MENTAL CAPABILITY in the ELDERLY

CASE PRESENTATION Mr Max Rich

WHAT IS FRAILTY? Irremediable dependence CAUSES cognitive impairment mobility failure both

Dementia Memory and other Cognitive Impairment That Affects Daily Function

7 Causes of Dementia Common – Alzheimer’s disease – Vascular dementia – Mixed AD and VaD Less Common – Frontal temporal dementia – Dementia with Lewy Bodies – Parkinson’s disease with dementia – Normopressure Hydrocephalus

Progression

MILD forgets recent events trouble with complex tasks SLOW to understand and accomplish things

MODERATE Doesn’t know year or address Word-finding trouble Very poor short-term memory

SEVERE Doesn’t recognize relativesDoesn’t recognize relatives WandersWanders Needs constant supervisionNeeds constant supervision

Who needs evaluation? A person may Want to do an important task Want to make a will Apparently need help or protection Have to make an important health care decision

General Principles Capability is Particular Capability is Presumed Is incapability permanent?

CAUSES Mental Incapability CAUSES Easy and Hard

Easy Dementia Mood Disorders Psychosis

Hard Disorders of judgement Mental retardation Intermittent incapacity Delirium Medication Alcohol

Hardest Communication problemsCommunication problems “out of practice” at task“out of practice” at task

TESTAMENTARY CAPACITY The bar is low… 1.Nature and effect 2.Assets 3.Heirs 4.Delusional? 5.(Undue influence)

Who MIGHT be Incapable? Elderly Strange Emotional Drunk etc

Screening For Dementia 1. MMSE (Folstein) 2. Montréal Cognitive Assessment (MoCA) 3. Sloan ’ s shortcut

Who ya gonna call?? Client’s GP Psychiatrist Geriatrician Neurologist GP with special interest

John P Sloan MD hours