Gayle Klaybor, Ph.D. LCSW recently presented a on a panel regarding dementia and Alzheimers for the Texas Bar Association. This blog is an overview of the essential points of the presentation.
According to
the American Bar Association, more than one-third of practicing attorneys are
over the age of 55. With that demographic and the prediction that the number
will grow, issues related to aging become increasingly more important. Maybe
some of the most troubling issues related to difficulties in aging are dementia
and Alzheimer’s Disease. As we grow older, it is normal to notice changes in
memory and cognition. For someone suffering from true dementia, however, these
changes are significant and cause real impairment. If you are concerned about a
colleague or law partner, the consequences of allowing an impaired attorney to
practice law are very serious. Malpractice suits and diminished quality of representation
and outcomes are just two.
Dementia is not a
specific disease. It's an overall term that describes a wide range of symptoms
associated with a decline in memory or other thinking skills severe enough to
reduce a person's ability to perform everyday activities. Alzheimer's disease,
the most common form of dementia, accounts for 60 to 80 percent of cases. Alzheimer’s
disease is a progressive brain disease but other kinds of dementia can be
successfully treated or slowed. Before Alzheimer’s can be accurately diagnosed,
other disorders need to be ruled out. For example, abuse of drugs (prescription
or illegal street drugs) or prescription side effects can cause behaviors that
look like dementia. Impairments in memory decision making, concentration,
self-care, confusion and judgement can all be signs of drug and alcohol issues.
When the addiction is treated and sustained sobriety occurs or a medication is
removed, the symptoms go away. Mini strokes and other circulatory problems can
also cause brain changes.
At this point
in time, Alzheimer’s Disease can only be truly diagnosed post-mortem. But by
looking at behaviors and administering specific tests, neurologists, psychiatrists
and neuropsychologists are able to make the diagnosis while a patient is
living. The number one risk factor for getting Dementia or Alzheimer’s Disease
is aging. One in 10 people over the age of 65 will be diagnosed with
Alzheimer’s. By the time a person reaches age 85, there is a 50% chance of
being diagnosed with this disease.
It is important
to distinguish early dementia symptoms and behaviors from those of normal
aging. For attorneys, these behaviors might become particularly apparent in the
workplace. Practicing law demands a good memory, clear thinking and excellent
problem- solving skills. When there is decline, changes are even more
noticeable. They are usually first noticed because there has been a significant
change from previous behaviors. For example, a once highly competent and
conscientious attorney becomes extremely forgetful and confused.
According to
the Alzheimer’s Association, there are in general 10 early signs and symptoms
of Alzheimer’s and a description of typical age-related changes:
1. Memory loss that disrupts daily life. For a practicing attorney, that might
mean missing filing deadlines, forgetting important information, or asking for
the same information repeatedly.
Typical aging:
Sometimes forgetting names or appointments, but remembering them later.
2. Challenges
in Planning or Solving Problems. An
attorney might be unable to follow a
plan especially related to numbers or taking much longer to accomplish tasks.
Typical aging: Making
occasional errors in math or needing to make a list to remember.
3. Difficulty completing familiar tasks at
work. Attorneys might
not remember important points of law or how to complete legal documents.
Typical aging: Temporarily
forgetting a legal point or letting filling out a document slip your mind but
soon retrieving the mental information.
4.
Confusion with time or place. An attorney with Alzheimer’s can lose
track of dates, seasons and the passage of time and neglect important
deadlines. He/she might forget where there are or how they got there.
Typical aging: Taking a
few moments to remember the day or time.
5.
Trouble understanding visual images and
spatial relationships. An
impaired attorney might have trouble reading legal documents or driving.
Typical aging: Vision
problems because of cataracts or other issues of eyesight.
6.
New problems with words in speaking or
writing. People with
Alzheimer’s have trouble finding the right name for something, stop in the
middle of a conversation and have no idea about how to continue. An attorney
might struggle to find a common legal term or have trouble making a cohesive
argument in court.
Typical aging:
Sometimes having trouble finding the right word or remembering a name
7.
Misplacing things and losing the ability
to retrace steps. People
with Alzheimer’s may put things in unusual places (like car keys in the
refrigerator) and not be able to retrace steps to find it.
Typical aging: Misplacing things and being able to retrace one’s steps.
8.
Decreased or poor judgement. An affected attorney might use
exceptionally poor judgement or decision-making in handling a case. There may
be a significant decline in grooming and hygiene.
Typical aging: Making a
bad decision or having a bad hair day once in a while.
9.
Withdrawal from work or social
activities- People with
Alzheimer’s might withdraw from previously enjoyed activities because they have
difficulty keeping up and tracking what’s going on. For example, following the
action in a football game or play.
Typical aging: Sometimes feeling tired of
socializing at work or with friends.
10. Changes
in mood and personality. An
attorney with Alzheimer may become very irritable, suspicious, depressed,
anxious and fearful (significantly different that previous behaviors) with
colleagues, clients, or in court.
Typical aging: Becoming irritable when a
behavior is interrupted.
When
these changes in behaviors are present and noticeable, what should a concerned
person do? One of the most challenging manifestation of this disease is that
the person showing the signs of Alzheimer’s disease doesn’t recognize the
problem. There is a joke among mental health professionals that goes, “If you
are worried that you have Alzheimer’s, there is a really good chance that you
don’t.” An attorney, probably with years
of competence and experience, may become defensive or even hostile about being confronted
about changes in behaviors or being called “crazy” or “demented.” Sometimes
lawyers experiencing this decline in thinking go under the radar for a time
They might compensate by having other attorneys, paralegals, or secretaries
prepare legal documents and monitor filing dates. Family members, friends and
colleagues are the first to notice changes in behavior. They are usually the
people suggesting a professional evaluation.
Here
are some suggestions for dealing with an attorney that you suspect may have
Alzheimer’s Disease:
1.
Contact
other professionals and family members who know this attorney in other
situations. Find out if the behavior is pervasive. You can also find out if
other factors are involved such as drug or alcohol abuse, other illness or
medications.
2.
Talk
with your colleague with a focus on concern for his/her well-being. Suggest
that there have been changes in behaviors and that a visit to a physician might
be a good idea. Remind the person that there may be several possibilities for
the changes and that the symptoms might be treatable. Remember only a qualified
doctor can make a diagnosis. Stay away from making guesses with the person.
3.
Contact
resources for support. TLAP (Texas Lawyers Assistance Program) is an excellent
organization to help you deal most successfully with this problem.
4.
Contact
the Alzheimer’s Association for information and support.