Law professor at Case Western Reserve University says that state medical boards need to better identify clinicians with cognitive decline
CASE WESTERN RESERVE UNIVERSITY
Sharona Hoffman, the Edgar A. Hahn Professor of Law
Credit: Case Western Reserve University
Older physicians benefit from their many years of experience and the skills they have developed over decades of practice. At the same time, they may be at risk of cognitive decline, raising concerns about job performance deficits.
That’s according to Sharona Hoffman, the Edgar A. Hahn Professor of Law and co-director of the Law-Medicine Center, who said that state medical boards have a role to play in identifying clinicians with cognitive decline.
In an article “Physicians and Cognitive Decline: A Challenge for State Medical Boards,” published in Journal of Medical Regulation, she discusses what state medical boards currently do in this regard and analyzes whether they should do more. It also discusses relevant legal constraints and ethical obligations.
The article ultimately concludes that state medical boards would be wise to adopt late career screening programs that are carefully designed to balance the interest of clinicians and patient safety.
“Such programs could be implemented only after experts determine which preliminary tests and more comprehensive follow-up tests can best identify job-related cognitive impairment and at what age the testing program should commence,” she wrote. “Any testing program would have to include due process protections, efforts to provide reasonable accommodations to facilitate job performance, and a public relations campaign to build support among clinicians and professional organizations.”
Although the article focuses on state medical boards, its analysis and recommendation are relevant to all state licensing boards that oversee health care providers.
This article follows an article Hoffman published in the spring in the Wake Forest Law Review, entitled “Cognitive Decline and the Workplace.” That article explores the topic of cognitive decline more generally and analyzes what employers can and cannot do to address concerns about it in the workforce.
Musical tests can detect mental deterioration in old age
Integration of music with analysis of electrical brain activity
Peer-Reviewed PublicationIMAGE: NETA MAIMON view more
CREDIT: TEL AVIV UNIVERSITY
Researchers at Tel Aviv University have developed a method that employs musical tests and a portable instrument for measuring brain activity to detect cognitive decline in old age. According to the researchers, the method, which is based on the measurement of 15 minutes of electrical activity in the brain while performing simple musical tasks, can be easily implemented by any staff member in any clinic, without requiring special training. The researchers: “Our method enables routine monitoring and early detection of cognitive decline in order to provide treatment and prevent rapid, severe deterioration. Prophylactic tests of this kind are commonly accepted for a variety of physiological problems such as diabetes, high blood pressure or breast cancer; however, to date no method has yet been developed to enable routine, accessible monitoring of the brain for cognitive issues.” The researchers further note that tests of this kind are particularly important in light of increasing longevity and associated growth of the elderly population.
The study was led at Tel Aviv University by PhD student Neta Maimon from the School of Psychological Sciences and the Buchmann-Mehta School of Music, and Lior Molcho from Neurosteer Ltd, headed by Prof. Nathan Intrator from the Blavatnik School of Computer Science and the Sagol School of Neuroscience. Other participants included: Adi Sasson, Sarit Rabinowitz, and Noa Regev-Plotnick from the Dorot-Netanya Geriatric Medical Center. The article was published in the journal Frontiers in Aging Neuroscience.
As part of the study, the researchers developed a groundbreaking method combining a portable device for the measurement and innovative analysis of electroencephalography (EEG), developed by Neurosteer, and a short musical test of about 12-15 minutes, developed by Neta Maimon. During the test, the subject is connected to the portable EEG device by means of a adhesive band with only three electrodes attached to the forehead. The subject performs a series of musical-cognitive tasks according to audible instructions given automatically through earphones. The tasks include short melodies played by different instruments, with the subjects instructed to perform various tasks on them at varying levels of difficulty. For example, pressing a button each time any melody is played or pressing it only when the violin plays. In addition, the test includes several minutes of musically guided meditation designed to bring the brain to a resting state, as this state is known to indicate cerebral functioning in various situations.
Neta Maimon, who specializes in musical cognition, explains that music has great influence on different centers in the brain. On the one hand, music is known to be a quick mood stimulant, particularly of positive emotion. On the other hand, in different situations, music can be cognitively challenging, activating the frontal parts of the brain, especially if we try to concentrate on different aspects of the music, and at the same time perform a particular task.
According to Maimon, if we combine these two capabilities, we can create cognitive tests that are quite complex, yet also pleasant and easy to perform. Furthermore, music that is positive and reasonably rhythmic will enhance concentration and performance of the task. Thus, for example, the famous “Mozart effect,” showing improved performance on intelligence tests after listening to Mozart’s music, actually has nothing to do with Mozart’s music, but rather the fact that music creates a positive mood and stimulates us to a state that is optimal for performing intelligence and creativity tests.
Accordingly, the researchers hypothesized that with musical tools, it would also be possible to challenge the subjects to an extent that would enable testing of the brain’s frontal activity as well as raising their spirits, thus enhancing their performance on the test while the overall experience is pleasant.
The study included an experiment at the Dorot-Netanya Geriatric Medical Center. Neta Maimon: “Anyone hospitalized at Dorot, or any other geriatric rehabilitation institution, undergoes a standard test called “mini-mental,” designed to evaluate their cognitive condition as a routine part of the intake process. The test is conducted by an occupational therapist specially trained for it, and includes a variety of tasks. For example, enumerating the days of the week or months of the year backwards. In this test, up to 30 points can be accrued. A high score indicates normal cognition.
The experiment included the testing of 50 elderly people hospitalized at Dorot who scored 18-30 on the mini-mental test, indicating various levels of cognitive functioning. The participants performed the musical-cognitive tasks, administered automatically. The EEG device registered the electrical activity in the brain during the activity, with the results analyzed using machine learning technology. This allowed mathematical indices to be identified that were precisely correlated with the mini-mental test scores; in other words, we obtained new neuro-markers (brain markers) that may stand alone as indices of the subject’s cognitive status.
Maimon adds: “We have actually succeeded in illustrating that music is indeed an effective tool for measuring brain activity. The brain activity and response times to tasks correlated to the subjects’ cerebral conditions (correlating to the mini-mental score assigned to them). More importantly, all those who underwent the experiment reported that, on the one hand, it challenged the brain, but on the other it was very pleasant to perform”.
The researchers conclude: “Our method enables the monitoring of cognitive capability and detection of cognitive decline already in the early stages. all by simple and accessible means, with a quick and easy test that can be conducted in any clinic. This method is of special importance today due to the increase in longevity and accelerated population growth, particularly among the elderly. Today, millions of people around the world already suffer or are liable to suffer soon from cognitive decline and its dire consequences, and their number will only increase in the coming decades. Our method could pave the way towards efficient cognitive monitoring of the general population, and thus detect cognitive decline in its early stages, when treatment and prevention of severe decline are possible. It is therefore expected to improve the quality of life of millions around the world.”
Keren Primor Cohen, CEO, Ramot at TAU: “We are pleased that a company based on a technology developed at TAU continues its collaboration on creative and multidisciplinary research.
Ramot will continue to promote and invest in novel technologies, as well as help TAU researchers to maximize their research’s potential.”
Link to the article:
https://www.frontiersin.org/articles/10.3389/fnagi.2022.773692/full
ARTICLE TITLE
Single-Channel EEG Features Reveal an Association With Cognitive Decline in Seniors Performing Auditory Cognitive Assessment
Mental impairment plea casts shadow over defendant’s future: study
Public perceptions can prejudice treatment after
sentencing
Peer-Reviewed PublicationIMAGE: DR MELISSA DE VEL-PALUMBO, FLINDERS UNIVERSITY CRIMINOLOGIST view more
CREDIT: FLINDERS UNIVERSITY
The defence of mental impairment gives a defendant reasons for their crime to be forgiven, but such a plea can have lingering negative effects on a person’s social standing and even civil rights, a new study led by Flinders University finds.
A defendant’s plea of reduced agency as a defence against criminal responsibility can lead to the person being seen as less morally deserving of certain rights in the community, Australian and US experts say in a new article in PLOS ONE.
“We argue that although this strategy may help defendants evade blame, it may carry longer-term consequences because lay people in society often perceive a person’s agency can be linked to some of the moral rights they grant them,” says first author Dr Melissa de Vel-Palumbo, from the Flinders University College of Business, Government and Law.
“After serving their sentence, people who have used this defence can be given fewer rights, as reduced agency can be perceived as increased dangerousness .
“This was observed through a range of different types of mental impairment, offences and sentences, and have broad implications for the legal and justice system – and defendants.”
For example, a person using a defence of mental impairment may be subjected to exclusionary policies and treatment, making it harder for them to reintegrate into the community.
Using online vignette scenarios, the analysis examined randomised responses from 1600 people to assess lay perceptions of a hypothetical defence of mental impairment to reduce their level of responsibility and punishment relative to a guilty plea.
“The research also speaks to broader philosophical questions of who is granted moral standing in the community, and why,” says Dr de Vel-Palumbo.
“Typically, we see vulnerable people as needing protection – but not in this case.”
However co-author Dr Rose Ferguson, from the Institute of Health and Wellbeing at Federation University, says the study also found a possible ways to mitigate the negative effect of the mental impairment defence on moral rights.
“When participants are given information that a defendant using this defence had subsequently engaged in treatment and was able to manage their illness independently, they were perceived as higher in agency and more worthy of rights,” says Dr Ferguson.
“This could suggest that providing the community with information about successful treatment outcomes may increase acceptance of defendants who had been found not criminally responsible for their actions due to mental impairment.”
The article, ‘Morally excused but socially excluded: Denying agency through the defense of mental impairment’ (2022) by Melissa de Vel-Palumbo, Rose Ferguson, Chelsea Schein, Melissa Xue-Ling Chang and Brock Bastian has been published in PLOS ONE doi: 10.1371/journal.pone.0272061
JOURNAL
PLoS ONE
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
Animals
ARTICLE TITLE
Morally excused but socially excluded: Denying agency through the defense of mental impairment
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