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Association of Neuropathologically Confirmed Frontotemporal Dementia and Alzheimer Disease With Criminal and Socially Inappropriate Behavior in a Swedish Cohort

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 co...

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Autores principales: Liljegren, Madeleine, Landqvist Waldö, Maria, Frizell Santillo, Alexander, Ullén, Susann, Rydbeck, Robert, Miller, Bruce, Englund, Elisabet
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450313/
https://www.ncbi.nlm.nih.gov/pubmed/30924889
http://dx.doi.org/10.1001/jamanetworkopen.2019.0261
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author Liljegren, Madeleine
Landqvist Waldö, Maria
Frizell Santillo, Alexander
Ullén, Susann
Rydbeck, Robert
Miller, Bruce
Englund, Elisabet
author_facet Liljegren, Madeleine
Landqvist Waldö, Maria
Frizell Santillo, Alexander
Ullén, Susann
Rydbeck, Robert
Miller, Bruce
Englund, Elisabet
author_sort Liljegren, Madeleine
collection PubMed
description 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.
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spelling pubmed-64503132019-04-24 Association of Neuropathologically Confirmed Frontotemporal Dementia and Alzheimer Disease With Criminal and Socially Inappropriate Behavior in a Swedish Cohort Liljegren, Madeleine Landqvist Waldö, Maria Frizell Santillo, Alexander Ullén, Susann Rydbeck, Robert Miller, Bruce Englund, Elisabet JAMA Netw Open Original Investigation 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. American Medical Association 2019-03-29 /pmc/articles/PMC6450313/ /pubmed/30924889 http://dx.doi.org/10.1001/jamanetworkopen.2019.0261 Text en Copyright 2019 Liljegren M et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Liljegren, Madeleine
Landqvist Waldö, Maria
Frizell Santillo, Alexander
Ullén, Susann
Rydbeck, Robert
Miller, Bruce
Englund, Elisabet
Association of Neuropathologically Confirmed Frontotemporal Dementia and Alzheimer Disease With Criminal and Socially Inappropriate Behavior in a Swedish Cohort
title Association of Neuropathologically Confirmed Frontotemporal Dementia and Alzheimer Disease With Criminal and Socially Inappropriate Behavior in a Swedish Cohort
title_full Association of Neuropathologically Confirmed Frontotemporal Dementia and Alzheimer Disease With Criminal and Socially Inappropriate Behavior in a Swedish Cohort
title_fullStr Association of Neuropathologically Confirmed Frontotemporal Dementia and Alzheimer Disease With Criminal and Socially Inappropriate Behavior in a Swedish Cohort
title_full_unstemmed Association of Neuropathologically Confirmed Frontotemporal Dementia and Alzheimer Disease With Criminal and Socially Inappropriate Behavior in a Swedish Cohort
title_short Association of Neuropathologically Confirmed Frontotemporal Dementia and Alzheimer Disease With Criminal and Socially Inappropriate Behavior in a Swedish Cohort
title_sort association of neuropathologically confirmed frontotemporal dementia and alzheimer disease with criminal and socially inappropriate behavior in a swedish cohort
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450313/
https://www.ncbi.nlm.nih.gov/pubmed/30924889
http://dx.doi.org/10.1001/jamanetworkopen.2019.0261
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