From: hounddog23x@gmail.com   
      
   New Criminal Behavior May Signal Frontotemporal Dementia    
   Pauline Anderson    
   January 05, 2015    
        
   New criminal behaviors, such as theft, sexual advances, and violence, can be   
   the first manifestation of dementia, and the frequency and type of such   
   behaviors may provide clues to a specific underlying neurodegenerative   
   disorder, according to a new study.   
       
      
   The study showed that new criminal activity is associated with behavioral   
   variant frontotemporal dementia (bvFTD) and semantic variant primary   
   progressive aphasia (svPPA), which can affect impulsiveness and inhibition.   
   However, such behaviors are much    
   less likely among patients with Alzheimer's disease (AD).    
      
   The study findings suggest that neuropsychological testing to rule out   
   involvement of a neurodegenerative disease might be beneficial for older   
   first-time offenders, said study author Georges Naasan, MD, assistant   
   professor, neurology, and clinical    
   director, Memory and Aging Center, University of California at San Francisco   
   (UCSF).    
      
   Previous studies had similar findings but were much smaller, Dr Naasan told   
   Medscape Medical News. "We were confirming what we knew before, but also   
   adding a sort of comparative flavor as to the differences between people with   
   frontal types of dementia    
   and other types of dementia."    
      
   While bvFTD and svPPA affect the frontotemporal circuit, and the inherited   
   Huntington disease (HD) affects the frontal-subcortical circuit, AD primarily   
   affects the hippocampal and posterior parietal-temporal circuits.    
      
   The study is published online January 5 in JAMA Neurology.    
      
   Driving Violations, Theft    
      
   Researchers reviewed the medical records of 2397 patients who were seen at the   
   UCSF Memory and Aging Center between 1999 and 2012. A retrospective study   
   design allowed investigators to analyze a very large number of patients with   
   rare disorders who    
   present infrequently.    
      
   To identify criminal behavior, they screened an electronic database containing   
   13,477 patient notes for key words such as "arrest," "court," "embezzle," and   
   "jail." From this process, they identified 204 patients as having demonstrated   
   criminal behavior    
   during their illness.    
      
   The major diagnostic groups were bvFTD (n = 64), svPPA (n = 24), AD (n = 42),   
   and HD (n = 6). Other diagnostic groups, including corticobasal syndrome, mild   
   cognitive impairment, vascular dementia, and progressive supranuclear palsy,   
   were not included in    
   the analysis.    
      
   Researchers stratified the criminal behaviors into the following categories:   
   driving under the influence, hit and run, traffic violations, speeding,   
   insubordination toward legal authorities, sexual advances, loitering, public   
   urination, theft,    
   trespassing (volitional vs wandering), and violence. They included only   
   criminal behaviors that occurred during the patient's illness.    
      
   Calculating the frequency of criminal behavior, researchers found that the by   
   FTD group had the highest percentage of criminal behaviors (37.4%), followed   
   by svPPA (27.0%) and HD (20.0%). Patients with AD were among the least likely   
   to commit crimes (7.7%   
    P < .001).    
      
   The odds ratio for criminal behavior in patients with FTD compared with those   
   with AD was 7.2 (P < .001), and in patients with svPPA compared with those   
   with AD, it was 4.4 (P < .001). Criminal behavior as a first presentation was   
   found in 14.0% of    
   patients with bvFTD, 7.8% of patients with svPPA, and 2.0% of patients with AD   
   (P < .001).    
      
   As for the type of crime, patients with bvFTD were significantly more likely   
   to commit all crimes except hit-and-run accidents. About 6.4% of those with   
   bvFTD exhibited violence (about half verbal and half physical) during their   
   illness compared with 3.4%   
    of patients with svPPA and 2.0% of patients with AD (P = .30 and .003,   
   respectively).    
      
   Sexual Advances    
      
   In patients with bvFTD, sexual advances, theft, and public urination were   
   common manifestations of their illness, occurring as the presenting symptom in   
   14.0% of these persons. According to the authors, changes to the ability to   
   avoid punishment are    
   characteristic of anterior insular and lateral orbital frontal injury, areas   
   that are particularly vulnerable to bvFTD.    
      
   "People with frontotemporal dementia don't have a lot of social inhibitions,   
   and they really try to seek rewards, or things that make them feel happy,"   
   commented Dr Naasan. "So they engage in trespassing because they enjoy being   
   in a particular place, or    
   they steal things because, in their minds, they're not stealing."    
      
   For the svPPA group, theft and traffic violations accounted for almost all   
   pathologic behaviors. The authors noted that the anatomic substrate of svPPA   
   is bilateral anterior temporal with some involvement of the orbitofrontal   
   regions, and that anterior    
   temporal degeneration, combined with disinhibition due to orbitofrontal   
   dysfunction, likely accounts for the propensity to steal.    
      
   Some patients with svPPA have an intense visual preoccupation and a compulsive   
   attraction to small objects. They may have lost the capacity to know the   
   meaning of these objects, so they may be holding a cup in their hand but have   
   no idea what it is, said    
   Dr Naasan.    
      
   Their propensity to steal is due in part to compulsiveness, added Dr Naasan.   
   "They can't control the impulse. They see a shiny object that they like; they   
   have no idea of what it is, but they take it anyway."    
      
   Patients with HD also display impulsiveness. Crimes committed by such   
   participants in the study included traffic violations, trespassing, and   
   violence.    
      
   "People with HD do a lot of things based on impulsive anger," noted Dr Naasan.   
   "They are more likely to be the person who, stuck in traffic, doesn't want to   
   wait anymore and so charges ahead and hits someone in front of them. They're   
   impulsive and they    
   have a lot of mood problems so the combination of the two sort of leads to   
   their behavior."    
      
   While bvFTD and svPPA affect the front part of the brain, and so affect social   
   behavior, AD affects the back part of the brain, or memory. "There is some   
   evidence to suggest that Alzheimer's patients are even more social than other   
   people," said Dr    
   Naasan. "Since the back part of their brain is sort of turned off in a way, or   
   is not working, the front part is taking over and it's over compensating. So   
   these patients can become overly nice or socially appropriate."    
      
      
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