News and Commentary Archive

Explore recent scientific discoveries and news as well as CLBB events, commentary, and press.

Mission

The speed of technology in neuroscience as it impacts ethical and just decisions in the legal system needs to be understood by lawyers, judges, public policy makers, and the general public. The Massachusetts General Hospital Center for Law, Brain, and Behavior is an academic and professional resource for the education, research, and understanding of neuroscience and the law. Read more

WATCH — The Vulnerable Brain

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Click poster to RSVP.

As the American population ages, the medical and legal systems will have to balance concerns about protecting the elderly from fraud and victimization with fundamental autonomy rights. In this event, the Center for Law, Brain & Behavior will present a case that concerns a tragic trajectory caused by undetected brain disease and discuss both missed opportunities to intervene and the implications for legal and social policy. Weaving a narrative that highlights the subject’s personal life and neurological decline, experts in psychiatry, law, and neurology will consider: what can be done to protect the vulnerable, aging brain?

Examining everything from forensic reports, to medical records, to a literal brain, CLBB Co-Director Dr. Judith Edersheim and CLBB Faculty Member Dr. Brad Dickerson (of Massachusetts General Hospital and Harvard Medical School) will tell a story that exemplifies how vulnerable an ailing, elderly person can be. CLBB Co-Director Dr. Bruce Price will join as a discussant during the Q&A session with the audience.

This event will be held on Thursday, December 15, 2016, at the Brigham and Women’s Hospital, Bornstein Amphitheater, from 7:00-8:30 pm.

Make sure to RSVP before the event!

This event is free and open to the public. A brief reception will precede the event from 6:30-7:00 PM. Continue reading »

Clues to How ‘Super-Agers’ Retain Young Memories

CLBB Faculty Members Dr. Bradford Dickerson and Dr. Lisa Feldman Barrett were featured for their recently-published research on older adults with extraordinary memory capacities. According to the article, “The study, published in the Journal of Neuroscience, is the first step in a research program aimed at understanding how some older adults retain youthful thinking abilities and the brain circuits that support those abilities.” Dr. Feldman Barrett notes:

“We also examined a group of regions known as the salience network, which is involved in identifying information that is important and needs attention for specific situations, and found preserved thickness among super-agers in several regions, including the anterior insula and orbitofrontal cortex.”

About the significance of the study, Dr. Dickerson comments:

“We desperately need to understand how some older adults are able to function very well into their seventh, eight, and ninth decades. This could provide important clues about how to prevent the decline in memory and thinking that accompanies aging in most of us.”

Read the full article, “Clues to How ‘Super-Agers’ Retain Young Memories”, published in the Harvard Gazette on September 13, 2016.

Elder Abuse

This comprehensive review article published by The New England Journal of Medicine highlights the scope and management of elder abuse, drawing from research and clinical evidence. Perhaps most strikingly, they estimate that the prevalence of elder abuse (physical, psychological, verbal, and sexual abuse, financial exploitation, and neglect) is around 10%.

By Mark S. Lachs and Karl A. Pillemer | The New England Journal of Medicine | November 12, 2015

Although it has probably existed since antiquity, elder abuse was first described in the medical literature in the 1970s.1 Many initial attempts to define the clinical spectrum of the phenomenon and to formulate effective intervention strategies were limited by their anecdotal nature or were epidemiologically flawed. The past decade, however, has seen improvements in the quality of research on elder abuse that should be of interest to clinicians who care for older adults and their families. Financial exploitation of older adults, which was explored only minimally in the initial studies, has recently been identified as a virtual epidemic and as a problem that may be detected or suspected by an alert physician.

In the field of long-term care, studies have uncovered high rates of interpersonal violence and aggression toward older adults; in particular, abuse of older residents by other residents in long-term care facilities is now recognized as a problem that is more common than physical abuse by staff.2,3 The use of interdisciplinary or interprofessional teams, also referred to as multidisciplinary teams in the context of elder abuse, has emerged as one of the intervention strategies to address the complex and multidimensional needs and problems of victims of elder abuse, and such teams are an important resource for physicians.4,5 These new developments suggest an expanded role for physicians in assessing and treating victims of elder abuse and in referring them for further care.

In this review, we summarize research and clinical evidence on the extent, assessment, and management of elder abuse, derived from our analysis of high-quality studies and recent systematic studies and reviews of the literature on elder abuse.6-10

DEFINITIONS AND ESTIMATES OF PREVALENCE

Debates about how to define elder abuse and which types of behavior to include in the definition greatly inhibited progress during the early period of research on this topic. Initial formulations were overly broad and included types of behavior that are not typically part of definitions of domestic abuse, such as crime by strangers, age discrimination, and failure to care for oneself (referred to as “self-neglect”). Over the past decade, however, consensus has arisen about the inclusion of five major types of elder abuse11-13: physical abuse, or acts carried out with the intention to cause physical pain or injury; psychological or verbal abuse, defined as acts carried out with the aim of causing emotional pain or injury; sexual abuse, defined as nonconsensual sexual contact of any kind; financial exploitation, involving the misappropriation of an older person’s money or property; and neglect, or the failure of a designated caregiver to meet the needs of a dependent older person (Table 1).

When these types of abuse have been considered together, epidemiologic surveys have shown generally similar prevalences of elder abuse over a period of 12 months, as indicated by three high-quality epidemiologic studies of community-dwelling older people (60 years of age or older). In a survey of more than 4000 older people in New York State, the rate of elder abuse was found to be 7.6%16,17; in a national survey by Laumann et al., the rate was 9%,12 and in a national telephone survey by Acierno et al.,18 the rate was 10%. It is likely that these figures are underestimates; the reliance on self-reported information from persons who are able to participate in a survey excludes patients with dementia, and studies have shown that dementia places older persons at greater risk for mistreatment.19 When the available evidence is taken into consideration, an estimated overall prevalence of elder abuse of approximately 10% appears reasonable. Thus, a busy physician caring for older adults will encounter a victim of such abuse on a frequent basis, regardless of whether the physician recognizes the abuse.

Continue reading the full journal article here.

Clinical Approach to the Differential Diagnosis Between Behavioral Variant Frontotemporal Dementia and Primary Psychiatric Disorders

By Simon Ducharme, Bruce H. Price, Mykol Larvie, Darin D. Dougherty, and Bradford C. Dickerson | American Journal of Psychiatry | September 1, 2015

Summary:

Frontotemporal dementia (FTD) describes a heterogeneous group of neurodegenerative diseases featuring various combinations of behavioral changes, language abnormalities, social cognitive impairment, and executive function deficits. FTD is divided into two major clinical syndromes: the behavioral variant (bvFTD) (1) and the language variants referred to as primary progressive aphasias (2).

Identifying bvFTD is challenging because symptoms can be subtle in the early stages, and they may combine features that are traditionally within the realm of psychiatry (e.g., personality changes, lack of empathy, compulsions) and others usually seen by neurologists (e.g., aphasia, cognitive impairments). Patients are often first evaluated in general psychiatric settings, and about 50% are initially diagnosed with a primary psychiatric illness (3).

Knowledge about FTD has grown exponentially over the past 10 years, and it is crucial for psychiatrists to include bvFTD as part of their differential diagnosis in a wide range of adult psychiatric disorders. In this article, we review the clinical approach to bvFTD, focusing in particular on the differential diagnosis between bvFTD and primary psychiatric disorders.

Read the full paper here.

In an Iowa courtroom, an astonishing case of sex and Alzheimer’s

By Sarah Kaplan | The Washington Post | April 7, 2015

They started flirting in choir, the vivacious retiree and the grandfatherly politician, both single after the deaths of their longtime spouses. Less than two years later, they were married in the church where they met, surrounded by a gaggle of children and grandchildren and hundreds of guests dancing the polka. It was an unexpected second chance at love for Donna Lou Young and Henry Rayhons, both past 70 at the time of their wedding.

“They were two good people who were good together,” the couple’s pastor recalled.

After a four-year battle with Alzheimer’s, Donna Lou Rayhons died in a nursing home in August, just four days shy of her 79th birthday. A week later, Henry Rayhons was arrested and charged with sexual abuse. State prosecutors accused him of having sex with his wife while she was incapacitated by dementia. Continue reading »