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A report by Pete Edwards.

With the desire of  election officials and political action groups to register people to

vote and assist the elderly and disabled  to the polls, is a  question of  who should be permitted to vote? The question of mental competence is  being debated in medical circles.

Should people with dementia and other mental disabilities be allowed to vote or more precisely, should care givers, guardians or election volunteers be allowed to vote for them?

In October, a Bradley County resident complained to the county election commission and the state election coordinator's office that a group with Down Syndrome were assisted to vote. On another occasion, a resident complained that an elderly gentleman, who was

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obviously mentally incompetent had his vote cast by his companion, essentially giving the person with him two votes.

Washington Post Staff  Writer Shankar Vedantam, reported in September 2004 (www.washingtonpost.com/ac2/wp-dyn/A18916-2004Sep13?language=printer) that Florida neurologist Marc Swerdloff was taken aback when one of his patients with advanced dementia voted in the 2000 presidential election. The man thought it was 1942 and Franklin D. Roosevelt was president. The patient's wife revealed that she had escorted her husband into the booth.

"I said 'Did he pick?' and she said 'No, I picked for him,' " Swerdloff said. "I felt bad. She essentially voted twice" in the Florida election, which gave George W. Bush a 537-vote victory and the White House.

According to Vedantam, "many people with advanced dementia appear to be voting in elections -- including through absentee ballot. Although there are no national statistics, two studies in Pennsylvania and Rhode Island found that patients at dementia clinics turned out in higher numbers than the general population."

About 4.5 million Americans have Alzheimer's disease, the most common cause of dementia. Florida alone has 455,000 patients, advocates estimate.

Concern is growing that people with dementia may be targets for partisan exploitation in nursing homes and other facilities. Even without abuse, family members and caregivers may unduly influence close elections.

"Precisely because Alzheimer's disease insidiously erodes the ability to make reasoned judgments, ... it is somewhat unnerving to consider that patients with dementia may routinely contribute to selecting the leader of the free world," Victor W. Henderson and David A. Drachman wrote after the 2000 election in the journal Neurology.

It was reported by Mackenzie Carpenter, of the Pittsburgh Post-Gazette (www.post-gazette.com/pg/04298/400195.stm) that in  California, Democratic activists  filed suit against a veterans' hospital whose officials, they said, prohibited them from talking to residents on the grounds that they have dementia and were therefore incompetent to vote.

In Mobile, Ala., the district attorney fielded complaints  that mentally incompetent residents of a nursing home were allowed to vote in a municipal election.

And in South Carolina, state Democrats held a new primary after a state senator complained of voting fraud with absentee ballots of people in nursing homes with dementia and Alzheimer's disease.

It's not known how many people with dementia actually vote, although recent studies in Pennsylvania and Rhode Island found that residents from dementia clinics voted in higher numbers than the population at large.

Legally, states are all over the map on the issue, said Dr. Jason H. Karlawish, a geriatrician at the University of Pennsylvania's Institute on Aging, who directs the Dementia Voter Project. Pennsylvania, like 26 other states, has no guidelines on how election officials and judges should handle questions about voters who may or may not be capable of voting -- although it is possible that individual counties and boroughs have their own rules, he said. On the other hand, the 23 states that do have guidelines are mostly focused on the delivery of absentee ballots to nursing homes rather than on issues around assistance in voting.

Diane Balcom, regional director of the Alzheimer's Association of Greater Pittsburgh, noted that the problem splits two ways. Those with advanced dementia may be the victims of voter fraud when nursing home officials mark their ballots, while many people with an early diagnosis of dementia may be denied their right to vote even though they're capable of it.

"There are people with dementia who might not be able to drive, but who still have the ability to cast a vote and understand the process," she said.

It is not clear what criteria is used to determine who should be allowed to vote and the level of assistance the disabled should receive.
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