Neurocognitive disorders are defined in the DSM as disorders involving cognitive impairment that is acquired due to an event or medical condition, rather than emerging as part of the developmental process. Neurocognitive disorders thus represent a decline from a previous level of mental functioning (Sachdev et al., 2014). Two examples of neurocognitive disorders are discussed in this section: traumatic brain injury and dementia.

Traumatic Brain Injury

Traumatic brain injury (TBI) is an injury to the brain that affects how the brain works (Centers for Disease Control and Prevention [CDC], 2024a). Falls, blunt trauma accidents, and injuries from assaults (like gunshot wounds) are among the leading causes of TBI (CDC, 2024a).

TBI is a major cause of death and serious injury in the United States. Symptoms vary depending on the severity of the TBI, but moderate to severe injuries come with a vastly shortened life expectancy and a seriously reduced quality of life. Survivors may experience impaired understanding and thinking, anger and aggression, impulsivity, and depression (CDC, 2024b).

Anyone can get a TBI, but certain groups of people are more likely to experience one, including men, older people, and those in military service. Significantly, some groups, including people of color, people who are unhoused, and survivors of intimate partner violence, are less likely to receive proper treatment when they do experience a TBI, leading to worse outcomes from these injuries (CDC, 2024c). People in the criminal justice system may have survived multiple violent encounters, including childhood abuse and violent victimization—any of which can cause TBI. Regardless of cause, TBI incidence is startlingly high in the criminal justice system. According to the CDC, up to 87% of jail and prison inmates report a head injury or TBI, in contrast to just about 8% to 9% of the general population (National Center for Injury Prevention and Control, 2007). Additionally, TBI symptoms, like so many mental disorders discussed in this text, are likely to impair a person’s ability to succeed in incarceration or rehabilitation environments. Typical symptoms of TBI can easily be perceived as defiance or deliberate lack of cooperation rather than as a product of this mental disorder, giving rise to disciplinary actions and recidivism, or return to the criminal justice system (Chan et al., 2022).

It is best practice for people in high-risk populations (e.g., homeless shelters or prisons) to be screened for TBI. This can be done by a simple questionnaire asking whether the person has ever received a blow to the head or lost consciousness. Of course, it is then critical that the person receive further diagnostic evaluation followed by necessary treatment and support (Dams-O’Connor et al., 2016). Treatment for TBI depends upon the severity of the injury. A more serious TBI can require significant rehabilitation and long-term care (CDC, 2024b).

Dementia

Dementia is a general term that refers to the loss of thinking abilities—like remembering and reasoning—to a degree that impairs a person’s ability to function. There are several different types of dementia, including Alzheimer’s disease and stroke-related dementia (CDC, n.d.). Many people are familiar with dementia from experience with family or loved ones, as it is common among aging people; as many as one-third of all people aged 85 or older may have some form of dementia (National Institute on Aging, n.d.). The CDC estimates that by the year 2060, 14 million people over the age of 65 will have a diagnosis of dementia (CDC, n.d.).

As dementia becomes more prevalent in the overall population, it increases in the criminal justice system as well—perhaps to an even greater degree. The marginalized groups that make up the U.S. prison population, for example, have more health problems than the general population overall, including an increased tendency to develop dementia:

The high risk [of dementia among incarcerated people] is because of challenges faced in prison life—and inmates’ experiences before incarceration. Prisoners are often marginalized members of society with less access to health care, poorer diet, issues with alcohol or drug misuse, mental health problems, and potential traumatic brain injuries—all factors that increase the likelihood of developing the condition (Novak, 2022).

Dementia is a criminal justice problem of growing enormity. As inmates with this disorder increase in number, often facing long sentences, they require significant supervision and care (Novak, 2022). Prisons are turning to various solutions to manage this growing population, ranging from creating memory care-type wards within prisons to allowing fellow prisoners to serve as caregivers or volunteer helpers to affected patients (figure 2.20) (Belluck, 2012).

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“Neurocognitive Disorders” by Anne Nichol is licensed under CC BY 4.0.

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Figure 2.20. Andrew Burton/ USA: Aging Prisoners Make Up Fastest Growing Segment Of Nation’s Prison Population via Getty Images.