Warning Signs of Dementia for Legal Professionals

As years of dedicated professional service go by, lawyers wind up encountering clients of every imaginable sort. Many of these clients have arrived at their present predicaments through a confluence of dire personal circumstances. New lawyers marvel at the mysterious complexity of these individual histories, while more experienced lawyers have progressed to the point at which they can hear some of the story and then predict the rest with surprising accuracy. In time, counsel learns the extent to which client adversity is essentially human adversity and develops a degree of empathy born of experience that is not merely understood but that is actually shared.  So it can be when counsel, having represented countless clients with mental illness, is faced with a diagnosis of a condition like dementia.

As described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (2013), a diagnosis of dementia reflects an overlapping host of cognitive deficits that can include declines in executive function, complex attention, learning, memory, language ability, perceptual-motor ability, and social cognition—skills that comprise as neat a list as one might desire of what is necessary to function successfully as an attorney. To find oneself diagnosed with dementia can be every bit as devastating personally as it is professionally. 

Warning Signs

The well-regarded Alzheimer’s Association maintains an updated posting of key warning signs that are applicable to all forms of dementia (https://tinyurl.com/Alzheimer10signs). Each of those signs is addressed here with annotations that relate them directly to counsel’s various practical functions as a legal practitioner.

1. Memory loss.
   The sheer press of business and the uniquely detail-oriented work of legal practice call for multiple backup systems. Datebooks, calendars, smartphone alerts, secretaries, and co-counsel all have well-defined roles to play in ensuring that as little as possible is forgotten. Still, there are many things that counsel must be able recall on their own, and not everything can be reduced to some form of written record for subsequent retrieval. The occasional slip is  nothing to inspire any particular concern. Persistent, consequential memory problems call for some form of professional attention.
2. Difficulty performing familiar tasks. 
   Law practice appears at times to be split equally between feverish improvisation and grinding, dull routine. In the latter instance, at least, counsel can take comfort from the notion that practice makes perfect. If tasks that have been performed almost reflexively for a number of years suddenly seem to require stepwise analysis, elaborate forethought, and laborious planning, it may be that simple fatigue is the culprit. Another suspect in this scenario could be burnout. Perhaps some time away from the office will cure these tendencies. If not, medical intervention should be considered.
3. Problems with language. 
   Hauling heavy files to the courthouse, wrenching open cell doors, and pounding the table are all staple activities of the working lawyer, but what really keeps the referrals coming and clients smiling is the lawyer’s way with words. Problems with language can involve receiving and encoding information as well as conveying it, and they can involve reading and writing as well as speaking and hearing. Each of these discrete functions is conducted on the basis of complex interactions between different part of the human brain, subject to disruption by the organic deterioration that forms the basis for dementia.
4. Disorientation to place and time.
   If 80% of success is just showing up, then counsel’s failure to know where and when to be is going to be a very significant problem indeed. To pursue this cliché just a bit further, clients are not paying for legal services that have at best a 20% chance of securing positive results. Not knowing where one is and what time it is are very easy problems to spot, and as a rule are not going to be attributable to boredom, overwork, or inattention. Dehydration can cause these difficulties, and so can delirium that occurs secondary to such factors as an unforeseen reaction to overprescribed or injudiciously combined medications. Dementia is another possibility that should be investigated promptly.
5. Poor or decreased judgment.
   The lifeblood of a lawyer’s practice is the tendency of other persons to exercise poor or decreased judgment. Lawyers understand how these lapses occurred in  the past and strive to explain them (By contrast, business lawyers understand how these lapses might occur in the future and strive to prevent them.).  Both functions require the lawyer to know how judgment should best be applied, in addition to which the lawyer will need to make quick, seasoned, well-informed decisions in order to best adversaries and hurdle a predictable array of procedural           barriers. The lapses associated with dementia can prevent counsel from performing with requisite precision and speed, potentially to calamitous effect.
6. Problems with abstract thought.   
   Higher-order, integrated thinking is a critical asset to any form of legal practice involving complex matters. Dementia can involve a deterioration in executive functioning, as a result of which a viable case strategy may simply fail to materialize, much less be carried out in an efficacious matter. The lawyer would never have gotten into law school, graduated from law school, or passed the bar examination without natural and subsequently well- honed talents in this regard. Abstract thinking ability involves skills that are far less likely to register via standard medical testing than they are on the basis of neuropsychological assessment, but professionals who conduct the former are ready, willing, and able to make referrals to professionals who conduct the latter.
7. Misplacing things.
   When physicians misplace things—a scalpel, for example--then the result is often regarded in terms of malpractice. For defendants in other contexts, the legal system turns to thoughts of theft or fraud. A lawyer is comparatively unlikely to be faced directly with such consequences when a file, a              phone number, or a set of keys is mislaid, but persistent problems of this nature can snowball to the point that far more serious errors can result. Family members with older relatives are used to gauging the potential for cognitive decline by a tendency to misplace things. So are physicians qualified to diagnose dementia.
8. Changes in mood and behavior.
   There are many, many events in a lawyer’s professional life that can work profound changes in mood and behavior. Seemingly unfair rulings. Overly lengthy, transparently gratuitous, or ostensibly random motions that are filed by the other side at the most inopportune of moments. Clients who fail to make appointments, fail to show up in court, or fail to pay. All of this is to say nothing, by the way, of similarly exasperating events  in counsel’s personal life. A lawyer’s mood and behavior may be contributing to errors that are misinterpreted as warning signs of dementia. They may also reflect counsel’s reaction to problems that are bona fide warning signs of dementia.
9. Changes in personality. 
   At first blush, changes in personality may seem largely indistinguishable from changes in mood and behavior, at least from a lay perspective. The critical difference here is personality’s manifestation as an interactive style, as opposed to mood and behavior symptoms that do not necessarily call for anyone else’s involvement. One largely unrecognized aspect of this phenomenon is that it is not only negative personality characteristics that function as indicia of dementia. When counsel is suddenly unusually indulgent, interested, and kind, this may actually represent a relational shift that heralds some form of brain deterioration. Counsel will not, of course, urgently seek medical attention when newly and inexplicably well-disposed toward others, but may will be worth  checking to see if other warning signs are surfacing as well.
10.  Loss of initiative.
    This situation may play out in either or both of two different ways. Loss of initiative may consist of lethargy, and it also may consist of what could be considered a failure of nerve. Depression could be one viable explanation for this state of affairs, perhaps exacerbated by an unusual string of  losses that are either personal or professional in nature. Dementia could be another viable explanation, possibly occasioned on one hand by counsel’s failure to cobble together the insight and inspiration needed for decisive action, or on the other hand by a fear of failure that reflects a growing sense of deteriorating faculties. 

None of these warning signs, in isolation or when combined, function as a guarantee of an accurate diagnosis of dementia. It is axiomatic that those who represent themselves have fools for lawyers, and something similar could justifiably be said of those who undertake to serve as their own doctors. The best reaction to suspicions of looming dementia will always be to seek the assistance of a qualified mental health professional. Most state bar associations dedicate resources to support members grappling with these issues.      

Recommending Assistance and Obtaining Help

Recommending assistance to one’s colleagues at the bar is not an easy task, and it is not one to be undertaken lightly. Any insinuation that a fellow attorney is not functioning at peak efficiency are likely to seen as a personal as well as professional affront. This observation is not meant to discourage intervention on another’s behalf; the message here is that some ways of going about this are better than others. Lawyers, after all, are typically in the best position to assess the performance of other lawyers, given the highly specialized nature of our work and the unique opportunities we have to witness each other’s labors, in places, manners, and context not accessible to laypersons.

Leaping directly to a diagnosis—in other words, asking colleagues outright if they believe they suffer from dementia—is a method virtually guaranteed to inspire alarm, resentment, and perhaps outright rejection. So, along the same lines, is any line of inquiry that styles apparent difficulties as “symptoms.” Counsel in almost every instance is not going to be a physician as well as an attorney. Lawyers are used to gauging their professional worth and efficacy in terms of performance.  This is a relatable notion that can allow for more constructive and potentially successful interaction. 

Someone may look tired, and why wouldn’t they after the week we’ve all had? Counsel can share their own positive outcomes from a simple, perhaps long overdue physical exam.  Wonders have been accomplished with a change of diet, a round of routinely prescribed medication, or maybe even the discovery of some nagging medical problem, attention to which can put the spring back into one’s step. The extent to which counsel can ascribe good results to their own experience—or that of a mutual acquaintance—may serve to move things along in a helpful direction. More dire and readily apparent problems, of course, will inspire inquiries of greater urgency and far less subtlety.

Conclusion

Day in and day out, lawyers solve problems for countless others who may be experiencing some of the worst moments of their lives. This does not necessarily mean that lawyers will always be able to recognize, understand, and solve problems for colleagues and for themselves. When it comes to dementia, warning signs—once learned—are both recognizable and potentially serious. Medical assistance and collegial support are readily available.