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- Title
Association of Neuropathologically Confirmed Frontotemporal Dementia and Alzheimer Disease With Criminal and Socially Inappropriate Behavior in a Swedish Cohort.
- Authors
Liljegren, Madeleine; Landqvist Waldö, Maria; Frizell Santillo, Alexander; Ullén, Susann; Rydbeck, Robert; Miller, Bruce; Englund, Elisabet
- Abstract
This cohort study reviews medical records to compare the prevalence of criminal and socially inappropriate behavior between Swedish patients with Alzheimer disease and those with frontotemporal dementia confirmed neuropathologically and investigates the association of protein pathology with criminal behavior in the frontotemporal dementia group. Key Points: Question: Is criminal and socially inappropriate behavior more common among patients with frontotemporal dementia than in those with Alzheimer disease, and is a certain type of protein pathology associated with criminal behavior in patients with frontotemporal dementia? Findings: This cohort study of 220 Swedish patients with neuropathologically verified frontotemporal dementia or Alzheimer disease found a significantly higher prevalence of criminal and socially inappropriate behavior among those with frontotemporal dementia compared with those with Alzheimer disease. An expression of non-tau pathology significantly increased the odds for criminal behavior among patients with frontotemporal dementia. Meaning: These findings might help in the clinical diagnostic process, especially when the clinical picture is unclear and the differential diagnoses are difficult to distinguish. Importance: 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. Objectives: 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. Design, Setting, and Participants: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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.
- Subjects
SWEDEN; ALZHEIMER'S disease diagnosis; CRIME; ALZHEIMER'S disease; AUTOPSY; BLOOD protein disorders; COMPARATIVE studies; CONFIDENCE intervals; DEAD; FISHER exact test; DISEASE relapse; LOGISTIC regression analysis; SOCIAL disabilities; BEHAVIOR disorders; DESCRIPTIVE statistics; FRONTOTEMPORAL dementia; ODDS ratio; FRONTOTEMPORAL lobar degeneration; DISEASE complications; DIAGNOSIS; DISEASE risk factors
- Publication
JAMA Network Open, 2019, Vol 2, Issue 3, pe190261
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2019.0261