By Erika Hayasaki | The Atlantic | January 9, 2014

While Alzheimer’s usually affects older people, and is detected as a person begins to lose memory, frontotemporal dementia causes people to lose their personalities first, and usually hits in the prime of their lives — the 30s, 40s, and 50s.

Over the last decade, new research in patients with frontotemporal dementia and other illnesses, has helped neuroscientists understand more about the roles different parts of the brain play in where our personalities come from.

A study released in October by Dr. Brad Dickerson, [Dr. Lisa Feldman Barrett,] and colleagues at Harvard Medical School in the Journal of Neurology, Neurosurgery & Psychiatry pinpointed regions in the brain that showed atrophy from frontotemporal dementia and found that those with the most damage to the “perception network” (amygdala, orbitofrontal cortex, superior temporal, and fusiform cortex) also showed the most prominent difficulty responding to social cues, facial expressions, and eye gaze, and had the most trouble interpreting gestures and body language—the kind of cues that sarcasm relies on.

Read the full article at The Atlantic Monthly.

Elder financial abuse
Researchers analyzed media reports from April through June 2010, and pinpointed 314 unduplicated reports of elder financial abuse that included detailed information. Source Metlife Study on Elder Financial Abuse. Credit: James Abundis, Boston Globe.

By Kay Lazar | The Boston Globe | January 6, 2014

Roughly 21,000 times last year, physicians, social workers, family members, and other concerned residents contacted Massachusetts Protective Services authorities to report suspicions that an elderly person was being abused.

In about one third of those cases, the concern involved financial exploitation, according to state officials, a problem that is expected to grow significantly as the population ages and the number of older adults left vulnerable by Alzheimer’s disease nationwide is projected to double, and perhaps triple, by 2050.

With a potential tsunami of elder financial abuse on the horizon, researchers, health care leaders, lawyers, and lawmakers have launched a number of initiatives to better understand the size and scope of the issue and craft strategies to minimize harm. Continue reading »

Click above to view the flyer for this event.

On December 12th, 2013, at Brigham and Women’s Hospital’s Bornstein Amphitheater, CLBB joined forces with the Boston Society of Neurology and Psychiatry to host a conversation among experts in neurology, psychiatry, and the law about how the science of aging could impact how we protect older adults from victimization and undue influence. Where do we draw the line between protection and paternalism?  What constitutes a bad financial decision?  Who needs additional protections?

Panelists included Bruce H. Price, MD, Chief of Neurology at McLean Hospital and Co-Director of CLBB;  Rebecca W. Brendel, MD, JD, Consultant to the Law & Psychiatry Service at MGH, Clinical Director of the Home Base Program,  Assistant Professor of Psychiatry, Harvard Medical School; Susan Stenger, Attorney with decades of experience handling probate litigation, including undue influence and lack of capacity cases; and Judge Susan Ricci, Associate Justice of the Massachusetts Probate and Family Court in Worcester.

Kay Lazar, Health Reporter at the Boston Globe with a focus on Aging, Sports Medicine and Public Health, moderated a panel discussion and Audience Q&A following the speaker remarks.

To watch video from this event, visit our Vimeo channel on Capacity, or watch individual segments below.

Also, read Kay Lazar’s story about this topic and CLBB’s role in the Boston Globe.

Continue reading »

The states have long been concerned with caregiver qualifications for nursing home employees. The elderly, whose health is failing, are at high risk for abuse, neglect, maltreatment, and assault by staff and even other nursing home residents. Accordingly, each state has enacted screening procedure to conduct thorough background checks on staff, and in many cases residents, prior to granting them access to the facilities. Yet, as USA Today reports, this high degree of caution has failed to translate to office workers in nursing homes. Unfortunately, the lack of proper screening procedures, has resulted in thousands, if not millions of dollars, in fraud. Read the full story here.

This timely reminder of the vulnerability of elderly is just another reason that CLBB’s work on understanding decision-making by the elderly is essential. If you are interested in learning more, please attend our symposium on 12/12/13 on Capacity, Finances, and the Elderly: Brain Science Meets the Law.

Source: USA Today, December 1, 2013.

As the incidence of cognitive impairment increases with advancing age, a larger number of our elderly population will suffer some variety of dementing disorder.  Causes include Alzheimer’s disease, multi-infarct dementia, and a variety of other disease states.  Effects can vary to very subtle to severe.  At some point, cognitive impairment may limit an elder adult’s ability to make decisions.  These limits may be in specific domains, such as financial or medical.

Alternatively, cognitive limitations may be more global in nature.  Some elder adults had the foresight to record specific beliefs prior to any cognitive disease.  Health care proxies, living wills, or financial power of attorney document an individual’s choices at an earlier time point.

But many adults do not put their wishes in writing.  Also, adults are free to change their opinion at any point.  The question must then be asked: at what point does cognitive impairment limit a person’s capacity to make decisions?  There is not one simple answer.  The level of scrutiny varies with the task.  For example, making changes to a will generally only requires a low level understanding of one’s estate and heirs.  Other tasks, such as consenting to a complicated medical treatment, will require far more understanding.  Thus, the level of scrutiny is much higher. But where should society draw the line between protection and paternalism?

These and other issues were addressed by a panel at this year’s Annual Meeting of the American Academy of Psychiatry and the Law (AAPL), which took place in San Diego, California on October 24-27, 2013.  The panel, entitled “Impaired Medical Decision-Making in Older Patients,” included a lively discussion between Stephen Read, M.D. of the Department of Psychiatry and Biobehavioral Sciences at UCLA; Debra Pinals, M.D., the Assistant Commissioner of Forensic Services for the Massachusetts Department of Mental Health; Phillip Resnick, M.D., the Director of the Forensic Psychiatry Fellowship at Case Western Reserve; Sherif Soloman, M.D., an Assistant Professor of Psychiatry at Case Western Reserve; and Robert Weinstock, M.D., the Director of the UCLA Forensic Psychiatry Fellowship Program.

Continue reading »