Shortly after she suffered a stroke in 2001, Flora L'Heureux was shown a single document that turned her life upside down.
The paper, called a Form 1, stated that she had "poor insight and judgment" associated with "frontal lobe dementia" and recommended she be assigned a legal guardian. It was signed by a doctor.
That was the start of a medical and legal process that would grant a public guardian control of where the Edmonton resident lived, how she managed her assets and who she chose as a doctor.
"I nearly choked on my breakfast," recalled the 76-year-old former businesswoman from her room in a long-term care facility of the moment she saw the doctor's form.
"How could they come to that conclusion? I'd never acted out or anything. With that little paper, my entire independence was gone."
On Monday, Ms. L'Heureux appeared in an Edmonton court to challenge her legal status as a "dependent adult," someone whose cognition is impaired to such a degree that they can't manage their own lives.
A judge adjourned the case until Sept. 17.
The case highlights one of the more troubling tasks both doctors and lawyers face when dealing with cognitive decline among the elderly.
In Alberta alone, 10,000 people like Ms. L'Heureux have had responsibility for their financial and personal affairs handed off to a public guardian.
The legal and medical path from full-functioning adult to dependent elder is wrought with imprecise science and legal proceedings open to nefarious intent - flaws that some seniors' groups insist warrant an overhaul of the entire system by which seniors are ruled incompetent.
"We are dealing with more and more people like Flora who've had all responsibility robbed from them," said Ruth Maria Adria, head of the Elder Advocates of Alberta Society, which is championing Ms. Adria's cause. "It's just far too easy to make someone a dependent adult."
Ms. L'Heureux attends college classes, buys groceries, makes her own coffee and has scored well on mental capacity tests in the past.
But taking stock of a person's ability to care for themselves is not a perfect science, according to doctors. Even as physicians adopt new cognitive tests, the process can be very subjective.
"There are grey zones," says David Hogan, chair of geriatric medicine at the University of Calgary. "Some doctors look at a cluster of facts and say the patient has capacity; someone else might look at those facts and say the person doesn't have capacity."
Some seniors decide to get their heads checked of their own volition; others are pushed into it by relatives, doctors or judges.
Doctors administer a series of tests when evaluating a person's mental capacity. The best-known is called the Mini-Mental. Patients must complete a series of timed tasks ranging in difficulty from routine (What country are we in?) to complex (Write any complete sentence on a piece of paper in 30 seconds).
The tasks can seem mundane, but the time limits can induce stress, and a mind under stress is more apt to reveal signs of dementia.
Some doctors also conduct a Montreal Cognitive Assessment, or MoCA, designed by a researcher at McGill University to detect mild impairment of the frontal lobe. The lobe controls social conduct and insight - qualities that often begin to erode before memory, damaging the judgment of a person who might seem fine.
Kenneth Rockwood, a geriatric specialist with Dalhousie University in Halifax, once had a patient who passed most written tests - "He could spell the prime minister's name backwards, no problem," Dr. Rockwood remembers - and yet, when the patient was visiting a resort and spotted some scantily clad women, he judged it okay to take his clothes off.
"By his thinking, he couldn't see that there was anything wrong with that," Dr. Rockwood said.
