ILNews

ABA releases tool to assess cognitive impairment

Back to TopCommentsE-mailPrintBookmark and Share

Working in a profession that prizes intellectual agility, lawyers can be especially sensitive to questions about their mental faculties.

Legal professionals tend to tie their sense of self to their cognitive function. They think of themselves as being well-educated problem-solvers who are trained to help others. Above all, they value intellectual stimulation.

However, the stressful sedentary lifestyle that typically accompanies a career in the law also puts lawyers at risk for cognitive impairment. And while lawyers can be hurt when someone points out they have packed on a few pounds, they can be devastated when a colleague tells them they are not fully comprehending their cases or their advice to clients is problematic.

To help attorneys who are concerned about the intellectual fitness of another lawyer or judge, the American Bar Association has recently released a cognitive assessment tool. In 2008, the ABA’s Commission on Lawyer Assistance Programs created what became the Senior Lawyer Committee, the group that led the work on developing the assessment instrument.

The “Working Paper on Cognitive Impairment and Cognitive Decline” is a questionnaire designed to give attorneys guidance in determining whether a partner or friend is just having a bad month or is suffering from something more serious. It also provides recommendations for talking to a colleague who is exhibiting troublesome behavior.
 

Terry Harrell mug Harrell

“This is not a diagnostic tool,” explained Terry Harrell, executive director of the Indiana Judges and Lawyers Assistance Program. “It’s a tool to determine 

if you need to ask someone to have an evaluation” by a medical doctor.

Harrell assisted in the development of the cognitive questionnaire when she served as co-chair of the ABA CoLAP Senior Lawyer Committee. She will become chair of the ABA Commission on Lawyer Assistance Programs in August.
 

The assessment tool was created in response to the rise in calls to lawyer assistance programs across the country from attorneys concerned about colleagues’ cognitive fumbles.

Harrell noted inquires about mental acuity remain a small percentage of the calls that assistance programs receive. Problems with depression and substance abuse far outpace cognitive impairments, but concerns about intellectual health are the fastest-growing segment of all calls.

Across the United States, lawyer assistance programs reported a 14-percent increase in cognitive inquires between 2010 and 2012, Harrell said.

Normal aging or a symptom?

Tip-of-the-tongue moments become more common as people age. The instances where someone’s name does not quickly come to mind or having to look a little longer for the car keys are the kinds of things that naturally happen when someone gets older.

Even as their mental abilities slow, people can still remain active and do their jobs very well, said Dr. Ann Marie Hake, associate professor of clinical neurology at Indiana University School of Medicine. The problem arises when those tip-of-the-tongue moments become more persistent and more frequent that they interfere with normal activities.

hake-ann Hake

Not recognizing family members, substituting the wrong word, getting lost near home and dramatic personality changes are possible signs of cognitive 

impairment, Harrell said.

The ABA’s cognitive assessment tool gives a picture of what is happening by having concerned colleagues put their observations on paper. Writing down any shortcomings in job performance along with changes in appearance or behavior, Harrell said, enables attorneys to better see how their partners and associates are functioning at the office.

Cognitive decline is not limited to senior citizens. Medical conditions, such as diabetes; prescription drugs; emotional turmoil caused by family troubles or even lack of sleep can interfere with the efficient function of a young or middle-aged lawyer’s brain.

Not the end of a career

Certainly, the practice of law can overwork a brain. Attorneys cannot control the pace of the work, so maybe one month they have multiple hearings and briefings to prepare which forces them to forgo sleep and a healthy diet while the next month, the list of things to do shrinks considerably.

“Part of the wear and tear of being a lawyer is that you have a variety of intense things to do that come on a regular, irregular basis,” said Jim Roth, chair of the Indiana State Bar Association Senior Lawyers Section.

Ironically, Hake said, while certain parts of practicing law can put attorneys at risk for cognitive impairment, other parts can diminish that risk.

Sitting all day, working in a high-pressure environment is not good for either the body or the brain, she said. But the high level of education attorneys have plus the amount of intellectual stimulation they get during the day actually exercises the brain in a good way.

Still, Roth questioned when slowing down cognitively becomes an impairment.

“What’s a problem?” he asked. “If you’re at 90-percent capacity of what you used to be, is that a problem?”

He then voiced what is likely a common fear of being told to quit practicing law rather than being allowed to continue doing what you love. He proposed instituting some type of mentor program that can help older attorneys do their work as lawyers. Someone to assist with the workload or to bounce ideas off can provide the needed boost to enable an attorney to keep serving clients.cognitive-facts.jpg
Hake agreed, saying she is not an advocate of retirement. With individuals who do suffer from degenerative dementia, the cognitive decline is usually gradual and with the proper medication and support, they can still contribute.

“These guys and gals have a lot of experience and a lot of knowledge,” Hake said. “Why put that to waste?”

Having a conversation

Doing the assessment is not easy. First the concerned attorney must identify the best people to speak with about the worrisome colleague. Ideally, it should be people who work closely with the colleague and care enough about him or her to be honest in their observations, Harrell said.

Second, the concerned attorney must have a conversation with the colleague.

Mike Long, attorney counselor with the Oregon Attorney Assistance Program, conceded talking to another attorney about his or her mental decline can be tremendously uncomfortable. Compounding the situation is that lawyers usually do not have any experience talking about cognitive problems, and questions about intellect can feel like a personal attack.

Long, who has counseled attorneys for more than 20 years, played a key role in developing the ABA cognitive assessment tool.

Although talking with a lawyer who shows signs of cognitive impairment is difficult, Long pointed out ignoring the problem can have severe consequences. Clients can be hurt, the law firm could get slapped with a malpractice lawsuit and ethical issues could sprout. All this could lead to the impaired attorney, who was once a well-respected member of the legal community, having his or her career ended by a disciplinary action.

Long advised the conversation should be objective and detail what behaviors and work habits have been observed that are causing concerns. Attorneys should be specific with the colleague, noting situations, for example, where appointments were forgotten or court dates missed. Speculation and hearsay should be avoided.

The ABA working paper drew praise from Hake who said the committee did a good job describing the signs and symptoms of possible impairment.

She also encouraged attorneys to be proactive and address any problems rather than dismissing them. The cause of a cognitive impairment might be reversible, but it should be addressed early otherwise it might cause permanent damage. And, if the cause is not reversible, attorneys can take steps to protect their clients and preserve their reputations.

“People shouldn’t be afraid to get checked out and help others get checked out,” Hake said.•
 

ADVERTISEMENT

  • Hope my money didn't fund that!
    If real money was spent on this study, what a shame. And if some air-head professor tries to use this to advance a career, pity the poor student. I am approaching a time that i (and others around me) should be vigilant. I don't think I'm anywhere near there yet, but seeing the subject I was looking forward to something I might use to look for some benchmarks. When finally finding my way to the hidden questionnaire all I could say to myself was...what a joke. Those are open and obvious signs of any impaired lawyer (or non-lawyer, for that matter), And if one needs a checklist to discern those tell-tale signs of impairment at any age, one shouldn't be practicing law. Another reason I don't regret dropping my ABA membership some number of years ago.
  • hmmmm
    I work with some older lawyers in the 70s, 80s, and they are sharp as tacks compared to the foggy minded, undisciplined, inexperienced, listless & aimless "youths" being churned out by the diploma mill law schools by the tens of thousands. A client is generally lucky to land a lawyer who has decided to stay in practice a long time. Young people shouldn't kid themselves. Experience is golden especially in something like law. When you start out as a new lawyer you are about as powerful as a babe in the cradle. Whereas the silver halo of age usually crowns someone who can strike like thunder.

Post a comment to this story

COMMENTS POLICY
We reserve the right to remove any post that we feel is obscene, profane, vulgar, racist, sexually explicit, abusive, or hateful.
 
You are legally responsible for what you post and your anonymity is not guaranteed.
 
Posts that insult, defame, threaten, harass or abuse other readers or people mentioned in Indiana Lawyer editorial content are also subject to removal. Please respect the privacy of individuals and refrain from posting personal information.
 
No solicitations, spamming or advertisements are allowed. Readers may post links to other informational websites that are relevant to the topic at hand, but please do not link to objectionable material.
 
We may remove messages that are unrelated to the topic, encourage illegal activity, use all capital letters or are unreadable.
 

Messages that are flagged by readers as objectionable will be reviewed and may or may not be removed. Please do not flag a post simply because you disagree with it.

Sponsored by
ADVERTISEMENT
Subscribe to Indiana Lawyer
  1. Indianapolis employers harassment among minorities AFRICAN Americans needs to be discussed the metro Indianapolis area is horrible when it comes to harassing African American employees especially in the local healthcare facilities. Racially profiling in the workplace is an major issue. Please make it better because I'm many civil rights leaders would come here and justify that Indiana is a state the WORKS only applies to Caucasian Americans especially in Hamilton county. Indiana targets African Americans in the workplace so when governor pence is trying to convince people to vote for him this would be awesome publicity for the Presidency Elections.

  2. Wishing Mary Willis only God's best, and superhuman strength, as she attempts to right a ship that too often strays far off course. May she never suffer this personal affect, as some do who attempt to change a broken system: https://www.youtube.com/watch?v=QojajMsd2nE

  3. Indiana's seatbelt law is not punishable as a crime. It is an infraction. Apparently some of our Circuit judges have deemed settled law inapplicable if it fails to fit their litmus test of political correctness. Extrapolating to redefine terms of behavior in a violation of immigration law to the entire body of criminal law leaves a smorgasbord of opportunity for judicial mischief.

  4. I wonder if $10 diversions for failure to wear seat belts are considered moral turpitude in federal immigration law like they are under Indiana law? Anyone know?

  5. What a fine article, thank you! I can testify firsthand and by detailed legal reports (at end of this note) as to the dire consequences of rejecting this truth from the fine article above: "The inclusion and expansion of this right [to jury] in Indiana’s Constitution is a clear reflection of our state’s intention to emphasize the importance of every Hoosier’s right to make their case in front of a jury of their peers." Over $20? Every Hoosier? Well then how about when your very vocation is on the line? How about instead of a jury of peers, one faces a bevy of political appointees, mini-czars, who care less about due process of the law than the real czars did? Instead of trial by jury, trial by ideological ordeal run by Orwellian agents? Well that is built into more than a few administrative law committees of the Ind S.Ct., and it is now being weaponized, as is revealed in articles posted at this ezine, to root out post moderns heresies like refusal to stand and pledge allegiance to all things politically correct. My career was burned at the stake for not so saluting, but I think I was just one of the early logs. Due, at least in part, to the removal of the jury from bar admission and bar discipline cases, many more fires will soon be lit. Perhaps one awaits you, dear heretic? Oh, at that Ind. article 12 plank about a remedy at law for every damage done ... ah, well, the founders evidently meant only for those damages done not by the government itself, rabid statists that they were. (Yes, that was sarcasm.) My written reports available here: Denied petition for cert (this time around): http://tinyurl.com/zdmawmw Denied petition for cert (from the 2009 denial and five year banishment): http://tinyurl.com/zcypybh Related, not written by me: Amicus brief: http://tinyurl.com/hvh7qgp

ADVERTISEMENT