LAUSR

the profound paucity of research in this area and a rapidly aging criminal justice population, we believe these are clinically important research findings. Indeed, we do not conclude that poor performance on the MoCA is due to agerelated cognitive impairment and instead call for the very research that Lloyd wishes we had conducted: “This study, the first to screen a large sample of incarcerated older adults for cognitive impairment, shows that cognitive screening tools validated for use in this population are urgently needed to identify age-related cognitive impairment in jails and prisons and to distinguish it from the high rates of traumatic brain injury found in incarcerated people of all ages.” Multiple reports in the lay press have described a growing number of incarcerated older adults with cognitive impairment. Yet a review of the recent medical literature found no studies describing this phenomenon in the United States. Our study advances knowledge in this area by showing (1) that more research about cognitive health in jails and prisons, including the development of validated screening tools, is needed, and (2) that jails and prisons should perform cognitive screening and be prepared to assess abnormal results as a possible risk factor for poor 6-month outcomes in this population. As we state in our article, “even though a MoCA screen is not diagnostic, the possibility that cognitive impairment in even a small proportion of older adults . . . is resulting in repeat arrest warrants greater attention to mitigate the possibility of older adults being punished for behavior that is medical rather than criminogenic in nature.” In view of the rapidly growing population of incarcerated older adults, many with significant risk factors for cognitive impairment, it is urgent that we better understand the impact of cognitive impairment in this population regardless of its cause.