Case Report Of An Elderly Woman Affected By Dementia Free Essay Example

The case report occurred in the winter of 2010 in Southern Italy. It is a case of an elderly woman, affected by dementia which is characterized by temporal-spatial disorientation and amnesia especially. She had disappeared from nursing care and was found dead the next day near the banks of a river that flowed under a railroad. The victim was found located near to a river affluent of Ionic Sea. This river flowed under a railway bridge distant 5 m from the crime scene.

Ideally, there were two possible pathways to crime scene: the first one (path A) originated from a train station and the second one (path B) corresponded to the railway. Soil and plants of both path A and B were analyzed. In path A (precipice), some plants were identified widely diffused in the Ionian Coast, while the soil was essentially constituted of clay and sand.

On the other hand, path B (bridge) (Fig. 1) was also evaluated through the presence of both plants and soil; this last one was mainly composed of gravel and a few types of plants.

The path A (Fig. 2) presented a steep area of more than 6 m away from crime scene. In this case, the victim was found under the bridge and forensic botany was essential for the support to determine the path taken by the victim on foot in order to understand the mode of death: suicide/homicide or accident? The on-site inspection and external examination of the victim showed some types of traumatic injuries to be attributed to a fall.

The death of the old woman could result from an accidental fall from a precipice, just a few meters from the river, or by precipitation from a railway bridge over the river instead. This question was resolved by the evaluation of species of plants called Xantium Orientalis subsp. Italicum found on the clothing of the victim. The botanical components of each path were identified and analyzed. The comparison of the plants found on the clothing and the like species found on the path A has made possible, with certainty, the identification of the manner and cause of death.

Materials and Methods

In this study, two possible ways of access to crime scene were identified and denominated “path A” and “path B” and they were recognized. Both types of soil and plants were identified, and the differences between two soils were noted (Figs 3 and 4). The bridge on path B and its ways of access and exit were noted. Proper scene documentation involved multiple formats, such as general note taking, photography, videotaping, and sketches and diagrams (4). Each plant was photographed, classified, and collected. In this case report, a digital camera was used. Collected plant specimens were preserved into sterile test tubes. All species were catalogued with labels and compared with the species found on the clothes of the victim. The botanical evaluation was done by macroscopic identification with plant systematics (taxonomy and species identification). Each plant was analyzed on electron microscope.

In particular, the presence of some fragmentation of spikes was investigated. The species found on the path A (Fig. 3) were compared with the type of plant found on the clothes (Fig. 4). The comparison was performed by macroscopic evaluation of plant anatomy. At last, an external examination of victim was performed. All clothes, plants, and external injuries were photographed (Fig. 4), catalogued, described, and measured. Each plant found on the clothes was collected and analyzed. An accurate autopsy was carried out. The organs collected from the old woman were photographed, examined, sectioned, and fixed in formalin at 10%. Findings at autopsy and histological investigation were compared with technical data from crime scene, and Results

Scene Investigation

The victim was an 80-year-old woman, who escaped from a neighboring hospital. In fact, she was affected by dementia with spatial-temporal disorientation. The woman was found under the bridge of the train station. The body lay on the river bed (Fig. 5). in particular, they were compared with the botanical investigation results.

Autopsy Findings

Autopsy findings revealed some interesting aspects. At autopsy, an intracranic hemorrhage and a large fracture of the spine backbone between D12-L1 vertebrae were found. The cause of death revolved around the hypothesis of suicide or accidental fall. The vertebral fracture could be compatible with a suicide/homicide from the bridge (path B) or an accidental fall from the precipice (path A). The autopsy findings were suggestive of a fall from a distance. The confirmation of an accidental fall from a distance was emerged from botanical survey that proved the passage of the old woman affected by dementia along the path A (precipice).

Histological Investigations

At the examination, a chronic ischemic heart disease was evident; vessels showed multiple atheromatus plaques. Both lungs displayed emphysema and fibrosis. At the examination of the encephalon, signs of edema and cerebral congestion were evident, besides an important vertebral osteoporosis highlighted at autopsy.

Botanical Surveys

The clothes of the victim were analyzed and collected, and some species of plants were entangled in the clothes. Some types of plants were classified as a Xanthium Orientalis subsp. Italicum found on the clothes of the victim. On the pullover, five samples of Xanthium Orientalis susp Italicum were found (Fig. 4) (10). The same species was found along the path A (Fig. 3). This analysis was conducted with the assistance of botanic experts of Faculty of Naturals Sciences of the University of L’Aquila (Italy). Sand and blades of grass were rolled around spikes of central part of some species of Xanthium Orientalis subsp. Italicum found on the victim (Figs. 6,7), while the plant samples taken on the path A (where the Xanthium Orientalis was localized) did not show these features (Fig. 8). This finding made it possible to reconstruct the dynamics of the sliding of the victim from the point where these plants were localized. In fact, the presence of these debris demonstrated a mechanical trauma in the fall sliding and rolling along the precipice.

Discussion

The examination of the setting allowed to point out two possible paths undertaken by victim before death. The path A, near the station, was characterized by a sandy clay soil with a substantial presence of various plant species and a rural road leading to a precipice. The precipice ended with the river bed; this location was characterized by an area with steep and rough ground. In particular, on the path A, a bush of Xanthium Orientalis subsp. Italicum was found at about 8 m from the victim. Some very similar specimens were found on top of old woman. The macroscopic comparison of the two specimens permitted to establish that the two specimens belong to the same species. The analysis of soil and plant species, along the path B (bridge), has conceded to exclude that victim stepped along that path. In fact, the ground and soil of path B did not show species of Xanthium Orientalis subsp. Italicum. The only way to determine the cause of death was represented by the autopsy.

While in this case, it has been possible to establish the mode of death (for accidental fall across the path A) only with botanical investigation and comparison of specimens found on the victim. The time of death was estimated by the study of ambient temperature, rigor mortis, hypostasis, temperature of the corpse (hepatic and rectal), and gastric contents (11). The harmonization of these data has revealed that death occurred after a few hours from her disappearance. The dynamic of accidental event has been reconstructed by the following: (i) a determination of path taken by the victim; (ii) external injuries on examination; (iii) analysis of Xanthium samples found on the victim; and (iv) presence of sand and blades of grass debris rolled around spikes of these plants. This investigation has allowed to establish that the victim (on the run at night) was not aware of the discontinuity of the ground for her confusional dementia and spatial-temporal disorientation (12).

Probably, the victim was proceeding along the path A when she slipped and felt along the precipice. The fall resulted in external injuries and vertebral fracture at autopsy. The victim tried to find shelter from a few meters away from the point of fall (under the bridge). Her attempt was not been successful. In fact, the old woman’s death occurred soon after. The study showed that the botanical evidence is crucial in the resolution of a case, especially the botanical evidence is important when crime scene and autopsy findings are not sufficient to define the dynamics and the modality of death. In this case, it was not necessary to perform the genetic investigation on shrubs of Xanthium because this plant was not present along the path B. However, it is important in genetic testing of plant to give a greater probative value, especially if represented at more than 1 site (13). At the crime scene, the analysis of places is very important (14).

In particular, botanical investigation is used to identify the crime scene whether the setting is primary or secondary (4) and to identify the modality of death (5). The collaboration with team of botany experts is important; in fact, they cooperate directly with investigators and forensic pathologists. The multidisciplinary investigation is the central focus of forensic science. In this study, only the comparison of the species found by an expert in botany allowed to determine with certainty the probative value of Xanthium Orientalis in the future transition of the victim along the path A. Sand and blades of grass were rolled around spikes of central part of some species of Xanthium Orientalis subsp. Italicum. This data were able to demonstrate that the plant material recovered from the clothing of the woman was deposited at the time of the final fall/incident rather than at some time prior.

Furthermore, by deduction, the presence of botanical elements on clothing has revealed that the woman’s death is incurred as a result of an accident due to a fall from precipice. Moreover, the autopsy data did not allow to define the modality of death but only the cause of traumatic death. In fact, the distance of the drop point from the point of impact of the two paths was the same; it was more than six meters in height. The injuries (fracture of the spine and head trauma) were compatible with trauma from falling that could have occurred both from the bridge (Path B) and over the precipice (Path A). The genetic investigation on Xanthium Orientalis would determine the exact classification of the specimen found on the old woman’s shirt with the shrub found along the path A. In this case, the genetic investigation was not carried out because a plant of Xanthium Orientalis that was not ubiquitous in soils and it was not present along the path B. In conclusion, crime scene evaluation is necessary to preserve and collect crime scene’s features, than showing the relationship of that evidence to the overall scene and other evidence (4).