title: Protecting the Health and Finances of the Elderly With Early Cognitive Impairment.
abstract: The projected expansion of the nation's elderly population necessitates the revision of health care and policy strategies for safeguarding the health and assets of this community. The elderly are at greatly increased risk for developing mild cognitive impairment and Alzheimer's disease. These conditions are associated with diminished complex decision-making abilities that adversely affect patients, their families, and society, even during early stages of Alzheimer's disease. We present three composite patient histories that demonstrate problems routinely encountered by families, health care providers, and legal professionals during the course of early AD and MCI. We review the prevalence of cognitive and behavioral symptoms associated with MCI and early AD. Obstacles to early detection of cognitive decline, limitations of current testing modalities and benefits of earlier detection are discussed. Central themes common to medical and judicial approaches toward capacity assessment are discussed. We argue that an emphasis on earlier detection will result in benefits for patient health and result in financial savings to patients and the country as a whole. Finally, we recommend national guidelines for the evaluation of task-specific decision-making capacities to reduce the variability of outcome and improve quality of evaluations found among medical professionals, forensic evaluators, and legal actors.
authors.affiliation: Dr. Edersheim is Co-Director, The Massachusetts General Hospital Center for Law, Brain and Behavior, Boston, MA, and Assistant Professor of Psychiatry, Harvard Medical School, Boston, MA. Dr. Murray is Director, Traumatic Brain Injury Center, Manchester VA Medical Center, and Assistant Professor of Neurology, Harvard Medical School, Boston MA. Dr. Padmanabhan is Instructor, Department of Psychiatry, Beth Israel Deaconess Medical Center and Instructor, Harvard Medical School, Boston, MA. Dr. Price is Chief, Department of Neurology, McLean Hospital, Boston, MA, and Associate Professor of Neurology, Harvard Medical School, Boston, MA.
authors.forename: Judith
authors.initials: J
authors.lastname: Edersheim
authors.affiliation: Dr. Edersheim is Co-Director, The Massachusetts General Hospital Center for Law, Brain and Behavior, Boston, MA, and Assistant Professor of Psychiatry, Harvard Medical School, Boston, MA. Dr. Murray is Director, Traumatic Brain Injury Center, Manchester VA Medical Center, and Assistant Professor of Neurology, Harvard Medical School, Boston MA. Dr. Padmanabhan is Instructor, Department of Psychiatry, Beth Israel Deaconess Medical Center and Instructor, Harvard Medical School, Boston, MA. Dr. Price is Chief, Department of Neurology, McLean Hospital, Boston, MA, and Associate Professor of Neurology, Harvard Medical School, Boston, MA.
authors.forename: Evan D
authors.initials: ED
authors.lastname: Murray
authors.affiliation: Dr. Edersheim is Co-Director, The Massachusetts General Hospital Center for Law, Brain and Behavior, Boston, MA, and Assistant Professor of Psychiatry, Harvard Medical School, Boston, MA. Dr. Murray is Director, Traumatic Brain Injury Center, Manchester VA Medical Center, and Assistant Professor of Neurology, Harvard Medical School, Boston MA. Dr. Padmanabhan is Instructor, Department of Psychiatry, Beth Israel Deaconess Medical Center and Instructor, Harvard Medical School, Boston, MA. Dr. Price is Chief, Department of Neurology, McLean Hospital, Boston, MA, and Associate Professor of Neurology, Harvard Medical School, Boston, MA.
authors.forename: Jaya L
authors.initials: JL
authors.lastname: Padmanabhan
authors.affiliation: Dr. Edersheim is Co-Director, The Massachusetts General Hospital Center for Law, Brain and Behavior, Boston, MA, and Assistant Professor of Psychiatry, Harvard Medical School, Boston, MA. Dr. Murray is Director, Traumatic Brain Injury Center, Manchester VA Medical Center, and Assistant Professor of Neurology, Harvard Medical School, Boston MA. Dr. Padmanabhan is Instructor, Department of Psychiatry, Beth Israel Deaconess Medical Center and Instructor, Harvard Medical School, Boston, MA. Dr. Price is Chief, Department of Neurology, McLean Hospital, Boston, MA, and Associate Professor of Neurology, Harvard Medical School, Boston, MA.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Price
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000523:psychology*; D017028:Caregivers / Q000331:legislation & jurisprudence / Q000523:psychology; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000523:psychology*; D019548:Crime Victims; D042241:Early Diagnosis; D004552:Elder Abuse / Q000331:legislation & jurisprudence* / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D016743:Mental Competency / Q000331:legislation & jurisprudence; D009483:Neuropsychological Tests; D011157:Population Dynamics