Police Interactions Among Neuropathologically Confirmed Dementia Patients: Prevalence and Cause.

OBJECTIVE: The aim of this study was to investigate and compare the prevalence and recurrence of police interaction (PI) with patients diagnosed with dementia. We also aimed to study the reason behind the PI, the time of occurrence of PI, and potential consequences of the PI. METHODS: For this retrospective medical records' review, we included 281 cases with a neuropathologic dementia diagnosis from the Department of Pathology, Region Skane/Lund University, between 1967 and 2013. The diagnoses were Alzheimer disease, frontotemporal lobar degeneration, vascular dementia, and mixed dementia. A prerequisite was that extensive clinical investigation and follow-up had been conducted at the Department of Geriatric Psychiatry in Lund. RESULTS: Of the 281 patients studied, 50 (18%) had a history of interacting with the police during the course of their disease. Frontotemporal dementia patients had a relatively higher prevalence of PI and more often due to criminal behavior. The recurrence of PIs differed among the groups; frontotemporal dementia patients exhibited a higher PI recurrence compared with the other groups. CONCLUSIONS: The patterns of PIs differ between the frontotemporal dementia and Alzheimer disease patients. Knowledge about such differences may be of value for the police, the judiciary system, and the society in general.

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 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.