Not surprisingly, there is an urgent need for standardized assessment tests to help geriatric forensic experts accurately decide whether people are mentally competent.

Daniel Marson, Ph.D., a lawyer, psychologist, and geriatric forensic authority with the University of Alabama in Birmingham, underscored this fact at the "measures of civil competency" session at the annual meeting of the American Academy of Psychiatry and the Law last month.

And indeed, Marson and his colleagues are developing some tests along these lines. For instance, they have devised a test to distinguish those who are competent to make medical decisions from those who are not. On this test, Marson explained, persons with mild Alzheimer’s did well at making rational choices, which are not especially challenging, but they did have difficulty providing reasons for their choices and understanding and recalling treatment information, which is tougher.

Marson and his colleagues have also developed a test to measure financial competency—ability to balance a bank statement, pay bills, tip in a restaurant, and so forth. On this test, Marson explained, persons with mild Alzheimer’s did much worse than controls at even the simplest tasks.

Sandra Baltz, M.D., a psychiatrist and geriatric forensic authority with Louisiana State University in New Orleans, said that she is excited about these tests, although her particular area of expertise, and challenge, is determining whether deceased persons were mentally competent when they wrote their wills.