Abstract
Criminal and socially inappropriate behavior is encountered among patients with dementia, and it is sometimes the first sign of a dementing disorder. This behavior constitutes a significant burden to society, patients' relatives, and patients themselves. To investigate and compare the prevalence and type of criminal and socially inappropriate behavior, as well as recurrence of criminal behavior, associated with Alzheimer disease (AD) and frontotemporal dementia (FTD) neuropathologically verified post mortem, and to assess whether there is a specific type of protein pathology more closely associated with criminal behavior in patients with FTD. Cohort study using medical record review of 220 Swedish patients with a postmortem neuropathologic diagnosis of AD (n = 101) or frontotemporal lobar degeneration (n = 119) (hereinafter referred to as FTD) diagnosed between January 1, 1967, and December 31, 2017. Patient notes containing reports of criminal and socially inappropriate behavior, as well as data on dominant protein pathology for patients with FTD, were duly reviewed and recorded. The Fisher exact test or logistic regression was used to assess possible differences between groups. Of the 220 patients studied, 128 (58.2%) were female, the median (range) age at disease onset was 63 (30-88) years and at death was 72 (34-96) years, and the median (range) disease duration was 9 (1-28) years. Instances of criminal behavior were found in 65 of the 220 patients (29.5%): in 15 of the 101 patients (14.9%) with AD and 50 of the 119 patients (42.0%) with FTD (P < .001). Recurrence of criminal behavior was significantly higher in the FTD group (89.0%) than in the AD group (53.3%) (P = .04). Instances of socially inappropriate behavior were found in 57 patients (56.4%) with AD and 89 (74.8%) with FTD (P = .004). An expression of non-tau pathology increased the odds for criminal behavior by a factor of 9.0 (95% CI, 3.4-24.0) among patients with FTD. These results suggest that criminal and socially inappropriate behaviors may be more prevalent and criminal behaviors may be more recurrent in patients with FTD than in those with AD. Non-tau pathology, but not tau pathology, appears to be associated with criminal behavior. These findings may help with the clinical diagnostic process.
Highlights
Previous research has shown that criminal behavior and socially inappropriate behavior are encountered among patients with dementia; they are sometimes the first sign of a dementing disorder.[1,2] Criminal behavior ranges from violence to sexual advances, theft, and traffic violations.[3,4,5,6,7] Socially inappropriate behavior may manifest as impulsive and disinhibited action, including open talk about private matters, rude comments to others, and maladaptive emotional reactions.[8]
An expression of non-tau pathology increased the odds for criminal behavior by a factor of 9.0 among patients with frontotemporal dementia (FTD)
These results suggest that criminal and socially inappropriate behaviors may be more prevalent and criminal behaviors may be more recurrent in patients with FTD than in those with Alzheimer disease (AD)
Summary
Previous research has shown that criminal behavior and socially inappropriate behavior are encountered among patients with dementia; they are sometimes the first sign of a dementing disorder.[1,2] Criminal behavior ranges from violence to sexual advances, theft, and traffic violations.[3,4,5,6,7] Socially inappropriate behavior may manifest as impulsive and disinhibited action, including open talk about private matters, rude comments to others, and maladaptive emotional reactions.[8]. In the context of neurodegenerative diseases, deviant behaviors are often associated with damage to the frontotemporal areas.[8,9,10] Criminal and socially inappropriate behaviors constitute a significant burden to society, patients’ relatives, and patients themselves; they may result in substantial financial loss and caregiver distress.[11,12,13,14]
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