops parts of the brain working properly over time. It's passed on (inherited) from a person's parents. It gets gradually worse over time and is usually fatal after a period of up to 20 years.
This document discusses ethical issues surrounding disclosure of diagnoses, specifically Alzheimer's disease, to patients and their families. It provides guidance on assessing a patient's understanding and desire to know their diagnosis before disclosure. When disclosing Alzheimer's, it is important to arrange a joint meeting with family, allow time for questions, discuss disease progression and care plans, and involve caregivers going forward. The case study describes one family's experience where the husband decided to disclose the wife's Alzheimer's diagnosis to her in the doctor's office, but she initially reacted with disbelief and later developed aggressive behaviors towards her husband caregiver.
The document discusses key challenges police officers face when dealing with individuals in behavioral crisis. It defines a behavioral crisis as mental or emotional distress that disrupts the person, community, or family. A crisis typically occurs due to a precipitating event combined with an individual's perception of the event and their normal coping methods failing. This can result in a loss of control, inappropriate responses, and feeling overwhelmed. When dealing with someone in crisis, it is important for officers to recognize that the person may have a mental illness, substance abuse issue, medical condition, intellectual/developmental disability, physical disability, or be experiencing situational stress. Understanding the factors behind erratic behavior helps officers determine the best approach to stabilize the situation. The document
This document provides information about Alzheimer's disease and dementia. Some key points:
- Alzheimer's disease is the most common form of dementia and causes nerve cell death and brain tissue loss. It is progressive, irreversible, and fatal.
- The first case was identified in 1901 by Alois Alzheimer. The term "Alzheimer's disease" was coined in 1910.
- Risk factors include genetic mutations, age, and lifestyle. The disease develops due to plaques, tangles, and neuronal loss in the brain.
- Symptoms start with mild cognitive decline and progress to severe cognitive and physical impairment. It affects memory, thinking, behavior, and ability to perform daily tasks.
- Over 5 million
Interdisciplinary Perspectives On Aging(2)vjthemetalhead
1. The document discusses several topics related to aging including cognitive changes, learning and memory, mental disorders like dementia and depression, and theories of adult development.
2. Key aspects of aging discussed include declines in fluid intelligence but stability of crystallized intelligence, changes in learning and memory processes, and increased risk of dementia, Parkinson's disease, and depression in older adults.
3. Theories of adult development addressed stage theories by Erik Erikson and Daniel Levinson that describe transitions in identity and personality across the adult lifespan.
The document announces the 7th International Conference on Dementia and Care Practice to be held in Toronto, Canada from August 14-16, 2017. The conference will bring together over 400 participants from around the world to discuss the latest research on dementia diagnosis, treatment, and care practices through keynote lectures, oral presentations, symposiums and workshops. The main theme of the conference is "Discernment into innovative research and care practice approaches towards Dementia".
Dementia is an acquired persistent and progressive impairment in intellectual function, with compromise of memory and at least one other cognitive domain. The key features of dementia include progressive decline in intellectual functions over months to years, loss of short term memory and at least one other cognitive deficit, no disturbance of consciousness, deficits severe enough to cause impairment in daily functioning, and not being in a state of delirium. Dementia can be categorized into reversible or partially reversible dementias and nonreversible dementias. Nonreversible dementias include Alzheimer's disease, vascular dementia, dementia with Lewy bodies, and frontotemporal dementias. Treatment involves acetylcholinesterase inhibitors, memantine, managing behavioral problems non-
Diagnostic considerations gambling use disorderdrleighholman
The document discusses changes made in the DSM-5 to the classification of Substance-Related Disorders, including renaming the category to Substance Use and Addictive Disorders. Gambling Disorder is included in this category, and Internet Gaming Disorder is included in a separate section. Process and behavioral addictions beyond substance use are also acknowledged. Key diagnostic criteria for Gambling Disorder include preoccupation with gambling, tolerance, withdrawal symptoms, unsuccessful attempts to control gambling, and continuing to gamble despite negative consequences. Epidemiology, course, risk factors, and common comorbidities of Gambling Disorder are also summarized.
April 27, 2018
With over 70 million Baby Boomers retiring, elder financial exploitation has been labeled the “Crime of the 21st Century.” In this half-day event, we will explore the neuroscience, psychology, and legal doctrine of financial decision-making in older adults. How does the aging brain make financial decisions, and when is it uniquely susceptible? How can courts best use science to improve their adjudication of disputes over “competency”, “capacity”, and “undue influence”? Is novel neuroimaging evidence of dementia ready for courtroom use? This conference brought together experts in medicine, science, and law to explore these important questions and chart a path forward for dementia and the law.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/our-aging-brains
Geriatric assessment for mental illnessramkumar g s
The document provides details on assessing the mental health of elderly patients. It discusses the adaptive tasks of aging, the purpose of geriatric psychiatric assessment, and outlines the domains to assess including mental health, physical health, functioning, and social situation. It then describes specific aspects of the assessment including the interview process, tools to evaluate cognition, and scales to measure depression, daily functioning, and physical health.
April 27, 2018
With over 70 million Baby Boomers retiring, elder financial exploitation has been labeled the “Crime of the 21st Century.” In this half-day event, we will explore the neuroscience, psychology, and legal doctrine of financial decision-making in older adults. How does the aging brain make financial decisions, and when is it uniquely susceptible? How can courts best use science to improve their adjudication of disputes over “competency”, “capacity”, and “undue influence”? Is novel neuroimaging evidence of dementia ready for courtroom use? This conference brought together experts in medicine, science, and law to explore these important questions and chart a path forward for dementia and the law.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/our-aging-brains
The document summarizes the insanity defense. It discusses how the insanity defense is based on the idea that some criminal defendants lacked criminal intent due to mental illness or defect. There are two conceptualizations of insanity - cognitive insanity which impairs understanding of wrongfulness, and irresistible impulse which allows understanding but inability to control actions. Determining legal insanity is difficult as it is a legal rather than psychiatric concept. If successful, the insanity defense results in a verdict of Not Guilty by Reason of Insanity or Guilty but Mentally Ill.
Alzheimer's Disease and Developmental DisabilitiesKendall Brune
How do we help older adults with DD maintain their independence and successfully age in place, especially as they face Alzheimer's or age related dementia?
This document provides an overview of forensic psychology, including key topics like eyewitness testimony, psychological testing, and profiling serial offenders. It discusses the differences between forensic psychology and psychiatry, as well as clinical psychology. Forensic psychologists may work on issues like competency evaluations, insanity defenses, and analyzing criminal patterns and motives. Psychological testing and eyewitness research have both provided insights but also have limitations for legal contexts.
Chapter 11 Clinical and Counseling Assessment.pptxDonnaMaeVAlejo
This document discusses methods of clinical and counseling assessment. It covers key concepts in diagnosing mental disorders using references like the DSM-5 and ICD-11. A biopsychosocial assessment takes a multidisciplinary approach exploring biological, psychological, social and cultural factors. Clinical interviews gather information through various structured approaches. Case history data and psychological tests provide additional information. Broad screening tests check for possible disorders while specific diagnostic tests inform on comorbidities or differentials. Assessments must be culturally informed and applied to specific contexts like addiction, forensic evaluations, custody decisions and predicting lethality or criminal responsibility. Clinical prediction combines experience with empirical data whereas mechanical prediction relies solely on statistical rules.
The document discusses mental health and illness, including definitions, causes, symptoms, stigma and discrimination, and the Indian Mental Health Act of 1987. Some key points covered include:
- Mental health is defined as a state of well-being and ability to cope with stress and function productively. Mental illness refers to conditions that affect cognition, emotion, or behavior.
- Mental illnesses have biological, psychological, and social causes, and are not due to personal weakness. They can cause suffering, disability, and increased mortality.
- The Indian Mental Health Act of 1987 aimed to safeguard rights of the mentally ill and regulate institutions, but was criticized for not fully reflecting medical considerations or removing criminal stigma.
This document discusses the intersection of mental illness and criminal behavior. It notes that 30% of individuals in the criminal justice system have a mental illness, and 50% of prisoners have a mental health problem. Mental illness can contribute to criminal behavior through impaired decision making and impulse control, and may lead to substance abuse. Identifying mental illness can be complex, and untreated mental illness can increase recidivism. The challenges in the criminal justice system for those with mental illness include stigma, lack of proper assessment, and limited access to mental health services. Screening, medication management, and therapeutic programs are treatment options.
The document discusses Alzheimer's disease and dementia. It provides epidemiological data showing that the number of people with Alzheimer's is increasing significantly and will rise to over 40 million worldwide by 2025. It describes the diagnostic criteria and clinical presentation of different types of dementia including Alzheimer's disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia, and rapidly progressive dementias like Creutzfeldt-Jakob disease. It discusses tools for assessing cognition and mental status in diagnosing dementia.
This document discusses mental health and different perspectives on mental illness. It defines mental health as emotional and psychological well-being that allows one to cope with life demands. Mental illness is caused by chemical imbalances in the brain that can sometimes be treated with therapy or medication. The document outlines the stigma around mental illness and different views on topics like the insanity defense in criminal trials. It explores the trial of Billy Milligan, who successfully pleaded insanity due to having multiple personalities. Overall, the document presents information on mental health and examines various perspectives on mental illness.
1. “In the aftermath of this mental
health service and policy shortfall,
this is an aging, mental health,
and criminal justice crisis that
is too large to ignore…
It is too costly and inhumane to
do nothing about this social
problem.”
Maschi, T. et al. (2012).
Forget me not: Dementia in prison.
The Gerontologist, Vol. 0, No. 0, 1—11
Dementia and Criminal Justice 72
2. on the Criminal Justice System
Presenter: Sharon J. Kernen, Ph.D.
Comprehensive Forensic & Clinical Neuropsychology Assessments
3. The cost of increasing dementia
Statistics
Definition of dementia
Cognitive domains: What is lost?
Myths
Epidemiology
Risk factors
Variations
Dementia and Criminal Justice 74
4. DSM-5 terminology
Diagnostic criteria
Roles of law enforcement, prosecutors,
defense counsels, and judges
Competency to Stand Trial
Overflowing prisons
Challenges facing prisons
Activities of daily living in prison
Dementia and Criminal Justice 75
6. What’s her name again?
◦ UNM Grad
◦ Forensic, clinical, and geriatric
neuropsychology
◦ Seven years in Second Judicial District
◦ Past history as certified personal trainer,
program manager, and aerobics director
working with “Mature Adults”
◦ Wife, mom and nana, and head dog wrangler
Dementia and Criminal Justice
9. 36 million with dementia globally
Triple that number in 2050
Approximately affects one in 20 over age 65
and one-fifth of people over 80
90% eventually require full-time nursing care
Average life span: six years post-diagnosis
Dementia rate among older prisoners largely
undetermined but estimated at 40,000 in U.S.
with increase of ¼ million by 2050.
Dementia and Criminal Justice 80
10. Estimated public spending is upward of 202
billion dollars, likely much more costly than care
in the community
In 2010 worldwide cost of dementia care in
general population estimated at $604 billion. In
the U.S. estimated at $157 billion to $215 billion
Annual cost to house older adults in prison is
$70,000, 3 times estimated comparable costs for
younger inmates
Dementia and Criminal Justice 81
11. Defined broadly: a syndrome of acquired
intellectual impairment produced by brain
dysfunction. Often called, “a cruel and unusual
disease.”
◦ Phillipe Pinel used it to refer to intellectual
deterioration and idiocy
◦ Others called it “senility
◦ Dementia praecox: Schizophrenia
Dementia and Criminal Justice 82
12. “Dementia” is a loss of mental functions not due to
delirium. It comprises of 3 or more deficit areas:
◦ Memory
◦ Language
◦ Perception
◦ Praxis
◦ Calculations
◦ Semantic knowledge
◦ Executive function
◦ Personality
◦ Social behavior
◦ Emotional awareness or expression
Documented by mental status assessments
Dementia and Criminal Justice 83
14. A global impairment
Must impair memory
A behavioral disorder
Inevitable with aging
Cannot have an acute onset
An untreatable disorder
Dementia and Criminal Justice 85
15. Single greatest predictor: Longer lifespan
After onset of dementia: 5 to 6 years
World Health Organization: 35.6 million
globally will triple by 2050
No quality data on number of prisoners with
dementia
Dementia and Criminal Justice 86
21. Mild/Major Neurocognitive Disorder due to…..page 602
◦ Alzheimer’s Disease
◦ With Lewy Bodies
◦ Vascular
◦ Traumatic Brain Injury
◦ HIV Infection
◦ Prion Disease
◦ Parkinson’s Disease
◦ Huntington’s Disease
◦ Another medical condition
◦ Multiple etiologies
◦ Unspecified
Dementia and Criminal Justice 92
22. Beyond renaming it “cognitive decline,” you
must specify “possible” or “probable” and
include the ICD code for due to…..
Page 603 and 604 will help with that.
Dementia and Criminal Justice 93
23. Probable Alzheimer’s Disease: diagnosed if
there is evidence of a causative Alzheimer’s
disease genetic mutation from either genetic
testing or family history
Possible Alzheimer’s Disease: diagnosed if
there is no evidence of causative Alzheimer’s
disease genetic mutation or family history and
all three of the following are present:
Dementia and Criminal Justice 94
24. (1) Clear evidence of decline in memory and
learning
(2) Steadily progressive, gradual decline in
cognition, without extended plateaus
(3) No evidence of mixed etiology (i.e.,
absence of other neurodegenerative of
cerebrovascular disease or another
neurological or systemic disease or condition
likely contributing to cognitive decline
Dementia and Criminal Justice 95
26. Executive function has evolved to broadly describe an
array of loosely defined control processes responsible
for planning, coordinating, sequencing, and monitoring
other cognitive skills, enabling goal-directed and
future-oriented behavior. Some also place extremely
functional activities such as attention, visuospatial
function, reasoning, and planning among the tasks to be
under the guidance of executive function. In other
words, executive function may be described by several
related but dissociable processes, including divided
attention, updating and monitoring, task shifting,
response inhibition, and visuospatial function or the
perception of the surrounding world.
Dementia and Criminal Justice 97
27. Neuropsychological Evaluation, usually on a
yearly basis with the first assessment used as a
baseline
An initial baseline MRI and repeated when
neuropsychological evaluation shows
cognitive decline
Dementia and Criminal Justice 98
28. Also includes
Early symptoms of
executive dysfunc-
tion rather than
memory
• Fluctuating cognition
• Visual hallucinations
• Parkinsonism
DSM-5—p.618
Dementia and Criminal Justice 99
29. Recent memory that affects daily life
Difficulty performing regular tasks
Problems with language
Disorientation of time and space
Decreased or poor judgment
Problems with complex tasks
Misplacing things
Changes in mood and behavior
Relating to others
Loss of initiative
Dementia and Criminal Justice
10
0
34. Aggression, sexual or physical often concludes
with interaction with the
police.
Police training needs to
include more information
about behaviors that
might be dementia rather
than criminal.
Criminalization of the
Symptoms
Dementia and Criminal Justice
10
5
35. Deserving of the same treatment given to those
with a mental
disorder:
a psychiatric
evaluation and
pharmaceutical
intervention.
Dementia and Criminal Justice
10
6
36. High rates of various mental health disorders
contribute to increased risk for dementia
Premature aging
Adverse environment (exceptional stresses)
Traumatic brain injury
Chronic substance abuse
Medication side effects
Historically poor diets
Dementia and Criminal Justice
10
7
37. Vitamin deficiencies
Exposure to violence
Inadequate service provision
Purpose is punishment
Poor quality of life
Lower educational status
Dementia and Criminal Justice
10
8
38. Awareness of the need to raise competency
Usually not difficult to get a judge to issue
such an order
Try to get them released from jail. If there is
no family to take them in, this may be difficult.
When dementia is suspected, considering
asking for approval for an LSR to evaluate
with a comprehensive neuropsychological
assessment.
Dementia and Criminal Justice
10
9
39. Need for specialized training on needs and
problems present in an elderly defendant
An appreciation of the potential conditions and
limitations
Awareness that their impairment may not be
obvious
Determination of whether the client’s medical
conditions will interfere with physical
competence or will stresses of trial exacerbate
illnesses and take preventative measures
Dementia and Criminal Justice
11
0
40. Presence of dementia may be relevant to conduct
during investigation
Confession, consent to search, understanding of
Miranda Waiver
Find a way to inform the jury as to why the
defendant cannot take the stand
Seek access to prosecution witness’ medical
records
Be alert to possibility of suicidal ideation
Use life expectancy tables and stages of dementia
to demonstrate the relationship of a sentence
A sentence of 10 years may equal a life sentence
Extremely low rate of recidivism among elderly
Dementia and Criminal Justice
11
1
41. Become aware and educated about what
constitutes dementia
Other than the case of a habitual offender or
violent behavior and if the dementia is well
documented by the examiner, first consider
stipulating to the diagnosis
Prisoners with dementia often do not remember
why they are in prison or how long they have
been there.
When treatment becomes punishment
Beware of criminalizing the symptom: Offenses
committed in old age are often expressions of the
onset of dementia. Pathological shifts can weaken
inhibitions, resulting in instances of violence and
deviant sexual behavior. Dementia and Criminal Justice
11
2
42. Some prosecutors have taken the media stance
to heart and feel that anyone who has been
arrested must be prosecuted
Prosecutors also need to be aware of what
dementia is and that it is irreversible and that
the defendant’s actions have been the result of
delusional thinking.
Attitude of being tough on crime (any crime)
and prison is the only appropriate
punishment
Yes, sometimes justice is blind
Dementia and Criminal Justice
11
3
43. Due to its increasing prevalence, judges need
to recognize the symptoms and have an
understanding of dementia. They need to opine
accordingly when competency is
raised and dementia is
documented and
diagnosed.
Dementia and Criminal Justice
11
4
44. Judges should have an understanding of
“criminalizing the symptom”
True for any mental illness, not just dementia
An understanding of dementia and its
irreversibility and progressive nature
With such an understanding, someone with
dementia would never be sentenced to prison for
a non-violent crime
Judges also allow themselves to be driven by
media opinion and societal bias
The public traditionally believes that any sentence
other than prison is too lenient for serious
offenders…many retail stores have a policy that
anyone caught shoplifting should go to jail
Dementia and Criminal Justice
11
5
45. Moreover some view mental illness as
volitional and perhaps a deliberate attempt to
avoid punishment
The public’s intolerance of perpetrators,
whether mentally ill or not, is demonstrated by
a desire for more restrictive detention laws
The statute for mens rea or diminished
capacity attenuates some harsh punishments.
New Mexico does have such a law.
Innocent until proven guilty
does not hold true
The Halls of Justice
Dementia and Criminal Justice
11
6
46. New Mexico Criteria for Determining
Competence to Stand Trial
The Client must have a factual understanding of the
charges and legal proceedings, (2) The Client must
also have a rational understanding of the charges
and legal proceedings, and (3) The Client must
have the ability to assist his or her attorney [State v.
Rotherham, 122 N.M. 246, 252, (1996)].
Dementia and Criminal Justice
11
7
47. Trial Deficits
Failure to understand Miranda
Legal charges
Potential penalties
Roles of court officers
Pleas
Plea bargaining
Inability to rationally assist
attorney
Be self-protective
Dementia and Criminal Justice
11
8
48. Appropriate courtroom behavior
Based on 30 studies average rate of
incompetence is 30% of those evaluated
Averages based on young defendants with
psychiatric disorders
Literature shows that those over 60, 30%
had dementia, 25% psychosis, and 38%
personality disorder and 50% deemed
incompetent, due to organic impairment
Very little research on geriatric defendants
Dementia and Criminal Justice
11
9
49. CST Group IST Group
% % p Value
Memory impairment 22.2 95.2 <0.0001
Impaired abstraction 25.0 85.7 <0.0001
Impaired concentration 27.8 71.4 <0.0001
Impaired calculation 19.4 61.9 <0.001
Thought process abnormality 5.6 47.6 <0.001
Hallucination s 8.3 14.3 <0.74,NS
Delusions 11.0 14.3 <1.0, NS
From: Journal of the American Academy of Psychiatry and the Law: 2002
Dementia and Criminal Justice
12
0
51. The worldwide growth of prison populations has
been spearheaded by the U.S. since the 1980s
with “tough-on-crime” criminal justice policies
Stricter sentencing laws and longer mandatory
prison terms set the upward trend of mass
incarceration
In terms of the elderly a more compassionate
stance is taking hold, such as the U.S.
Compassionate Release Laws and moving away
from overly punitive policies that affect older
adults.
Other countries have begun to follow suit
Dementia and Criminal Justice
12
2
53. Dementia is a hidden problem that may show
in early stages as depression, aggression, and
anxiety and they go unnoticed
Prison systems too large to devote the time to
diagnose early dementia effectively
Highly regimented nature of prison life
determines that mental health issues are easily
missed or ignored
Older offenders reluctant to seek attention or
report changes in mood, as many have been
raised with a more stoic attitude and are
therefore non-medicated
Mental health services directed toward
younger more vocal inmates
Dementia and Criminal Justice
12
4
54. Lack of comprehensive screening policies for
dementia
Medical screenings are performed but they are
not designed to detect issues associated with
aging, i.e., cognitive impairment
Healthcare practitioners in the community also
lack proper tools and disregard standardized
scoring
Identifying dementia further encumbered by
deficiencies in staff training and health care
Unawareness of need to conduct regular
mental health checks on older prisoners whose
symptoms may fluctuate
Dementia and Criminal Justice
12
5
55. Repeated requests for healthcare units to train
and oversee the delivery of care for older
detainees have gone unheeded
COs are in best position to notice changes in
mood or behavior but lack required skills
Improved communication between security
and mental health staff, including officer
observations in functional evaluations is a
need
Aims of incarceration, whether punitive or
rehabilitative hold little meaning for the
inmate with dementia.
Dementia and Criminal Justice
12
6
56. Research on the experiences of older people in
prison is replete with examples of detainees
oblivious to their surroundings and mentally
incapable of participating in courses required for
release even in the institutions that provide
compassionate release
There are major operational implications for
facilities lacking knowledge, tools and resources
to effectively manage, ensuring more older
inmates will be left “vegetating”
Dementia and Criminal Justice
12
7
57. Aggression
Violence
Bullying
Mocking
Provoking
Sexual
Dementia and Criminal Justice
12
8
61. Inmates with dementia: Prison Statistics
Dementia and Criminal Justice
13
2
62. Basic physical needs
◦ Grooming and personal hygiene
◦ Dressing
◦ Toileting/Continence
◦ Transferring
◦ Ambulating
◦ Eating
Dementia and Criminal Justice
13
3
63. Categorized separately from ADLs
Managing finances
Managing medications
Appointments
Driving
ADLs are more preserved and impairment
shows up in later stages, dependent on physical
functioning
IADLs performance is more sensitive to early
cognitive decline
Dementia and Criminal Justice
13
4
65. Restructure of the environment to reduce the
potential for confusion and agitation
◦ Good lighting
◦ Quiet surroundings
◦ Contrasting colors to delineate bathrooms
and other accessibility needs
◦ Remove mirrors
Dementia and Criminal Justice
13
6
66. ◦ Simple signage including pictures with
words
◦ Handrails
◦ Wheelchair accessible showers
◦ Locked units
◦ Absence of rugs or carpeting with edges
◦ Consistent daily routines
◦ Hearing aids
◦ Eyeglasses
◦ Clothing: velcro and elastic designs
Dementia and Criminal Justice
13
7
67. Dropping to the floor for alarms
Standing for head counts
Ambulating to dining hall
Hearing orders from staff
Climbing up and down: top bunk
Staff must be trained that inability to perform
does not equal defiance but may be indication of
disease
Dementia and Criminal Justice
13
8
68. Inability to perform PADLs leaves the prisoner
vulnerable to harsh punishment or segregation
Violation of facility rules may result in solitary
confinement, which further compromises their
physical and mental well-being
Dementia and Criminal Justice
13
9
69. Used to be sociable, now withdrawn
Some memory lapses
Misplacing items
Mood changes
Temperamental
Easily agitated
Confusion
Dementia and Criminal Justice
14
0
70. Staff training for those who see individuals
frequently
◦ Communications
◦ Take their perspective seriously
◦ Never try to argue them out of delusions or confusion
◦ Non-judgmental
◦ Patience, discipline, and flexibility
◦ No multi-step directions
◦ Support autonomy: keep choices simple and
manageable
Dementia and Criminal Justice
14
1
71. May need to re-introduce self each time
Make sure you have their full attention
Talk slowly, use gestures, and allow time to
process
Try not to initiate a behavioral crisis
Policy changes:
◦ Compassionate Release Programs
◦ Institute programs where other compatible
prisoners can be their gentle guide
◦ Do not incarcerate individuals with dementia for
non-violent crimes
◦ Plan for older prisoners (50+) to have regular
checkups: early detection is key
Dementia and Criminal Justice
14
2
73. Alternative Placement Area (APA): A designated
living area for inmates who have special housing
designation and who meet specified mental health
criteria
◦ Mental Health Treatment Center: only at CNMCF and
from description, this would be the only likely
placement for later stages of dementia
◦ Rounds: Visits by Behavioral health clinician to provide
brief conversation, discussion, and receive requests for
behavioral health services
◦ Well-Being Checks: Designed to monitor for any
mental health deterioration
Dementia or any special needs for same is not
mentioned
The legal mandate for prisoner healthcare also does
not mention providing for special geriatric needs
Dementia and Criminal Justice
14
4
74. Released prisoners without family may be
helplessly lost: Programs need to be in place
that will help guide them appropriately
Nursing homes (in NM) will not take a
convicted felon
More group homes with trained staff are a
must: some will need 24/7 supervision
Financially, it will eventually be less
expensive than caring for them in prison
Dementia and Criminal Justice
14
5
75. Please do not hesitate to contact me if you
have any further questions:
505-263-8055kershar@comcast.net
dr.s.kernen@gmail.com
505-263-8055
…and as always my best regards
Dementia and Criminal Justice
14
6
Editor's Notes
It should be acknowledged that many mentally ill (including dementia) persons who commit serious crimes and enter the criminal justice system might not have engaged in such behavior if they had been receiving adequate and appropriate mental health treatment (John Hyde)….The less serious misdemeanor offense is often a way of asking for help. People living on the streets, in missions, or cheap hotels obviously have a minimum of community supports.
Let’s see, maybe it is Shannon or Karen….Karen sort of goes with Kernen. It was my work in the Mature Adult Program at Sports and Wellness that brought the realization that I could be doing much more. That and the skillful teaching of a fantastic mentor that revealed the challenges and mysteries of the human brain, particularly as it changes over time.
As an expert witness, the prosecution does their best to make you look incredibly uninformed. Love the word “absolutely” and use it a lot. Expert Witness has a whole different meaning in NM. The ADA is the most knowledgeable person in the room and the judge does not know any differently. Law School: Arrogance 101
Are you certain of your diagnosis?
Can NP count?
Incident with WAIS-IV
Expert Witness cannot ask questions….dependent on defense counsel to cover in redirect
Familial with early onset
Late onset
Memory is usually first skill lost with A.
My memory’s not as sharp as it used to be. Also, my memory’s not as sharp as it used to be.
Things your brain does for you automatically.
In order to appropriately diagnose dementia, each domain must be tested.
Don’t let aging get you down. It’s too hard to get back up.!
Better preventative health care
Better nutrition
Higher educational status
Not all with dementia have AD
Mixed etiologies (next slide)
Mixed etiologies, particularly vascular and AD
AD can only be diagnosed at autopsy. Dependent on neuropsychological testing and collaborative reports (difficult to do in the prison setting)
double vision and misinterpretation of what the see
Cause: There has been a gene link but it’s not thought to be strongly heriditary. DLB risk is heightened
APOE4 allele. Involves death of cholinergic and dopaminergic neurons. Abnormal collection of protein
within the cells. These structures are called the Lewy bodies. Pathology is often concomitant with AD
Often misdiagnosed ROBIN WILLIAMS
Vascular: must have neuroimaging evidence to diagnose
“Sugar why don’t you sit down by the table and we’ll start supper.” Said Dorothy to her Husband of 50 years. “Sure thing,” said her husband settling himself down.
“Now darling, would you like the soup first or the salad?” Questioned Dorothy.
“Umm I guess I’ll take the soup.” He responded.
After a whole meal of one endearing term after another, their guest Bob couldn’t contain his curiosity any longer. Bob snuck into the kitchen and asked, “Dorothy do you always talk to your husband like that?”
“Bob, I’ll be honest with you,” Dorothy replied. “It’s been five years now, I just can’t remember his name, and I am just too embarrassed to ask him!”
Precursors to vascular dementia
A number of dementias are brought about by other disease factors: HIV, Hepatic encephalopathy, TBI
What is encephalopathy?
Onset and progression differences
What is meant by unspecified?
Very first action is complete medical checkup
Neuropsychological baseline: HISTORY! Bring someone who knows you well.
Neurologist….MRI
Differences in diagnosing someone who has been high functioning. May still be quite articulate.
Many clinicians feel that this is insufficient:
National Institute on Aging and Alzheimer’s Association : dementia may be diagnosed when there are cognitive or neuropsychiatric symptoms that interfere with work or normal activities, reveal a decreased level of function from baseline and cannot be explained by any other psychiatric disorder or delirium.
Impairment must be in two of five domains:
Acquiring and remembering new information
Ability to reason judge and handle complex tasks
Visual spatial abilities
Language functions
Changes in personality or behavior
Possible AD: atypical course (sudden onset or insufficient historical data), or demonstrates mixed etiology
Probable AD: more classical presentation with insidious onset, history of cognitive decline, memory or word-finding deficits, spatial cognition, impaired judgment or executive dysfunction. Clinician must evaluate in two sessions and document decline
Aphasia: speech problems
Apraxia: movement problems
Agnosia
Executive Function: often the most troublesome
Why must be rule out delirium? Fluctuating deficits and eventually reverses.
EF mediates almost everything. Why young people seem to have none. Not all of these functions are in top performance mode all the time.
Depression/Anxiety may allow the limbic cortex to take over
Impacted by most mental illnesses
Mr. B.
Phineas Gage if time
How many prisoners get neuropsychological baseline
How many get an MRI
Experience of being in the scanner
MRI: magnetic properties of tissue can be used to obtain information about the structure and function of the living brain. Signals are produced by protons in the brain tissue. The proton, the magnetic nucleus of the hydrogen atom responds to applied magnetic fields by emitting characteristic radio waves. Protons each rotate around their axis and normally rotate at random until a second radio frequency is applied to make them all rotate together. Then when it is taken away they return to normal rotation but at different rates. Functional MRI records changes related to tissue functions in successive images.
Thinness of slices improves diagnostics
DLB: closely associated with Parkinson’s Disease
more rapid cognitive decline but fluctuating in nature
develop hallucinations
variable attention and focus
sleep behavior disorder (abnormalities in REM); vivid dreams, violent movements, falling out of bed
Tremors less common than in Parkinson’s
Stiff movements
Difficulty swallowing
orthostatic hypotension
Explain MRI, SPECT, Pet scans
Positron Emission Tomography: Involves introduction of substances tagged with radionuclides that emit positrons (positively charged electrons)
Single Proton Emission Computed Tomography: Imaging techniques for biochemical processes. Records different levels of cerebral blood flow, hyperfusion and hypofusion
Stage 7 is imminently terminal. One does not die from dementia.
Alzheimer’s Association has produced a number of good handouts.
Also refer to the website for Crisis Prevention Intervention (CPI)
URLs part of handouts
Louis
Could use some behavior modification therapy?
Someone calls the police because of an aggressive argument with a neighbor who threatens to punch him out.
Circumstance could very well be a dementia symptom but neighbor will be arrested and charged with a misdemeanor. Part of decision making rests on person’s background…habitual offender or first time?
The neighbor needs to go to the hospital for an evaluation. There are pharmaceutical interventions for violent and/or sexually inappropriate behaviors. Usually an antipsychotic.
Dementia meds:
Donepizil/aricept. Memantime, galantamine, revastigmine….cholinesterase inhibitors
Role of brain chemical acetylcholine…activating role….a neurotransmitter that modulates processes, causes neurons to fire. Is also part of the peripheral nervous system.
These are risk factors that are not present in most of the general population. Prisoners develop dementia at much younger ages.
They are there to be punished for their crime. Why should they be provided special attention, diets, increased access to medical assistance. Many prisons do not have cholinesterase inhibitors in their formulary, so prisoners don’t get them. The National Commission on Correctional Healthcare maintains clinical practice guidelines on a variety of topics, dementia is not mentioned.
How do you get a knowledgeable history?
Some attorneys are very good at recognizing possible dementia and are quick to raise competency. Others are not quite so good and may interpret it as irrascible behavior or even presumptive MR. They do raise competency for the latter.
Determination of medical condition is important. If too medically fragile to work with attorney and defend selves, they are not competent to stand trial. Again past record is taken into consideration.
Jury trial vs. bench trial:
Can a defendant be forced to take the stand?
Jury can be much more dicey
PTSD case …psychotic….diminished capacity
Medically fragile may prefer to die
May need to get the physician to attest to medical condition
The reason why our trial process is so slow. A more reasonable attitude is decidedly needed
Treating to competency….explain process
Bias
Fear of the media
Re-election
Must appear to be tough on crime
Keep prosecutors under control
JUDGES ARE TRAINED IN JURISPRUDENCE AND NOT SOPHISTICATED PSYCHOLOGICAL DIAGNOSIS. The psychologist expert witness does not tell the judge or the DA how to interpret the law, yet prosecutors question our findings at every turn.
The Supreme Court ruled one can only be held for a reasonable length of time but did set a maximum time limit for restoration to competency. Some are held in “competency limbo”
Describe process here
When possible happens in first six months usually
Those who are chronically psychotic with lengthy history of inpatient hospitalization or those with irreparable cognitive disorders have very low probability.
PEOPLE WITH INTELLECTUAL DISABILITIES AND BRAIN DISORDERS SUCH AS DEMENTIA, MAY FACE PARTICULAR CHALLENGES IN RESTORING COMPETENCY…..an understatement…traditional treatments are ineffective and inappropriate.
New Mexico: 9 months except if felony involving great bodily harm, use of firearm, aggravated arson, CSP, the court may order a hearing on factual guilt (1.5) and if found guilty and dangerous may order continued treatment for period not to exceed max sentence (John Hyde)
Talk about plea bargaining
What else happened in the 1980s?
Expansion of geriatric release laws could increase the cost savings. States need to combine a lower age threshold with geriatric specific risk and needs assessment. Refining these policies would decrease costs and not jeopardize public safety.
Some policy choices that result in longer prison terms: mandatory minimum, truth in sentencing laws and the abolition of parole
Working Programs:
California Men’s Colony…convicted killers stepping up to help with ADLs. Helpers, called Gold Coats, are trained by the Alzheimer’s Association. The helpers gain as well…they learn empathy and compassion. One said, “I was a predator, now I’m a protector.
Staff Training: Kentucky Public Health Leadership..Program for training officers in proper care inmates with dementia