title: Criminal behavior in frontotemporal dementia and Alzheimer disease.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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
  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.
authors.affiliation: Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Liljegren
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California, San Francisco.
authors.forename: Georges
authors.initials: G
authors.lastname: Naasan
authors.affiliation: Department of Medicine, University of Notre Dame, Fremantle, Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Temlett
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California, San Francisco.
authors.forename: David C
authors.initials: DC
authors.lastname: Perry
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California, San Francisco.
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Rankin
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California, San Francisco.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Merrilees
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California, San Francisco.
authors.forename: Lea T
authors.initials: LT
authors.lastname: Grinberg
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California, San Francisco.
authors.forename: William W
authors.initials: WW
authors.lastname: Seeley
authors.affiliation: Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Englund
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California, San Francisco.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Miller
mesh_terms: D000342:Affective Symptoms / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D057237:Criminals / Q000523:psychology*; D005260:Female; D057180:Frontotemporal Dementia / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D013800:Theft / Q000523:psychology; D014754:Violence / Q000523:psychology*