The Unique Predisposition to Criminal Violations in Frontotemporal Dementia

Department of Neurology, University of California at Los Angeles, USA.
The journal of the American Academy of Psychiatry and the Law (Impact Factor: 0.93). 09/2010; 38(3):318-23.
Source: PubMed


Brain disorders can lead to criminal violations. Patients with frontotemporal dementia (FTD) are particularly prone to sociopathic behavior while retaining knowledge of their acts and of moral and conventional rules. This report describes four FTD patients who committed criminal violations in the presence of clear consciousness and sufficiently intact cognition. They understood the nature of their acts and the potential consequences, but did not feel sufficiently concerned to be deterred. FTD involves a unique pathologic combination affecting the ventromedial prefrontal cortex, with altered moral feelings, right anterior temporal loss of emotional empathy, and orbitofrontal changes with disinhibited, compulsive behavior. These case histories and the literature indicate that those with right temporal FTD retain the capacity to tell right from wrong but have the slow and insidious loss of the capacity for moral rationality. Patients with early FTD present a challenge to the criminal justice system to consider alterations in moral cognition before ascribing criminal responsibility.

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    • "Psychopathy, for instance, is characterized by specific impairments in emotional empathy [3] and by specific deficits in recognizing emotions and distress in others [7], [8]. Emotional empathy is also disrupted in alcohol dependence and frontotemporal dementia and in some sex offenders [9]–[11]. Although the widely observed impairments in emotional empathy point to the clinical importance of understanding this ability, few animal models have historically been proposed for its study. "
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    ABSTRACT: Empathy is an important psychological capacity that involves the ability to recognize and share emotions with others. In humans, empathy for others is facilitated by having had a similar prior experience. It increases with the intensity of distress that observers believe is occurring to others, and is associated with acute emotional responses to witnessing others' distress. We sought to develop a relatively simple and fast mouse model of human empathy that resembled these characteristics. We modeled empathy by measuring the freezing of observer mice to observing the footshock of a subject mouse. Observer mice froze to subject footshocks only when they had a similar shock experience 24 hours earlier. Moreover, this freezing increased with the number of footshocks given to the subject and it was accentuated within seconds after footshock delivery. Freezing was not seen in naïve observers or in experienced observers that observed a subject who was spared footshock. Observers did not freeze to a subject's footshock when they had experienced a swim stress 24 hours prior, demonstrating a specific effect for shared experience, as opposed to a generalized stressor in eliciting observer mouse freezing. We propose that this two-day experimental protocol resembles many aspects of human empathy in a mouse model that is amenable to transgenic analysis of neural substrates for empathy and its impairment in certain clinical disorders.
    Full-text · Article · Sep 2013 · PLoS ONE
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    • "Ce sont surtout les troubles de la cognition sociale qui caractérisent la DFT : trouble de reconnaissance des émotions, sur les visages [40] et dans la voix [41], capacité d'attribuer les états mentaux de soi-même et d'autrui (théorie de l'esprit) évalués par le test des faux pas, des fausses croyances, des sarcasmes ou du jugement moral [42] [43]. La reconnaissance de ces troubles est un enjeu de responsabilité pénale car l'altération du jugement moral, de l'empathie émotionnelle, et les conduites désinhibées et compulsives de ces patients peuvent être associées à une bonne connaissance des règles morales et des conventions, la préservation des capacités à distinguer les « bonnes » et les « mauvaises » conduites, une conscience de leurs actes, une bonne mémoire et de bonnes performances aux tests d'évaluation cognitive globales comme le MMS, mais sans rationalité morale [44]. "
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    ABSTRACT: Frontotemporal dementias (FTD) are defined by a gradual change in social conduct, behavior and language, associated with frontal and anterior temporal lobe degeneration. The clinicalfeatures depend on the location of the degenerative process. In the last 20 years, increasingly specific and sensitive operational criteria have been established. Ongoing neuropathological and genetic studies have highlighted overlaps between FTD, motor neuron disease, and atypical parkinsonian syndromes (supranuclear palsy, corticobasal degeneration). They have also provided a better knowledge of the pathophysiology of FTD, and new specific therapeutic targets. These dementias, which usually occur before the age of 65 years, are now better recognized but are still underdiagnosed and often initially mistaken for psychiatric illnesses. Healthcare professionals managing these patients must therefore be better informed Serotonergic agents provide a symptomatic improvement, but environmental adaptation, prevention of language and swallowing difficulties, and information and support for the family and caregivers remain essential.
    Full-text · Article · Feb 2012 · Bulletin de l'Académie nationale de médecine
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    • "These findings suggest that executive dysfunction underlies some, but not all, of these deficiencies. A recent report described four patients with FTLD, but also with a clear consciousness (i.e., when specific actions were pointed out, these were not denied; the subjects described the actions in detail, and agreed that they were both wrong and harmful) and sufficiently intact cognition (i.e., defined by neuropsychological assessment), who committed criminal violations (Mendez, 2010). They understood the nature of their acts and the potential consequences, but did not feel sufficiently concerned to be deterred. "
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    ABSTRACT: This paper reviews findings in three subcomponents of social cognition (i.e., Theory of Mind, facial emotion recognition, empathy) during ageing. Changes over time in social cognition were evaluated in normal ageing and in patients with various neurodegenerative pathologies, such as Alzheimer's disease, mild cognitive impairment, frontal and temporal variants of frontotemporal lobar degeneration and Parkinson's disease. Findings suggest a decline in social cognition with normal ageing, a decline that is at least partially independent of a more general cognitive or executive decline. The investigation of neurodegenerative pathologies showing specific deficits in Theory of Mind in relation to damage to specific cerebral regions led us to suggest a neural network involved in Theory of Mind processes, namely a fronto-subcortical loop linking the basal ganglia to the regions of the frontal lobes.
    Full-text · Article · Dec 2011 · Ageing research reviews
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