Tag: cognitive impairment
The twentieth anniversary of 9/11 took place this past weekend. It was a day of reflection, heavy with the sentiment that we must “never forget” what transpired. There were endless stories on the heroism of first responders in Ground Zero but the story that gave me the most pause was this Washington Post article on “The Mystery of 9/11 and Dementia”.
The article by Patrick Hruby starts with Ron Kirchner. Ron was a firefighter in Queens. He was in his thirties on September 11, 2001. By 2009, Ron was retired on disability. He had asthma and lung disease that were both linked to Ground Zero exposure. By 2015, Ron was diagnosed with dementia. He was only 52 years old at the time. Ron’s neurologist thought that his brain scan resembled the brain scan of an 85-year old. Ron now requires full-time care as he has trouble speaking, eating, and bathing.
In one study, 9/11 first responders were found to report instances of cognitive impairment three times the rate of people in their 70’s.
In another study, first responders with PTSD and cognitive impairments were found to have both blood and brain protein abnormalities as those with Alzheimer’s.
The article notes that cognitive ailments are not currently covered under the 9/11 Health and Compensation Act, a federal statute that provides health care and compensation to responders, survivors, and victims. In order to add cognitive ailments to the Act, more research is needed to show that the condition is substantially likely caused by 9/11 exposures.
Hopefully, with the media attention on 9/11 first responders and their needs, funding for all necessary research will be made available to effectively help this tremendous group of individuals.
Thanks for reading.
In the course of reviewing medical records in advance of estate litigation, one will encounter a wide variety of cognitive screening tools used to identify cognitive impairment. A handful of these tools are described here:
• Confusion Assessment Method (CAM): an ICU assessment tool used to detect the presence or absence of delirium. A CAM assessment is usually carried out once every 8-12 hours (once per nursing shift). Results are presented as either ‘CAM-positive’, or ‘CAM-negative’, indicating the presence or absence of delirium, respectively.
• Mini-Mental Status Examination (MMSE): a quantitative measure of cognitive status in adults. Despite its well-documented limitations, the MMSE is the most widely used standardized cognitive screening test in both clinical practice and research. Scores (out of a maximum 30 points) are paired with an associated level of impairment, i.e. no impairment, mild impairment, moderate impairment or severe impairment.
• The Montreal Cognitive Assessment (MoCA): a rapid cognitive screening instrument used to detect mild cognitive impairment. This user-friendly tool assesses attention and concentration, executive functions (these are the high-level abilities that control more basic abilities and behaviours), memory, language, conceptual thinking, visuoconstructional skills, calculation and orientation. Studies have shown the MoCA to be far more sensitive than the Mini-Mental Status Examination (MMSE) in its ability to detect mild cognitive impairment.
There are dozens of other cognitive screens in use including the Mini-Cog, the Rowland Universal Dementia Assessment Scale (RUDAS), the Clinical Dementia Rating (CDR), the Memory Impairment Screen (MIS), and the recently published Self-Administered Gerocognitive Examination (SAGE). In the context of a dispute regarding testamentary capacity, cognitive screening results are valuable for the estate practitioner, in that they provide tangible, measurable, time-sensitive information regarding the testator’s cognitive functioning, and serve as a tool for assessing the progression of the impairment.
Jennifer Hartman, guest blogger
Huntington’s disease (HD) is a progressive, degenerative brain disorder that causes certain nerve cells in the brain to waste away. Huntington’s is inherited, and if one of your parents has Huntington’s disease, you would have a 50% chance of getting the gene for the disease. Everyone who carries the gene will develop the disease. Since the HD gene was isolated in 1993, one can be tested to see if they are a carrier, however because there is no cure for HD, some people choose not to be tested.
About 1 in 10,000 Canadians has HD.
There are two types of HD: i) adult-onset, the most common form, with symptom onset in the mid 30s and 40s; and ii) early onset, which accounts for about 16% of all HD cases, with symptoms developing in childhood or adolescence.
Huntington’s disease is associated with three types of symptoms:
· Movement symptoms, referred to as chorea, which consist of jerking, involuntary movements (‘tics’) of the limbs, trunk or face;
· Cognitive symptoms including a gradual impairment of concentration, memory, judgment, reasoning, decision-making and learning. This cognitive decline starts in a very subtle fashion, but eventually results in dementia; and
· Psychiatric symptoms may include depression, and psychotic behaviours such as delusions, hallucinations, paranoia and inappropriate outbursts.
HD usually runs its course in about 10 to 30 years, with a strong correlation between an earlier onset and a more rapid progression of the disease.
Jennifer Hartman, Guest Blogger
This week on Hull on Estate and Succession Planning, Ian talks about a seminar he attended and participated in last week called ‘Insights on Aging and the Elderly’. The seminar was hosted by B’nai Brith and featured Dr. Nathan Herrmann, Ian Hull, Rabbi Roy D. Tanenbaum and Charles B. Wagner.