Evaluating Testamentary Capacity
from Handwriting: Research &
Applications
Heidi H. Harralson, MA, D-BFDE
Association of Forensic Document Examiners
October 17, 2010, Phoenix, Arizona
Impaired Cognition
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Alzheimer’s
Parkinson’s
Dementia
Delirium
Drugs/medications
Stroke
Disturbed Movement
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Hand movements and the generation of writing
movements are complex processes involving the
integration of different instances, from planning
to the activation and execution of simple motor
programs. Disturbances in any of these
instances therefore result in disturbed
movement sequences
Schroter, A., Mergl, R., Burger, K., Hampel, H., Moller, H.-J., & Hegerl, U. (2003).
Kinematic analysis of handwriting movements in patients with Alzheimer’s disease,
mild cognitive impairment, depression and healthy controls. Dementia and Geriatric
Disorders, 15, 132-142.
Dysgraphia & Delirium
Inability to write
 Tremor
 Clumsiness
 Micrographia
 Reiterated drawing [perseveration]
 Spatial disorders
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Macleod, A. D., & Whitehead, L. E. (1997). Dysgraphia and terminal delirium.
Palliative Medicine, 11, 127-132.
Macleod, A. D., & Whitehead, L. E. (1997). Dysgraphia and terminal delirium.
Palliative Medicine, 11, 127-132.
Macleod, A. D., & Whitehead, L. E. (1997). Dysgraphia and terminal delirium.
Palliative Medicine, 11, 127-132.
Macleod, A. D., & Whitehead, L. E. (1997). Dysgraphia and terminal delirium.
Palliative Medicine, 11, 127-132.
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Most consistent defect was reduplication
of letters
Tendency to perseverate is a common
feature of delirium
Of the language impairments in delirium,
dysgraphia is the most significantly
impaired (subjects could not write their
names or addresses)
Macleod, A. D., & Whitehead, L. E. (1997). Dysgraphia and terminal delirium.
Palliative Medicine, 11, 127-132.
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Although dysgraphia is undoubtedly a
sensitive sign of higher central nervous
system dysfunction, it is not specific to
delirium, and dysgraphic errors occur in
other organic mental disorders.
Macleod, A. D., & Whitehead, L. E. (1997). Dysgraphia and terminal delirium.
Palliative Medicine, 11, 127-132.
Alzheimer’s & Dementia
Kinematic Analysis
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Patients v. healthy controls:
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strokes significantly less consistent lengths
(variability)
Strokes consistently less consistent duration
(variability)
Less peak velocity
Perseveration (multiple sets of responses; excessive
repetitions in llll’s)
Slavin, M. J., Phillips, J. G., Bradshaw, J. L., Hall, K. A., & Presnell, I. (1999).
Consistency of handwriting movements in dementia of the Alzheimer’s type: A
comparison of Huntington’s and Parkinson’s disease, Journal of the International
Neuropsychological Society, 11, 20-25.
Perseveration
Slavin, M. J., Phillips, J. G., Bradshaw, J. L., Hall, K. A., & Presnell, I. (1999).
Consistency of handwriting movements in dementia of the Alzheimer’s type: A
comparison of Huntington’s and Parkinson’s disease, Journal of the International
Neuropsychological Society, 11, 20-25.
Errors
Slavin, M. J., Phillips, J. G., Bradshaw, J. L., Hall, K. A., & Presnell, I. (1999).
Consistency of handwriting movements in dementia of the Alzheimer’s type: A
comparison of Huntington’s and Parkinson’s disease, Journal of the International
Neuropsychological Society, 11, 20-25.
Alzheimer’s & Mild
Cognitive Impairment
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Significant correlations were found…between
cognitive function and kinematic handwriting
parameters, reflecting poorer motor coordination
in cognitively impaired patients.
Loss of fine motor performance
Performed worse on tasks
Schroter, A., Mergl, R., Burger, K., Hampel, H., Moller, H.-J., & Hegerl, U. (2003).
Kinematic analysis of handwriting movements in patients with Alzheimer’s disease,
mild cognitive impairment, depression and healthy controls. Dementia and Geriatric
Disorders, 15, 132-142.
Mild Cognitive Impairment and
Mild Alzheimer’s Disease
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Cognitively-impaired patients
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Higher temporal measures
Pressure was lower
Loss of fine motor performance
Less regular movements
Longer “in-air” time
Werner, P., Rosenblum, S., Bar-On, G., Heinik, J., & Korczyn, A. (2006). Handwriting
process variables discriminating mild Alzheimer’s disease and mild cognitive
impairment. Journal of Gerontology, 61B(4), 228-236.
Testamentary Capacity
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25 patients referred for mental
deterioration to a neuropsychological clinic
Administered
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Milan Overall Dementia Assessment (MODA)
scale
Mini Mental State Examination (MMSE)
Fontana, P., Dagnino, F., Cocito, L., & Balestrino, M. (2008). Handwriting as a
gauge of cognitive status: A novel forensic tool for posthumous evaluation of
testamentary capacity. Neurological Sciences, 29, 257-261.
Testamentary Capacity
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Three writing samples collected from each
subject
Analyzed using semi-quantitative scale
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Verbal/lexical skills
Spatial orientation
Fontana, P., Dagnino, F., Cocito, L., & Balestrino, M. (2008). Handwriting as a
gauge of cognitive status: A novel forensic tool for posthumous evaluation of
testamentary capacity. Neurological Sciences, 29, 257-261.
Verbal/Lexical Skills
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Evaluation
Scale
No mistakes
-
5
-
4
-
3
-
2
-
1
Some mistakes (e.g., missing or wrong letters, words
written in a wrong way), however text can be easily
understood
Some mistakes (as above), however text can be
understood with some effort
Some mistakes (as above), text can be understood
only with considerable effort
Text not understandable
Spatial Orientation
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Evaluation
Scale
Normally oriented rows. In each row, beginning and
end correspond to the page margins
5
Rows slightly distorted or with beginning and end
bearing little correspondence to the page margins
4
Rows clearly distorted or with beginning and end not
corresponding to the page margins
3
Words or letters inserted where they do not belong in
the text
2
Chaotic orientation of the rows
1
Score
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Data showed that no patient who had a writing
score < 5 had a MODA score higher than 60 or a
MMSE higher than 20
The latter is believed to represent a cutoff point
distinguishing mild dementia from a more severe
form
A writing score < 5 is a strong indicator of
severe mental impairment
Case Study
Perseveration, errors, in-air time?
Verbal/lexical = 3
Spatial = 2
Writing Index = 5
Irregularity, illegibility, errors
Verbal/lexical = 2
Spatial = 2
Writing Index = 4
Verbal/lexical = 1
Spatial = 2
Writing Index = 3
Results
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The questioned handwriting displays
erratic and distorted handwriting features
including tremor, irregular alignment,
errors, cross-outs, spelling errors, irregular
handwriting forms, letter form errors,
decreased legibility.
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Tremulous writing does not automatically
equal cognitive impairment
Opinion
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The deterioration of the questioned handwriting
is consistent with the deterioration that results
from health and/or medication related causes.
The deterioration of the handwriting could be
caused by impaired cognitive status at the time
the handwriting was executed on the questioned
documents.
Limitations
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Awkward writing position
Guided hand
Other medical conditions can impair handwriting
without necessarily impairing cognition
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focal brain lesions caused by stroke or tumor…these
can selectively affect speech or visuospatial abilities1
Essential tremor (extreme cases)
Fontana, P., Dagnino, F., Cocito, L., & Balestrino, M. (2008). Handwriting as a
gauge of cognitive status: A novel forensic tool for posthumous evaluation of
testamentary capacity. Neurological Sciences, 29, 257-261.
1
Context Issues
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Alleged elder abuse
Medical/surgery complications
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postoperative delirium
Medications
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Morphine, Percocet, Xanax
Conclusion
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Evaluating testamentary capacity may be
possible from handwriting as long as
limitations are evaluated and incorporated
into the opinion
Contact
Heidi H. Harralson, MA, D-BFDE
Spectrum Forensic International, LLC
[email protected]