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ABA releases tool to assess cognitive impairment

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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.•
 

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  • 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.

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  1. I have been on this program while on parole from 2011-2013. No person should be forced mentally to share private details of their personal life with total strangers. Also giving permission for a mental therapist to report to your parole agent that your not participating in group therapy because you don't have the financial mean to be in the group therapy. I was personally singled out and sent back three times for not having money and also sent back within the six month when you aren't to be sent according to state law. I will work to het this INSOMM's removed from this state. I also had twelve or thirteen parole agents with a fifteen month period. Thanks for your time.

  2. Our nation produces very few jurists of the caliber of Justice DOUGLAS and his peers these days. Here is that great civil libertarian, who recognized government as both a blessing and, when corrupted by ideological interests, a curse: "Once the investigator has only the conscience of government as a guide, the conscience can become ‘ravenous,’ as Cromwell, bent on destroying Thomas More, said in Bolt, A Man For All Seasons (1960), p. 120. The First Amendment mirrors many episodes where men, harried and harassed by government, sought refuge in their conscience, as these lines of Thomas More show: ‘MORE: And when we stand before God, and you are sent to Paradise for doing according to your conscience, *575 and I am damned for not doing according to mine, will you come with me, for fellowship? ‘CRANMER: So those of us whose names are there are damned, Sir Thomas? ‘MORE: I don't know, Your Grace. I have no window to look into another man's conscience. I condemn no one. ‘CRANMER: Then the matter is capable of question? ‘MORE: Certainly. ‘CRANMER: But that you owe obedience to your King is not capable of question. So weigh a doubt against a certainty—and sign. ‘MORE: Some men think the Earth is round, others think it flat; it is a matter capable of question. But if it is flat, will the King's command make it round? And if it is round, will the King's command flatten it? No, I will not sign.’ Id., pp. 132—133. DOUGLAS THEN WROTE: Where government is the Big Brother,11 privacy gives way to surveillance. **909 But our commitment is otherwise. *576 By the First Amendment we have staked our security on freedom to promote a multiplicity of ideas, to associate at will with kindred spirits, and to defy governmental intrusion into these precincts" Gibson v. Florida Legislative Investigation Comm., 372 U.S. 539, 574-76, 83 S. Ct. 889, 908-09, 9 L. Ed. 2d 929 (1963) Mr. Justice DOUGLAS, concurring. I write: Happy Memorial Day to all -- God please bless our fallen who lived and died to preserve constitutional governance in our wonderful series of Republics. And God open the eyes of those government officials who denounce the constitutions of these Republics by arbitrary actions arising out capricious motives.

  3. From back in the day before secularism got a stranglehold on Hoosier jurists comes this great excerpt via Indiana federal court judge Allan Sharp, dedicated to those many Indiana government attorneys (with whom I have dealt) who count the law as a mere tool, an optional tool that is not to be used when political correctness compels a more acceptable result than merely following the path that the law directs: ALLEN SHARP, District Judge. I. In a scene following a visit by Henry VIII to the home of Sir Thomas More, playwriter Robert Bolt puts the following words into the mouths of his characters: Margaret: Father, that man's bad. MORE: There is no law against that. ROPER: There is! God's law! MORE: Then God can arrest him. ROPER: Sophistication upon sophistication! MORE: No, sheer simplicity. The law, Roper, the law. I know what's legal not what's right. And I'll stick to what's legal. ROPER: Then you set man's law above God's! MORE: No, far below; but let me draw your attention to a fact I'm not God. The currents and eddies of right and wrong, which you find such plain sailing, I can't navigate. I'm no voyager. But in the thickets of law, oh, there I'm a forester. I doubt if there's a man alive who could follow me there, thank God... ALICE: (Exasperated, pointing after Rich) While you talk, he's gone! MORE: And go he should, if he was the Devil himself, until he broke the law! ROPER: So now you'd give the Devil benefit of law! MORE: Yes. What would you do? Cut a great road through the law to get after the Devil? ROPER: I'd cut down every law in England to do that! MORE: (Roused and excited) Oh? (Advances on Roper) And when the last law was down, and the Devil turned round on you where would you hide, Roper, the laws being flat? (He leaves *1257 him) This country's planted thick with laws from coast to coast man's laws, not God's and if you cut them down and you're just the man to do it d'you really think you would stand upright in the winds that would blow then? (Quietly) Yes, I'd give the Devil benefit of law, for my own safety's sake. ROPER: I have long suspected this; this is the golden calf; the law's your god. MORE: (Wearily) Oh, Roper, you're a fool, God's my god... (Rather bitterly) But I find him rather too (Very bitterly) subtle... I don't know where he is nor what he wants. ROPER: My God wants service, to the end and unremitting; nothing else! MORE: (Dryly) Are you sure that's God! He sounds like Moloch. But indeed it may be God And whoever hunts for me, Roper, God or Devil, will find me hiding in the thickets of the law! And I'll hide my daughter with me! Not hoist her up the mainmast of your seagoing principles! They put about too nimbly! (Exit More. They all look after him). Pgs. 65-67, A MAN FOR ALL SEASONS A Play in Two Acts, Robert Bolt, Random House, New York, 1960. Linley E. Pearson, Atty. Gen. of Indiana, Indianapolis, for defendants. Childs v. Duckworth, 509 F. Supp. 1254, 1256 (N.D. Ind. 1981) aff'd, 705 F.2d 915 (7th Cir. 1983)

  4. "Meanwhile small- and mid-size firms are getting squeezed and likely will not survive unless they become a boutique firm." I've been a business attorney in small, and now mid-size firm for over 30 years, and for over 30 years legal consultants have been preaching this exact same mantra of impending doom for small and mid-sized firms -- verbatim. This claim apparently helps them gin up merger opportunities from smaller firms who become convinced that they need to become larger overnight. The claim that large corporations are interested in cost-saving and efficiency has likewise been preached for decades, and is likewise bunk. If large corporations had any real interest in saving money they wouldn't use large law firms whose rates are substantially higher than those of high-quality mid-sized firms.

  5. The family is the foundation of all human government. That is the Grand Design. Modern governments throw off this Design and make bureaucratic war against the family, as does Hollywood and cultural elitists such as third wave feminists. Since WWII we have been on a ship of fools that way, with both the elite and government and their social engineering hacks relentlessly attacking the very foundation of social order. And their success? See it in the streets of Fergusson, on the food stamp doles (mostly broken families)and in the above article. Reject the Grand Design for true social function, enter the Glorious State to manage social dysfunction. Our Brave New World will be a prison camp, and we will welcome it as the only way to manage given the anarchy without it.

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