Dementia and competency to stand trial in the United States: A case law review.

Abstract

OBJECTIVE Competency to stand trial (CST) is foundational to the U.S. criminal legal system. Dementia is increasingly prevalent in the United States, and older adults are becoming involved with the U.S. criminal legal system at unprecedented rates, which carries significant implications for legal professionals and clinicians involved in CST cases. Unfortunately, CST research to date has largely excluded considerations of dementia and aging. The present study addressed this gap by reviewing U.S. case law related to dementia and CST. HYPOTHESES The present study had no hypotheses because of its descriptive nature. METHOD This was a case law review of 118 U.S. court cases involving dementia and CST from 2002 through 2022. Relevant information was coded about the legal case, defendant demographics, clinical evaluation(s), and court determination. RESULTS Competency was mostly raised by the defense (81%). Similar percentages of defendants were involved in one, two, and three or more evaluations, mostly conducted by experts appointed by courts or retained by the defense. Trends for court determinations were based on the number of evaluations conducted and experts' (dis)agreement about diagnosis and CST recommendation. Ultimately, 45% of defendants were determined incompetent, with trends appearing for dementia diagnosis, cognitive deficits, index offense, and jurisdiction, but not age. Ability to assist was the most cited reason for determinations of incompetence, often in combination with both factual and rational understanding or one of these psycholegal abilities alone. CONCLUSIONS Dementia and related impairments appear especially relevant to CST among older adults and carry important implications for clinicians, legal professionals, and policymakers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).