By Will Boggs MD
NEW YORK—Patients with frontotemporal dementia (FTD) are more likely than patients with Alzheimer disease to manifest criminal or socially inappropriate behavior, according to a Swedish medical records review.
"Criminal and socially inappropriate behaviors could be signs of dementia," Dr. Madeleine Liljegren of Lund University told Reuters Health by email. "When previously law abiding citizens start to behave in an odd way or even commit crimes, we suggest that they be screened for neurodegenerative disorders. This could potentially lead to a shorter time from symptom onset to diagnosis and hence proper care in time. The odd behaviors constitute a significant burden to society, patients' relatives, and the patients themselves."
These inappropriate behaviors are sometimes the first sign of a demanding disorder, but it has remained unclear whether patients with certain types of dementia are more predisposed to criminal and socially inappropriate behaviors.
Dr. Liljegren and colleagues used data from 119 patients with a diagnosis within the FTD spectrum and 101 patients with a diagnosis of Alzheimer disease to compare the prevalence, recurrence and type of criminal and socially inappropriate behavior between the two groups.
Criminal behavior was significantly more common in the FTD group (50 incidents/119 patients, 42.0%) than in the Alzheimer disease group (15 incidents/101 patients, 14.9%), a 3.5-fold increased in odds after adjusting for age and sex.
Criminal behavior recurrence rates were also significantly higher among patients with FTD (82.0%) than among patients with Alzheimer disease (53.3%), the team reported in JAMA Network Open, online March 29.
Similarly, significantly more patients with FTD (74.8%) than with Alzheimer disease (56.4%) exhibited socially inappropriate behavior during the course of their disease, a 2.2-fold increase in odds after adjustment.
Most patients in both groups who exhibited criminal behavior also exhibited socially inappropriate behavior.
Just under half of the patients in both groups who exhibited criminal behavior did so for the first time during the first half of their disease course.
Within the FTD group, among patients who exhibited criminal behavior, the expression of tau pathology was less common than the expression of non-tau pathologies. Expression of non-tau pathologies was associated with 9.0-fold higher odds for criminal behavior, a significant increase.
"To our knowledge, protein pathology in relation to criminal behavior has not previously been presented," Dr. Liljegren said.
"These findings might help in the clinical diagnostic process, especially when the clinical picture is unclear and the differential diagnoses are difficult to distinguish," she said. "FTD patients can sometimes verbalize that their actions are wrong but proceed with their criminal behavior. This is especially problematic when FTD patients are facing criminal charges and something the judicial system should be aware of and take into account when handling these patients."
"I hope that we will see prospective studies, including imaging, on this matter with neuropathological follow-up in the future," Dr. Liljegren said. "I believe the health care system, the police force, and the judicial system need to be more vigilant when meeting these individuals."
"Today none of the various universities and schools for higher education providing police education in Sweden offers specific training in meeting or handling people with dementia," she said. "We believe that a basic training program for police officers, focusing on age-related health and dementia, would be useful in Sweden to increase the police force’s knowledge and skills and to avoid harmful situations. It is important that the judiciary system and especially the police force are vigilant when it comes to socially deviant, criminal, and antisocial behavior in middle-aged and older adults."
JAMA Netw Open 2019.
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