In the last episode of this long serial that is the Negreira case, the magistrate in charge of the Court of Instruction No. 1 of Barcelona, Joaquín Aguirre, requested a few days ago that a forensic psychiatrist rule whether the former referee investigated for receiving more than seven million euros from FC Barcelona actually suffers from a degenerative disease that prevents him from testifying in court, as El Confidencial reported on September 5.
Shortly after the case broke out publicly, in February of this year, his defense presented a medical report prepared by the Ace Alzheimer Center in Barcelona, where Negreira went with his family in September 2022.. Although the document was not conclusive – the neurologists requested neuroimaging tests to complete the diagnosis – it did mention, as a guide, “mild dementia”, caused by a “possible neurodegenerative disease.”.
The document, of course, is from. Although the family said they went to the center when they saw strange behavior in Enríquez Negreira, such as him neglecting his image or going out in pajamas to drink coffee, the fact that they knew they were being investigated (the Prosecutor's Office started the investigations four months earlier, in May) could have influenced, since if it is proven that the accused really suffers from Alzheimer's, he could be declared unindictable.
“Here there are two aspects to consider,” José Carlos Fuertes Rocañín, renowned forensic psychiatrist, explains to this newspaper.. “The first is if the person is not in a position to testify, which is what it seems they are asking for, due to a mental anomaly, and another thing is to assess imputability, that is, whether or not the person can respond for the acts.” what has been done based on that possible illness”.
Therefore, the judge is obliged to corroborate this diagnosis with an independent professional.. These are not abundant, and surely Judge Aguirre will go to one of the forensic psychiatrists from the Institute of Legal Medicine of Barcelona. Another way they have is to issue a letter to the Barcelona College of Physicians and request a psychiatrist with forensic experience, who would be chosen at random, to act as a judicial expert..
The psychiatric facts
Negreira's defense spoke in its argument of a “beginning of Alzheimer's”, something that bothers Fuertes a lot.. “That doesn't exist, either you have Alzheimer's or you don't,” he explains.. “What does exist is cognitive deterioration, which is usually the beginning of any dementia”.
Dementia is generally understood as a disease characterized by a partial or complete loss of higher mental functions: memory, intelligence, attention or concentration.. Among these, Alzheimer's, which fundamentally affects memory, usually accounts for 70% of all dementias.. In any case, they all begin in the same way, with a deterioration that, fortunately for science and Justice, can be measured..
Dr. José Cabrera boasts that there is no one alive in Spain who has gone to more evaluations of this type than him.. “In these 40 years I have attended 7,000 trials as a forensic psychiatrist,” he explains.. “An Alzheimer's is a deterioration of the brain, and to objectify it before a judge there are psychic tests and medical tests; we, unlike a clinical psychologist, do both: the first consist of examinations, interviews, watching the subject's behavior…. What is known as anamnesis. And then the medical part, which are objective tests: a scan, an MRI, evoked potentials, an encephalogram…”.
In a case like this, the judge makes available to the forensic doctor the documentation provided to the case by the defense and urges him to report, through the examination he considers appropriate, whether or not the accused suffers from that disease, what degree of illness he has. and if this makes it impossible for you to make a declaration.
These professionals are prepared for anything. In front of a forensic psychiatrist, “a person can simulate, which is deliberately deceiving to obtain a benefit, they can oversimulate, about the existence of a real disorder, enlarge or distort it, and they can also dissemble, it also happens that someone has the disease and wants to be considered healthy,” explains Fuertes Rocañín.
How the coroner deals with deception
Of course, it is not as simple as asking the accused directly if he remembers what he is being tried for.. This has a name: selective amnesia, and it is typical of simulation.. Furthermore, dementia usually begins with forgetting the recent past, not the remote one.. Typically, someone with progressive Alzheimer's does not remember what they ate today, but is able to remember if they received hundreds of thousands of euros from an important soccer team between 2001 and 2018..
Therefore, it is necessary to display great subtlety. “First there is a battery of neuropsychological tests, it is not one, there are several,” says Fuertes. A part of these tests is designed, precisely, to indicate if the person is lying, if they want to give a distorted or simply false image of themselves.. “If, for example, in question 7 the subject says that we are not in January and in question 24 he says yes, with all these details a preliminary profile is created that tells the doctor or psychologist if the test can be invalidated because The results don't add up.”. This profile scores three characteristics: it indicates if it is reliable, if it is valid and if it is sensitive..
They are “different types of questions in which the same thing is asked, but in different ways,” defines Cabrera, “then you confuse the accused and he does not have time, there is no brain sufficiently furnished to be able to solve a well-done questionnaire.”.
In addition to the aforementioned tests, if the psychiatrist still had doubts, he could expand the inspection of the accused and perform, for example, a nuclear resonance or a CT scan, which, although not a definitive diagnosis, would offer a very precise photograph of how he is doing. Enríquez Negreira's brain right now. If you suffer, for example, from cortical atrophy: indicative proof that we would be facing a damaged brain, aged prematurely and possibly with Alzheimer's..
And even more conclusive are the two main markers that are known to detect the disease even in a preclinical phase: the tau and beta amyloid proteins, whose presence could also appear in an analysis if necessary.. In the case of the former referee, a distortion in the normal values of these markers would be more evident based on the statements made by his family to those responsible for the Barcelona clinic that issued that preliminary report, where they stated that, since the pandemic, Negreira had presented symptoms. anxiety, memory lapses or incorrect reasoning.
The key to this type of reports is that they must be very solid. An (informed, but subjective) opinion from the coroner is not enough, because something like that is susceptible to being challenged. Unfortunately for those who seek to use the ruse of mental illness as a disqualifying factor to testify or be charged, in legal medicine this is well studied.. “Before simulating dementia, I would simulate any other disease,” says Fuertes Rocañín. “Dementia in that sense is the worst, because it is the one that can most easily be evaluated”.
“Anyone who wants to fake Alzheimer's is not fooling me,” says Cabrera after having evaluated hundreds of defendants.. The key is in the combination of both strategies, psychic and medical.. “Sometimes somatic tests do not show signs of atrophy and, nevertheless, the individual has Alzheimer's,” he adds, “or there may be a false positive in a scan, then with some analyses, well-constructed protocols and tests specifically made to catch the cheater…. you know yes or yes”.
The report is usually completed in one or two weeks, depending on the case, and what the judge receives will consist of several parts. First, a preamble detailing who the author of the document is and what their credentials are. Next, an expository part: the clinical history of the subject from birth to the present moment, and, then, the complementary examinations. “In the end, what is given is a percentage, not an estimate, but 'the probability is 70% that this subject has a deterioration in spatial abilities and sensory abilities.'”
Then comes another very different game, which is to transfer that knowledge to the world of law to understand what it can mean for the future of the case. “The forensic report must clarify, it must not leave doubts and ambiguities,” says Fuertes Rocañín.
