Jane Lonie - Academia.edu (original) (raw)

Papers by Jane Lonie

Australian Bar Review, 2017

The accurate assessment of testamentary capacity is especially challenging in light of increasing... more The accurate assessment of testamentary capacity is especially challenging in light of increasing incidents of mentally disabling conditions, such as dementia. The legal test for establishing testamentary capacity is well-established with little change since its 1870 inception in Banks v Goodfellow (‘Banks’). However, dementia has different markers to psychosis, the issue in Banks. Accordingly, it presents distinctive problems for modern testamentary capacity assessment. The legal profession is increasingly adopting a multidisciplinary approach to assessments, however, difficulties arise because the clinical concepts of capacity assessed by health professionals do not map to the overarching legal framework in which capacity is ultimately determined. Consequently, health and legal professionals need to develop a more erudite understanding of how cognitive impairment affects a client’s ability to meet the requisite legal criteria in specific contexts. To this end, a review of judicial decisions for the past twelve months has been conducted to critically evaluate how testamentary capacity has been assessed. This article will critically discuss these decisions in light of the effects of cognitive impairment on testamentary capacity. It will explore the fundamental importance of understanding cognitive impairment in dementia when assessing testamentary capacity, as well as the inadequacies of applying the Mini-Mental State Examination (MMSE) and the notion of a lucid interval in the accurate assessment of testamentary capacity. Some practical tips will then be offered for assessing capacity in this context.

Alzheimer's & Dementia, 2013

Background: The role of vascular risk factors (VRF) in precipitating or accelerating cognitive de... more Background: The role of vascular risk factors (VRF) in precipitating or accelerating cognitive deterioration in older adults is not fully understood. Cross-sectional studies have demonstrated that individuals with VRF exhibit lower performance on cognitive tests. Longitudinal studies have suggested that the presence of VRF accelerates cognitive decline. The aim of this study is to investigate the impact of VRF on the rate of cognitive change in a group of healthy AIBL participants who remain cognitively intact over a three-year period. Methods: A group of 768 healthy participants (age 69.966.9 years, range 60-95, 331M/437F, and 27% APOE ε4+) underwent the comprehensive AIBL neuropsychological examination at baseline. Serial assessments were repeated at 18-month intervals over a 36-month period. By the end of the study period, 32 participants had attracted a diagnosis of MCI or dementia, 120 had withdrawn, 13 were deceased and 48 did not have complete information. The remaining individuals (n¼555) were divided according to the presence (n¼442) or absence (n¼113) of VRF. Participants with VRF had at least one of the following risk factors: (1) hypertension, (2) diabetes, (3) dyslipidaemia, (4) Body Mass Index>30, (5) chronic kidney disease, (6) smoking history, and (7) elevated homocysteine levels (males>16.2mmol/L; females>13.6mmol/L). Results: The rate of cognitive change in the 555 healthy individuals with/ without VRF was evaluated by means of a linear mixed model adjusted for age, premorbid IQ, and APOE ε4 load. Relative to individuals without VRF, those with VRF displayed a significantly different rate of change in performance on the Controlled Oral Word Association Test (COWAT), F(2, 1096.8)¼3.03, p<0.05. Cross-sectional findings indicated statistically significant main effects between individuals with and without VRF in the Stroop Color Word Test F(1, 602)¼8.36, p<0.05, and the Rey Complex Figure Test (RCFT) F(1, 646.3)¼7.19, p<0.05. No significant difference in performance was identified on the California Verbal Learning Test or Boston Naming Test. Conclusions: Cognitive change was detectable on tests, at least two of which tap executive function. No effect was detected on measures of memory or language. While the effects of VRF on cognition are subtle, this study suggests the existence of neurocognitive vulnerability in older adults with VRF.

Full list of author information is available at the end of the articleEmotional memory

Bal Fluency; V-Lex – Lexical Verbal Fluency; PAL – Paired Associates Learning from CANTAB battery... more Bal Fluency; V-Lex – Lexical Verbal Fluency; PAL – Paired Associates Learning from CANTAB battery; DMTS – Delayed Matching to Sample stages from the CANTAB battery.<b>Copyright information:</b>Taken from "Estimated pre-morbid IQ effects on cognitive and functional outcomes in Alzheimer disease: a longitudinal study in a treated cohort"http://www.biomedcentral.com/1471-244X/8/27BMC Psychiatry 2008;8():27-27.Published online 21 Apr 2008PMCID:PMC2374779.

In a majority of syndromes giving rise to questionable testamentary capacity, concerns center aro... more In a majority of syndromes giving rise to questionable testamentary capacity, concerns center around cognitive function more so than frank psychiatric disorder. Dementia, a cognitive illness, poses the largest threat to testamentary capacity in modern society. Cognitive assessment is therefore central to the evaluation and determination of testamentary capacity as well as to the formulation of the reasoning base from which expert opinions on the matter are formed. A better understanding of the way in which dementia related cognitive impairment can impact upon a testator’s ability to fulfil the relevant legal criteria, would inform the focus of cognitive assessment within the context of testamentary capacity evaluations. In this article we review the recent past (i.e. 10 years) literature informing ‘what cognitive abilities are required to satisfy the legal criteria for testamentary capacity’. There is an alarming scarcity of work in this area with little discussion spanning beyond a...

Forty-six patients with mild cognitive impairment (MCI), twenty patients with very early Alzheime... more Forty-six patients with mild cognitive impairment (MCI), twenty patients with very early Alzheimer’s disease (AD), twenty psychiatric outpatients with depressive symptoms, and 24 health elderly volunteers were examined cross-sectionally using clinical and neuropsychological scales. Patients with amnestic mild cognitive impairment were followed up on average for four years. Smaller subgroups of patients were examined with an α4β2-nicotinic ligand tracer and single photon emission tomography, and diffusion tensor magnetic resonance imaging to examine white matter tract micro-integrity. One quarter of referrals to our Edinburgh neuropsychological assessment service for older people received the diagnosis of amnestic mild cognitive impairment (aMCI). Most of these also displayed non-memory cognitive deficits, without qualifying for a diagnosis of dementia. While some of the neuropsychological measures were highly specific and sensitive to early dementia, they achieved usually only one of the two for aMCI. Two fifths or our aMCI patients ‘converted’ to AD within four years of follow-up. They could be predicted at baseline with an accuracy of 75%. Typical patterns of nicotinic receptor binding and white matter integrity were found in patients with MCI

Five patients with Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;... more Five patients with Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease and five healthy volunteers were examined by SPECT with the nicotinic receptor ligand 123I-5-IA-85380. Patients were scanned before and after 6 weeks of treatment with donepezil. Quantification by regions of interest was reliable and the optimal normalisation procedure used cerebellar ratios. We found relative reductions in 5-IA binding capacity in patients in thalamus, frontal and central regions of interest of approximately one standard deviation unit (Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s d = 1). Reductions in binding after treatment with the acetylcholinesterase inhibitor donepezil of the same magnitude occurred in the brain stem. The study was clearly too small to confirm group differences, but it suggests that 5-IA can be used to examine both group differences and treatment effects in patients with Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease.

Psychiatry Research - Neuroimaging, 2010

Psychological Medicine, 2008

BackgroundThe dual task paradigm (Baddeley et al.1986; Della Sala et al.1995) has been proposed a... more BackgroundThe dual task paradigm (Baddeley et al.1986; Della Sala et al.1995) has been proposed as a sensitive measure of Alzheimer's dementia, early in the disease process.MethodWe investigated this claim by administering the modified dual task paradigm (utilising a pencil-and-paper version of a tracking task) to 33 patients with amnestic mild cognitive impairment (aMCI) and 10 with very early Alzheimer's disease, as well as 21 healthy elderly subjects and 17 controls with depressive symptoms. All groups were closely matched for age and pre-morbid intellectual ability.ResultsThere were no group differences in dual task performance, despite poor performance in episodic memory tests of the aMCI and early Alzheimer's disease groups. In contrast, the Alzheimer patients were specifically impaired in the trail-making test B, another commonly used test of divided attention.ConclusionsThe dual task paradigm lacks sensitivity for use in the early differential diagnosis of Alzhei...

Neurochemical Research, 2007

Five patients with Alzheimer's disease and five healthy volunteers were examined by SPECT with th... more Five patients with Alzheimer's disease and five healthy volunteers were examined by SPECT with the nicotinic receptor ligand 123 I-5-IA-85380. Patients were scanned before and after 6 weeks of treatment with donepezil. Quantification by regions of interest was reliable and the optimal normalisation procedure used cerebellar ratios. We found relative reductions in 5-IA binding capacity in patients in thalamus, frontal and central regions of interest of approximately one standard deviation unit (Cohen's d = 1). Reductions in binding after treatment with the acetylcholinesterase inhibitor donepezil of the same magnitude occurred in the brain stem. The study was clearly too small to confirm group differences, but it suggests that 5-IA can be used to examine both group differences and treatment effects in patients with Alzheimer's disease.

Neurobiology of Aging, 2010

Treatments currently licensed for Alzheimer's dementia target cholinergic brain systems. In vivo ... more Treatments currently licensed for Alzheimer's dementia target cholinergic brain systems. In vivo nicotinic receptor binding may provide an early marker of illness and treatment suitability. In this pilot, we examined nine patients with amnestic mild cognitive impairment (MCI) and ten age and education matched healthy volunteers with high resolution SPECT and the nicotinic receptor ligand 123I-5-IA-85380. Uptake data were analysed using voxel-based techniques for group comparisons and regression analyses with cognitive impairment as covariates. MCI patients had discrete reductions in uptake in medial temporal cortex. Correlations with cognitive impairment were found in left temporo-parietal areas (Addenbrooke's Cognitive Examination) and bilateral temporo-limbic areas (Reye Auditory Verbal Learning Test), and right parahippocampal gyrus (Reye Complex Figure Test) within the patient group. In vivo nicotinic receptor binding appears to be sensitive to brain changes in MCI. Larger scale explorations of patients undergoing treatment will be necessary to evaluate its use in predicting or monitoring treatment response.

Journal of Neuropsychology, 2009

Episodic memory is compromised in amnestic mild cognitive impairment (aMCI), but lesser deficits ... more Episodic memory is compromised in amnestic mild cognitive impairment (aMCI), but lesser deficits in other cognitive domains are also commonly observed and may be helpful in identifying this group. The relative difference in performance on lexical and semantic fluency tasks may be a sensitive and specific measure in aMCI and early Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD). We compared four groups of participants, 35 early AD, 47 aMCI, 24 healthy controls, and 18 depressive out-patient controls, on semantic and lexical fluency as well as other neuropsychological tests. Early AD and aMCI patients showed a distinct pattern of semantic impairment in the two fluency measures compared with the healthy and depressive controls. The findings implicate early failure of the semantic memory system in aMCI and AD and suggest that consideration of the discrepancy in performance on semantic and lexical fluency measures may help in the early identification of AD.

International Journal of Geriatric Psychiatry, 2009

International Journal of Geriatric Psychiatry, 2007