Over One-Third of Older Texas Prisoners Suffering Cognitive Impairment
A recently published study of cognitive impairment (CI) among older prisoners held by the Texas Department of Criminal Justice (TDCJ) showed that over 35%—more than 1 in 3—suffered from some form of CI.
The study used a random and representative sample of 143 of the state’s 20,202 prisoners aged 55 and over at the time; their mean age was 61.3. Each participant took the Montreal Cognitive Assessment (MoCA), a screening tool which involved a 15-minute interview with a masters-level psychologist. The MoCA has “high sensitivity for the detection of MCI [mild cognitive impairment] and dementia, especially in persons with low formal education,” the study report noted. Scores under 23 indicated CI while those under 18 indicated dementia, under MoCA scoring guidelines.
The results also showed that 9.1% of TDCJ participants “met the threshold for dementia.” Blacks, Hispanics and those suffering from serious depression “had a higher prevalence of a positive screen for MCI or dementia.” Alarmingly, only 15.4% of those who screened positive for dementia had a prior diagnosis of dementia in their medical records, indicating a severe under diagnosis of dementia among Texas prisoners.
This was the first look at CI in a randomized study of older state prisoners. “Given the dramatic increase in older incarcerated patients in recent years, cognitive impairment represents one of the most challenging and costly health care issues facing the U.S. correctional system,” the report noted. Moreover, “impairment in executive cognition and impulse control can hinder older adults’ ability to navigate the criminal justice system, in particular limiting their ability to engage in fair plea bargaining and sentencing.”
Although the MoCA is a screening tool that cannot diagnose CI, it has an 87% specificity with respect to both MCI and dementia. The results of the study were largely similar to three comparable studies of populations outside prison, given that those studies were of persons 62-90 or over 64. See: Journals of Gerontology: Series B, Vol. 78, Issue 12, p.2141.