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2015 ; 72
(3
): 295-300
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Criminal behavior in frontotemporal dementia and Alzheimer disease
#MMPMID25559744
Liljegren M
; Naasan G
; Temlett J
; Perry DC
; Rankin KP
; Merrilees J
; Grinberg LT
; Seeley WW
; Englund E
; Miller BL
JAMA Neurol
2015[Mar]; 72
(3
): 295-300
PMID25559744
show ga
IMPORTANCE: Neurodegenerative diseases can cause dysfunction of neural structures
involved in judgment, executive function, emotional processing, sexual behavior,
violence, and self-awareness. Such dysfunctions can lead to antisocial and
criminal behavior that appears for the first time in the adult or middle-aged
individual or even later in life. OBJECTIVE: To investigate the frequency and
type of criminal behavior among patients with a diagnosed dementing disorder.
DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective medical record
review of 2397 patients who were seen at the University of California, San
Francisco, Memory and Aging Center between 1999 and 2012, including 545 patients
with Alzheimer disease (AD), 171 patients with behavioral variant of
frontotemporal dementia (bvFTD), 89 patients with semantic variant of primary
progressive aphasia, and 30 patients with Huntington disease. Patient notes
containing specific keywords denoting criminal behavior were reviewed. Data were
stratified by criminal behavior type and diagnostic groups. MAIN OUTCOMES AND
MEASURES: Frequencies of criminal behavior and ?² statistics were calculated.
RESULTS: Of the 2397 patients studied, 204 (8.5%) had a history of criminal
behavior that emerged during their illness. Of the major diagnostic groups, 42 of
545 patients (7.7%) with AD, 64 of 171 patients (37.4%) with bvFTD, 24 of 89
patients (27.0%) with semantic variant of primary progressive aphasia, and 6 of
30 patients (20%) with Huntington disease exhibited criminal behavior. A total of
14% of patients with bvFTD were statistically significantly more likely to
present with criminal behavior compared with 2% of patients with AD (P?.001)
and 6.4% were statistically significantly more likely to exhibit violence
compared with 2% of patients with AD (P?=?.003). Common manifestations of
criminal behavior in the bvFTD group included theft, traffic violations, sexual
advances, trespassing, and public urination in contrast with those in the AD
group, who commonly committed traffic violations, often related to cognitive
impairment. CONCLUSIONS AND RELEVANCE: Criminal behavior is more common in
patients with bvFTD and semantic variant of primary progressive aphasia than in
those with AD and is more likely to be an early manifestation of the disorder.
Judicial evaluations of criminality in the demented individual might require
different criteria than the classic "insanity defense" used in the American legal
system; these individuals should be treated differently by the law. The
appearance of new-onset criminal behavior in an adult should elicit a search for
frontal and anterior temporal brain disease and for dementing disorders.