1. MENTAL CAPABILITY in the ELDERLY

2. CASE PRESENTATION Mr Max Rich

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

6. Dementia Memory and other Cognitive Impairment That Affects Daily Function

7. 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

8. Progression

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

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

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

12. 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

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

14. CAUSES Mental Incapability CAUSES Easy and Hard

15. Easy Dementia Mood Disorders Psychosis

19. Hard Disorders of judgement Mental retardation Intermittent incapacity Delirium Medication Alcohol

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

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

26. Who MIGHT be Incapable? Elderly Strange Emotional Drunk etc

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

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

29. John P Sloan MD tosloan@shaw.ca 604 788 4037 24 hours