December 21, 2022
After more than 40 years of working with patients who have Alzheimer’s and other forms of dementia, Dr. Steve Fox has become a trusted expert witness for Chicago-area courts. As Wellspring’s Medical Director, Dr. Fox assesses all new clients and directs their plan of care, in coordination with the client’s doctors.
Dr. Fox has been providing expert testimony for over 30 years. His first cases related to questions of an individual’s decision-making capacity for personal and financial matters. He performs a comprehensive assessment including neurobehavioral testing to establish the need for a guardian. His work and experience in long-term care has also led to expert testimony in nursing home, assisted living and home care negligence.
In a recent case, attorney Michael M. Viglione of Ryan Ryan & Viglione in Waukegan asked Dr. Fox to assess a man in his 80s who had been in a car accident and was suing for damages. The man, whom we’ll call Mr. Smith, was driving his car with his wife. The driver of a truck made an illegal U-turn in front of them and hit their car. Mr. Smith banged his head on the steering wheel and was diagnosed with a mild concussion.
Dr. Fox was called about a year after the accident because Mr. Smith’s wife and their lawyer thought he had not been the same cognitively since the accident. Mr. Smith’s family and medical history showed no reason for him to have dementia or other cognitive problems. In fact, six months before the accident, his hospital had cleared him of any signs of dementia. Mr. Smith was an electrical engineer and had continued working into his late 70s.
At his first examination with Mr. Smith, Dr. Fox saw what he calls “very subtle signs” of dementia. In his written report for that examination, he noted that those signs may have been caused by the mild concussion Mr. Smith had suffered in the accident. “As we age, our brain shrinks somewhat,” explains Dr. Fox, “which creates room around the brain tissue that makes it more susceptible to injury from an impact.” This movement of the brain during a concussion leads to a break in the “blood-brain barrier.” Leakage of white cells and the chemicals they produce causes what’s called a cytokine storm, a hurricane of immunologic and inflammatory products that destroy normal brain function.
As an article from the National Library of Medicine explains, “Cytokines impact neurocircuits in the brain including the basal ganglia and anterior cingulate cortex, leading to significant changes in motor activity and motivation as well as anxiety, arousal, and alarm.”
When Dr. Fox made a second assessment of Mr. Smith about 18 months later, what he found was shocking. “His dementia onset had progressed about four to five times faster than someone with typical dementia onset,” said Dr. Fox, who attributed the accelerated dementia to the brain injury. Mr. Smith could no longer perform simple household tasks and experienced significant personality changes such as frustration and anger. “Those behaviors are very specific to the right frontal region of brain, where impulsivity and anger sit, and that is where he was injured,” said Dr. Fox.
Dr. Fox’s expert evaluation and testimony helped make it clear to the jury that the collision had caused both the brain injury and the dementia. Mr. Smith won the case and was awarded a $7.27 million settlement. “Michael Viglione really did his job as a lawyer,” said Dr Fox. “I’m incredibly proud of his work as a lawyer and that I worked with him.”
A note about falls and head injuries in older adults
Head injuries are among the most common injuries in older adults. Falls can happen any time, including while the person is simply walking. Dr. Fox notes that it’s always possible that the older adult “didn’t just fall down.” He explains, “You have to be aware that the fall may have injured their brain. Every single fall must be recorded and acted upon, with supervision and monitoring.” That’s something that Wellspring Personal Care does very well. Please contact us to learn more about our medical assessment of new clients and our range of in-home care services.
If you’re concerned about a loved one’s decreasing abilities, use our simple Frailty Assessment.
The image depicts cytokines involved in inflammation processes: TNF, G-CSF, IL-4, IL-6, IL-8.