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   JAMA Neurol. 2015 Mar;72(3):295-300. doi: 10.1001/jamaneurol.2014.3781.   
   Criminal behavior in frontotemporal dementia and Alzheimer disease.   
   Liljegren M1, Naasan G2, Temlett J3, Perry DC2, Rankin KP2, Merrilees J2,   
   Grinberg LT2, Seeley WW2, Englund E1, Miller BL2.   
   Author information   
   Abstract   
   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 χ² 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.   
   Comment in   
   Dementia. Criminality can be an early sign of frontotemporal dementia. [Nat   
   Rev Neurol. 2015]   
   PMID: 25559744 [PubMed - indexed for MEDLINE] PMCID: PMC4432918 [Available on   
   2016-03-01]   
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   http://www.ncbi.nlm.nih.gov/pubmed/25559744   
      
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