An Australian Study uses an experimental screening tool to examine the propensity and nature of criminal risk behaviors in dementias like FTD. While further research is needed to better understand criminal risk and dementia, the study finds that these behaviors may be more common than previously expected and occur across dementia types.
Study Shows More Severe Criminal Risk Behaviors in FTD than Alzheimer’s
Published in the journal Alzheimer’s & Dementia – Diagnosis, Assessment & Disease Monitoring, the study notes that behavioral changes are typically the earliest and most noticeable dementia symptoms. Because FTD can affect the areas of the brain responsible for regulating behavior, these changes are usually more pronounced in FTD than in other dementias, and can include disinhibition and a loss of empathy for others. Pwith FTD disorders may end up accidentally committing crimes because their sense of social and legal norms has been altered; however, many people with FTD do not show criminal behavior, as the symptoms affect everyone differently.
While the authors identified prior research that showed criminal risk behaviors were more common in behavioral variant FTD (bvFTD), they theorize that the actual prevalence of criminal risk behaviors in dementias is likely an underestimate. To try to capture the prevalence of these behaviors in Australia and to identify predictors of criminal risk for people with dementia, the authors set out to develop and test a novel screening tool.
Creating the Misdemeanors and Transgressions Screener (MATS) began with a literature review to find reported criminal risk behaviors; the resulting list of behaviors was then categorized into broad domains such as traffic violations, financial recklessness, and theft. Researchers accounted for potentially criminal behavior before the onset of dementia during screening. The team asked a care partner, spouse, or family member who spent regular time with a person diagnosed to take the screener while control participants self-reported; the authors noted this as a limitation of their study and encouraged future research to use self-reporting from persons diagnosed instead.
A cohort of people with dementia was recruited through the FRONTIER Dementia Research Group, a specialist dementia clinic operated by the University of Sydney. Of these participants, 64 had bvFTD, 37 had Alzheimer’s disease, and 43 had semantic variant primary progressive aphasia (svPPA) that predominantly affected either the left or right temporal lobe. Fifty-three controls without dementia were recruited from community organizations, websites, and word of mouth. The participants were asked to complete the questionnaire, with the team asking for details and clearing up misunderstandings where necessary.
Onset of New Criminal Risk Behaviors at 50 or Older: A Potential Clinical Sign of FTD
The results of the interviews did not reveal any significant differences between the interviewed groups in history of potential criminal behavior, age, or years of education. In bvFTD, however, the team noticed a higher ratio of men to women who experienced criminal risk behaviors (51 to 13).
Among those experiencing criminal risk behaviors after being diagnosed, 19.1% had interactions with the police as a result; this is a stark contrast to the lack of encounters with police faced by control participants. The authors underscored the role of dementia in this; control participants reported benign infractions such as forgetting to scan at checkout or catching themselves speeding, while people with dementia were involved in more serious incidents, like altercations with strangers or going missing due to roaming/wandering. Participants who answered for people with dementia noted that those who encountered law enforcement faced apprehension, warnings from officers, and, in some cases, being banned from an establishment.
The authors confirmed earlier findings that bvFTD had the highest prevalence of criminal risk behaviors but also found it elevated in people with svPPA, predominantly affecting the right temporal lobe. The most common behaviors experienced by participants with dementia were physical assault, inappropriate behaviors, and financial/professional recklessness, while traffic violations and verbal abuse were common in both persons diagnosed and control participants.
The study notes how the data aligns with earlier work suggesting criminal risk behaviors can result from disinhibition and agitation/paranoia, the former being common in FTD. Underscoring the spike in criminal risk behaviors in bvFTD after diagnosis, the authors also highlight how the onset of uncharacteristic criminal risk behaviors under the age of 50 is a potential clinical sign of FTD. These findings have implications for identifying behaviors early for clinical management and education of frontline workers such as law enforcement and legal professionals to divert people with dementia from the criminal justice system.
As highlighted in an issue of Scientific American, the U.S. Justice System often stumbles when confronted with people who have FTD and other forms of dementia. For more information about criminal risk and FTD, be sure to watch the recording of AFTD’s webinar At The Intersection of FTD and the Law. Are you concerned that you or a loved one may experience these behaviors due to FTD? AFTD’s HelpLine is here to support you – contact the HelpLine at 1-866-507-7222 or [email protected].
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