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 There is a subgroup of people, especially older adults who are
first-time offenders, who may have a degenerative brain disease
underlying their criminal behavior, said Dr. Georges Naasan of the
Memory and Aging Center and Department of Neurology at the
University of California, San Francisco.
He and his coauthors reviewed the medical records of 2,397 patients
diagnosed with Alzheimer’s disease or other types of dementia
between 1999 and 2012. They scanned patient notes for entries about
criminal behavior using keywords like ‘arrest,’ ‘DUI,’ ‘shoplift’
and ‘violence’ and uncovered 204 patients, or 8.5 percent, who
qualified.
Their behaviors were more often an early sign of frontotemporal
dementia (bvFTD) or primary progressive aphasia (PPA), a type of
language-deteriorating dementia, than of Alzheimer’s disease.
Of the ‘criminal’ group, 64 had bvFTD, 24 had PPA, 42 had
Alzheimer’s, and the rest had various other forms of dementia.
Patients with bvFTD or PPA tended to be younger, averaging 59 to 63
years old, compared to Alzheimer’s patients, who were an average age
of 71, when their doctors made notes about criminal behaviors.
More than 6.4 percent of those in the “criminal group” with bvFTD
exhibited physical or verbal violence during their illness, compared
to 3.4 percent of those with PPA and two percent of those with
Alzheimer’s disease, the researchers reported in JAMA Neurology.
For four percent of patients with bvFTD, violence was one of the
first symptoms of their brain disease.
Men were considerably more likely than women to make sexual advances
to others and to urinate in public.
If patients have a family history of the neurodegenerative disease,
it may be possible to connect new criminal behavior to an underlying
problem with the brain, Naasan said.
“However, most of these diseases are 'sporadic' meaning that they
occur for no identifiable genetic cause and it is difficult to
predict,” he said. “In general, an early detection of changes in
personality, deviation from what constituted a ‘norm’ for a
particular individual, should prompt an evaluation for possible
brain causes.”
Early signs of bvFTD can include personality changes including
disinhibition, lack of empathy, loss of motivation or apathy, or
obsessive-compulsive behavior, he said.
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“It is sometimes hard to wrap our minds around the concept that a
specific part of our brain is not functioning properly, leading to
behaviors that may range the gamut of disruptive, detached and
sometimes criminal,” Naasan said.
Family and friends can easily take these behavior changes
personally, but they should understand that it may be the first sign
of a disease and should request a medical evaluation, he said.
“The amoral conduct seen in FTD spectrum disorders strikes the
examiner as patient’s deliberate choice, these individuals seem
selfish and temperamental with little regard for their worried and
frustrated family members,” said Dr. Adonis Sfera, staff
psychiatrist at Patton State Hospital in Orange County, California,
who was not part of the new research.
“As their behavior looks like mental illness, some of these people
end up admitted in psychiatric hospitals, while others are
imprisoned or placed in state psychiatric hospitals after being
diagnosed with antisocial personality disorder,” Sfera told Reuters
Health by email.
It’s difficult to say how much crime may be due to these types of
causes, Naasan told Reuters Health by email.
He and his colleagues did not survey criminal records and so they
can’t say what percentage of all people who commit crimes have
neurological disorders.
Health care providers are not usually familiar with FTD, and
frequently misdiagnose it as bipolar disorder or late onset
schizophrenia, he added.
FTD spectrum disorders can be accurately diagnosed with so-called
PET scans (positron emission tomography) and neuropsychological
testing, “but only if we think of it,” Naasan said.
SOURCE: http://bit.ly/1xLrXw4
JAMA Neurology, January 5, 2015.
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