Cognitive dysfunction in older prisoners in Germany: a cross-sectional pilot study

Abstract

Purpose The purpose of this study is to collect the first empirical data on the cognitive state of elderly prisoners in Germany and to examine associations between cognitive function and sociodemographic, clinical and incarceration characteristics. Design/methodology/approach All prisoners aged 60 years and older of five prisons in North Rhine-Westphalia, Germany, were asked to participate. The cognitive screening instruments mini-mental state examination (MMSE) and the DemTect were used to assess global cognition. Executive functions were tested with the trail making test and the frontal-assessment-battery. The Patient Health Questionnaire (PHQ-9) was used to assess participants’ affective state. Findings The sample of this study consisted of 58 prisoners with a mean age of 65.52 years (standard deviation = 6.03); 82.8% are male. Using the MMSE with age- and education-corrected z-scores, 36.9% of the prisoners showed marginal or impaired global cognition scores. Using the DemTect, 41.4% of the prisoners were classified as being cognitively impaired. Up to 40% of the prisoners showed deficits in executive functioning and around 60% of the prisoners showed depressive symptoms. The correlation analysis revealed significant associations between cognitive scores and age (rho = –0.335, p = 0.014), education (rho = 0.309, p = 0.020), sentence duration (rho = 0.409, p = 0.007) and duration of current incarceration (rho = 0.302, p = 0.043). The DemTect total score was significantly associated with the PHQ-9 (rho = –0.335, p = 0.016). Practical implications A large group of the prisoners showed a higher prevalence of cognitive dysfunction than that observed in same-age people who are not incarcerated. Taken together, there is an urgent need for an adequate management of older cognitively impaired prisoners including routine cognitive testing and guidelines-oriented treatment of cognitive symptoms. Originality/value This study has several strengths. To the best of the authors’ knowledge, this is the first study examining the cognitive and affective state in a German prison population. The authors considered female and male prisoners, as well as different prison settings, representing a realistic prison sample. The authors used several neuropsychological instruments to get a more detailed insight into the older prisoners’ cognitive status while trying to consider the economy of time and possible attention deficits to prevent dropouts during testing.