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   Dement Geriatr Cogn Dis Extra. 2011 Jan-Dec; 1(1): 433–438.   
   Published online 2011 Dec 24. doi:  10.1159/000330929   
   PMCID: PMC3265807   
   Criminal Manifestations of Dementia Patients: Report from the National   
   Forensic Hospital   
      
   Jeong-Min Kim,a,b Kon Chu,a,b Keun-Hwa Jung,a,b Soon-Tae Lee,a,b Sang-Sub   
   Choi,c and Sang Kun Leea,b,*   
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   Abstract   
   Background/Aims   
      
   Some dementia patients have profound behavioral and psychological symptoms   
   which might cause legal violation. We illustrate clinical and criminal   
   characteristics of dementia patients who had been incarcerated because of   
   criminal activity.   
      
   Methods   
      
   The National Forensic Hospital is the only hospital-based correctional   
   facility in the Republic of Korea which incarcerates criminals with   
   psychiatric or neurological disease. Between May 2008 and April 2009, those   
   patients who had been diagnosed with    
   dementia in the National Forensic Hospital were included in the study. We   
   reviewed their medical and legal reports.   
      
   Results   
      
   There were 7 dementia patients out of 752 patients, including 2 Alzheimer's   
   disease (AD) patients, 1 vascular dementia patient, and 4 patients with   
   alcohol-related dementia. Criminal behavior included simple larceny by the 2   
   AD patients, and multiple    
   violent crimes in a drunken state by the other 5 patients.   
      
   Conclusions   
      
   This study reported diverse criminal behaviors among dementia patients.   
   Inebriation may be related to violent criminal behavior among some dementia   
   patients.   
      
   Key Words: Dementia, Violence, Crime, Behavioral disorders   
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   Introduction   
   The present time is characterized by a rapid increase in the aged population.   
   As the elderly population expands, it is conceivable that various unexpected   
   problems concerning dementia patients will be encountered. Abusive or criminal   
   behavior toward    
   dementia patients has been a major concern in countries with aging   
   populations, and warrants adequate action for the protection of dementia   
   patients [1]. On the other hand, it may be also possible that legal violation   
   by dementia patients will become    
   another distressing problem in the future, considering that behavioral and   
   psychosocial dysfunction are sometimes associated with patients with advanced   
   dementia [2,3]. Several studies have reported increased aggressive behavior in   
   dementia patients    
   compared with the normal population [4]. Another study reported that the most   
   common medical condition in elderly criminals was alcohol abuse, followed by   
   dementia [5]. A transgenic animal model of Alzheimer's disease (AD) showed   
   increased violence    
   compared with wild-type animals [6]. It may be important to find potential   
   factors triggering criminal behavior in dementia patients to prevent unwanted   
   sequelae. In this study, we reviewed criminal cases committed by 7 dementia   
   patients in various    
   situations and suggested possible criminogenic risk factors.   
      
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   Patients and Methods   
   The National Forensic Hospital is the only hospital-based correctional   
   facility in the Republic of Korea that incarcerates criminals with psychiatric   
   or neurological disease. Those criminals who have committed crimes as a   
   manifestation of their    
   psychiatric or neurological disease in South Korea are sent to this forensic   
   hospital by the court system. The majority of the incarcerated criminals were   
   diagnosed with psychiatric diseases including schizophrenia, bipolar disorder,   
   and major depressive    
   disorder (92.8%). Other minor diseases include intellectual disability,   
   epilepsy, dementia, and substance abuse. When a patient with progressive   
   cognitive decline is admitted, we perform the Seoul Neuropsychological   
   Screening Battery (SNSB) including    
   mini-mental status examination (MMSE), electroencephalography, and brain   
   magnetic resonance imaging (MRI). We also perform blood tests including those   
   for thyroid function, Venereal Disease Research Laboratory titer, human   
   immunodeficiency virus antibody,   
    vitamin B, and folate level. Dementia diagnosis is made according to the   
   Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)   
   guidelines by a neurologist and psychiatrist. Dementia subtype is determined   
   according to the criteria    
   from the National Institute of Neurological and Communicative Disorders and   
   Stroke and the Alzheimer's Disease and Related Disorders Association, DSM-IV   
   guideline, and Oslin's criteria [7]. Once the diagnosis is made, we measure   
   global deterioration    
   scale (GDS), Hachinski score, and clinical dementia rating (CDR) regularly.   
   Between May 2008 and April 2009, the dementia patients who had been   
   incarcerated in the National Forensic Hospital were enrolled in this study. We   
   retrospectively reviewed their    
   medical and legal reports. Violent crime was defined to include homicide,   
   attempted murder, rape, assault, arson, and robbery. This study was reviewed   
   and approved by the institutional review board of the National Forensic   
   Hospital in Korea.   
      
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   Results   
   There were a total of 7 dementia patients out of 752 incarcerated prisoners.   
   The age spectrum of dementia patients was between 54 and 63 years, and there   
   was 1 female patient. Clinical characteristics of the dementia patients are   
   indicated in table ​   
   table1.1. The range of MMSE scores was 16–24, and dementia subtypes included   
   2 probable AD patients, 1 vascular dementia (VD) patient, and 4    
   lcohol-related dementia (ARD) patients. Five patients (ARD+VD) had a history   
   of harmful use of alcohol and had    
   experienced at least one episode of head trauma. The VD patient had   
   experienced two episodes of ischemic stroke and one hemorrhagic stroke. He was   
   also diagnosed with a meningioma on his left frontal convexity, which was   
   removed by surgical treatment    
   after admission. SNSB showed that all the patients had considerable frontal   
   lobe dysfunction, and brain MRI disclosed various degrees of atrophic change   
   because of head trauma, stroke, and probably dementia itself (fig.   
   ​(fig.1).1). No patient had    
   clinically significant findings on their blood serum tests. One AD patient   
   progressed considerably during her incarceration such that her sentence was   
   suspended and she was transferred to a nursing hospital after 5 years.   
   However, the progression of 4    
   ARD patients was relatively slow or stationary, although cognitive function   
   was not restored after a prolonged period of alcohol abstinence.   
      
   Fig. 1   
   Fig. 1   
      
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