13 Jan 2015
For some, it starts with stealing candy. For others, it’s a reckless car crash, or a sudden penchant to urinate in public. The type of incident varies, but according to a study published January 5 in JAMA Neurology, more than a third of people with frontotemporal dementia (FTD) act out criminal behaviors. In some cases, the odd conduct is the first clear signal to their loved ones that something is way off. Led by Bruce Miller at the University of California, San Francisco, the study also reported bad behavior in people with Alzheimer’s and Huntington’s diseases; however, those patients’ misconduct tended to surface later in the disease and to a lesser degree than it did in people with FTD. The study raises questions about how the criminal justice system should handle people with FTD and, even more pressingly, concerns about the plight of undiagnosed patients who may be languishing in prisons or on the streets.
FTD Behind Bars?
More than a third of people with FTD act out criminal behavior. How many of them wind up in prison is an open question, particularly for the undiagnosed.[Image courtesy of Auntie P., Flickr Creative Commons.]
Dealing with wayward behavior is nothing new to Miller and other seasoned clinicians who work with FTD patients. “We have seen many examples of these cases over the years, so we thought it was time to put them into the literature,” Miller told Alzforum. “We want people to understand that you have to think very seriously about the brain whenever someone commits a crime, particularly when they commit a crime for the first time after age 50.”
Frontotemporal lobar degeneration (FTLD) chips away at regions of the brain that rein in impulsivity and support inhibition and empathy, thus creating a prime environment for behavior that defies social norms. These problems often emerge while cognition remains intact, so family, friends, and co-workers tend to see the person as rude, odd, or worse, rather than as someone suffering from a neurodegenerative disorder, said co-first author Madeleine Liljegren of Lund University in Sweden. “They get judged as a weird person or sent to a psychiatrist, where they might be misdiagnosed with bipolar disorder or depression,” she said. “If society in general were more aware of these disorders, people could receive proper care from the start and avoid getting into trouble.”