By Tonita E. Wroolie, Ph.D. Clinical Psychologist
Diminished capacity due to cognitive dysfunction is not always obvious, but possible signs may be evident during an interview. Short-term memory problems (poor retention of recent information, frequently repeating oneself) may be observed. Communication problems may be subtle but include difficulty with word finding, paraphasia errors (use of incorrect words or syllables), or more obvious non-fluent or limited speech production. Comprehension problems are harder to detect, but may be elicited by asking the individual to explain what they were just told. Often with brain-based language dysfunction, both expressive and receptive impairments exist simultaneously. Difficulties with higher order abilities (executive functions) are displayed as lack of mental flexibility/perseverative behavior (“getting stuck), disinhibition/impulsivity, poor reasoning ability, and poor judgment. Other cognitive signs of diminished capacity include disorientation to time, place, person, recent events, or calculation problems.
Emotional or behavioral signs may be present that could be evidence of diminished capacity. For instance, severe emotional distress, emotional lability or inappropriateness, psychotic thinking such as delusions and/or hallucinations, as well as poor grooming and hygiene are examples of possible diminished capacity.
Diminished capacity can be the result of numerous medical and psychological disorders. The most common causes are due to neurodegenerative disorders such as Alzheimer’s disease or vascular dementia. Capacity evaluations based only on subjective observation, however, can result in gross error, and formal evaluations are necessary to adequately detect or rule out the presence of impairment. Declaring lack of capacity can have profound effects on one’s freedom and must be carefully weighed with the need to protect the safety and health of an individual.