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Carbone F, Djamshidian A. Impulse Control Disorders in Parkinson's Disease: An Overview of Risk Factors, Pathogenesis and Pharmacological Management. CNS Drugs 2024; 38:443-457. [PMID: 38613665 PMCID: PMC11098885 DOI: 10.1007/s40263-024-01087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/15/2024]
Abstract
Impulse control disorders in Parkinson's disease are relatively common drug-induced addictive behaviours that are usually triggered by the dopamine agonists pramipexole, ropinirole and rotigotine. This narrative review aimed to provide a comprehensive overview of the current knowledge of impulse control disorders in Parkinson's disease. We summarised the prevalence, clinical features, risk factors and potential underlying mechanisms of impulse control disorders in Parkinson's disease. Moreover, recent advances in behavioural and imaging characteristics and management strategies are discussed. Early detection as well as a tailored multidisciplinary approach, which typically includes careful adjustment of the dopaminergic therapy and the treatment of associated neuropsychiatric symptoms, are necessary. In some cases, a continuous delivery of levodopa via a pump or the dopamine D1 receptor agonist, apomorphine, can be considered. In selected patients without cognitive or speech impairment, deep brain stimulation of the subthalamic nucleus can also improve addictions. Finding the right balance of tapering dopaminergic dose (usually dopamine agonists) without worsening motor symptoms is essential for a beneficial long-term outcome.
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Affiliation(s)
- Federico Carbone
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
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Subramaniam S, Blake DT, Constantinidis C. Cholinergic Deep Brain Stimulation for Memory and Cognitive Disorders. J Alzheimers Dis 2021; 83:491-503. [PMID: 34334401 PMCID: PMC8543284 DOI: 10.3233/jad-210425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 12/20/2022]
Abstract
Memory and cognitive impairment as sequelae of neurodegeneration in Alzheimer's disease and age-related dementia are major health issues with increasing social and economic burden. Deep brain stimulation (DBS) has emerged as a potential treatment to slow or halt progression of the disease state. The selection of stimulation target is critical, and structures that have been targeted for memory and cognitive enhancement include the Papez circuit, structures projecting to the frontal lobe such as the ventral internal capsule, and the cholinergic forebrain. Recent human clinical and animal model results imply that DBS of the nucleus basalis of Meynert can induce a therapeutic modulation of neuronal activity. Benefits include enhanced activity across the cortical mantle, and potential for amelioration of neuropathological mechanisms associated with Alzheimer's disease. The choice of stimulation parameters is also critical. High-frequency, continuous stimulation is used for movement disorders as a way of inhibiting their output; however, no overexcitation has been hypothesized in Alzheimer's disease and lower stimulation frequency or intermittent patterns of stimulation (periods of stimulation interleaved with periods of no stimulation) are likely to be more effective for stimulation of the cholinergic forebrain. Efficacy and long-term tolerance in human patients remain open questions, though the cumulative experience gained by DBS for movement disorders provides assurance for the safety of the procedure.
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Affiliation(s)
- Saravanan Subramaniam
- Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David T. Blake
- Brain and Behavior Discovery Institute, Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Christos Constantinidis
- Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Neuroscience Program, Vanderbilt University, Nashville, TN, USA
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Fostinelli S, De Amicis R, Leone A, Giustizieri V, Binetti G, Bertoli S, Battezzati A, Cappa SF. Eating Behavior in Aging and Dementia: The Need for a Comprehensive Assessment. Front Nutr 2020; 7:604488. [PMID: 33392240 PMCID: PMC7772186 DOI: 10.3389/fnut.2020.604488] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/23/2020] [Indexed: 01/01/2023] Open
Abstract
Eating behavior can change during aging due to physiological, psychological, and social changes. Modifications can occur at different levels: (1) in food choice, (2) in eating habits, and (3) in dietary intake. A good dietary behavior, like the Mediterranean dietary pattern, can be a protective factor for some aging related pathologies, such as dementia, while a worse eating behavior can lead to pathological conditions such as malnutrition. Changes in eating behavior can also be linked to the onset of dementia: for some types of dementia, such as frontotemporal dementia, dietary changes are one of the key clinical diagnostic feature, for others, like Alzheimer's disease, weight loss is a clinical reported feature. For these reasons, it is important to be able to assess eating behavior in a proper way, considering that there are normal age-related changes. An adequate assessment of dietary behavior can help to plan preventive intervention strategies for heathy aging or can help to identify abnormal behaviors that underline aging related-diseases. In this review, we have analyzed normal age-related and dementia-related changes and the tools that can be used to assess eating behavior. Thus, we make recommendations to screening and monitoring eating behavior in aging and dementia, and to adopt these tools in clinical practice.
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Affiliation(s)
- Silvia Fostinelli
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Ramona De Amicis
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| | - Alessandro Leone
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| | - Valentina Giustizieri
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| | - Giuliano Binetti
- Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Simona Bertoli
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy.,Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Obesity Unit and Laboratory of Nutrition and Obesity Research, Milan, Italy
| | - Alberto Battezzati
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| | - Stefano F Cappa
- University School for Advanced Studies, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
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Abstract
Impulse control disorders (ICDs) are neuropsychiatric conditions characterized by the repeated inability to resist an impulse, drive, or temptation to perform an act that is harmful to the person or others. Although classification approaches to ICDs vary both diachronically and synchronically, this group of conditions encompasses a wide range of syndromes, including pathologic gambling, kleptomania, trichotillomania, excoriation (skin picking) disorder, intermittent explosive disorder, pyromania, oppositional defiant, conduct, and antisocial personality disorders. ICDs can play a significant role as comorbidities in both neurodevelopmental (eg, attention-deficit/hyperactivity disorder, Tourette syndrome) and neurodegenerative (eg, Parkinson disease) disorders.
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Affiliation(s)
- Bruno Silva
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK; NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Hugo Canas-Simião
- Department of Psychiatry, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Andrea E Cavanna
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK; Institute of Clinical Sciences, University of Birmingham, Birmingham, UK; School of Life and Health Sciences, Aston University, Birmingham, UK; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK.
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Frileux S, Millet B, Fossati P. Late-Onset OCD as a Potential Harbinger of Dementia With Lewy Bodies: A Report of Two Cases. Front Psychiatry 2020; 11:554. [PMID: 32714212 PMCID: PMC7344181 DOI: 10.3389/fpsyt.2020.00554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Obsessive-compulsive disorder usually begins in adolescence or young adulthood. OCD cases appearing after the age of 50 years are rare, most often associated with inflammatory, brain lesions, or neurodegenerative comorbidities. We describe two cases of late-onset obsessive compulsive disorder followed by the development of Dementia with Lewy Bodies and review the links between these two disorders. METHODS AND RESULTS We describe the clinical history of two patients that first showed OCD symptoms at an atypical age (>60 years). After several failed treatment attempts, they were hospitalized in our unit. Both presented severe sensitivity to antipsychotic agents that led to a diagnosis of Dementia with Lewy Bodies. Administration of cholinesterase inhibitors was associated with decrease of psychiatric symptoms in both cases. In addition to those clinical observations, a systematic review of the literature suggests that, beyond prefrontal cortex, temporal lobe and putamen have important roles in OCD pathophysiology. Based on these findings, we discuss four hypotheses to explain the sequential appearance of OCD and DLB symptoms. First, we considered the possibility that comorbidity of OCD with DLB was coincidental. Second, we propose to interpret OCD symptoms as motor stereotypies. Third, we hypothesize that late-onset OCD might be a symptom of late-onset depression. Four, we hypothesize that through early deterioration of basal ganglia, DLB caused the onset of OCD. CONCLUSION In conclusion, we recommend that cases of late-onset treatment-resistant OCD should be carefully tested for possible organic etiologies, and for DLB in particular.
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Affiliation(s)
- Solène Frileux
- Control-Interoception-Attention Team, Brain Institute of Paris, Paris, France.,Faculty of Medicine, University of Sorbonne Universités UPMC, Paris, France.,Department of Psychiatry, University Hospital La Pitié Salpêtrière, Paris, France
| | - Bruno Millet
- Control-Interoception-Attention Team, Brain Institute of Paris, Paris, France.,Faculty of Medicine, University of Sorbonne Universités UPMC, Paris, France.,Department of Psychiatry, University Hospital La Pitié Salpêtrière, Paris, France
| | - Philippe Fossati
- Control-Interoception-Attention Team, Brain Institute of Paris, Paris, France.,Faculty of Medicine, University of Sorbonne Universités UPMC, Paris, France.,Department of Psychiatry, University Hospital La Pitié Salpêtrière, Paris, France
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Lewis C, Walterfang M, Velakoulis D, Vogel AP. A Review: Mealtime Difficulties following Frontotemporal Lobar Degeneration. Dement Geriatr Cogn Disord 2019; 46:285-297. [PMID: 30423586 DOI: 10.1159/000494210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/01/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) can result in a decline in behavior, language, and motor function. Mealtime disturbances are a common and significant outcome of FTLD. Disturbances during mealtimes can arise from dysphagia or may occur secondary to behavioral changes such as rapid eating, mealtime rigidity, and altered diet preferences. SUMMARY Few studies have comprehensively evaluated eating behavior or dysphagia in individuals presenting with FTLD pathology despite the potential impact on medical safety and individual quality of life. Dysphagia is reported in the late stages of frontotemporal dementia and early in the motor subtypes of FTLD. The identification of dysphagia can alert individuals and medical teams to disease progression and provide insight into the nature and spread of the underlying neuropathology. Improved understanding of eating behaviors can improve individual care and may enhance diagnostic accuracy. Key Message: Aberrant eating behavior and swallowing difficulties are reported in the conditions associated with FTLD neuropathology. The consequences of mealtime disturbances include health risks associated with an increased BMI and aspiration, reduction of an individual's independence, and an increase in caregiver stress and burden. Here we review and summarize the literature on eating behavior and swallow impairments (dysphagia) in each of the syndromes caused by FTLD.
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Affiliation(s)
- Courtney Lewis
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Victoria, Australia, .,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany, .,Redenlab, Melbourne, Victoria, Australia,
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Moheb N, Charuworn K, Ashla MM, Desarzant R, Chavez D, Mendez MF. Repetitive Behaviors in Frontotemporal Dementia: Compulsions or Impulsions? J Neuropsychiatry Clin Neurosci 2019; 31:132-136. [PMID: 30537913 PMCID: PMC6535208 DOI: 10.1176/appi.neuropsych.18060148] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The presence of repetitive behaviors is one of the core criteria for behavioral variant frontotemporal dementia (bvFTD). Patients with bvFTD often have perseverative, stereotyped, or compulsive-ritualistic behavior as an early aspect of their disorder. It is unclear whether such behaviors are related to compulsions, as in obsessive-compulsive disorder (OCD), or are part of the impulse disorder spectrum. METHODS The authors investigated early (within 3 years) repetitive behaviors among 93 well-characterized patients who met International Consensus Criteria for clinically probable bvFTD and compared the results with the literature on OCD. The most common repetitive behaviors among 59 (63.4%) bvFTD patients were stereotypies of speech (35.5%), simple repetitive movements (15.2%-18.6%), hoarding and collecting (16.9%), and excessive or unnecessary trips to the bathroom (13.5%). RESULTS Only hoarding and collecting was significantly common in both bvFTD and OCD; otherwise, the bvFTD patients had very low frequencies of the common OCD behaviors of checking, cleaning, counting, and ordering. The repetitive behaviors in bvFTD were not associated with verbalized anxiety, obsessional ideation, or reports of relief after completing the act. In contrast, these behaviors were often triggered by environmental stimuli and could be temporarily prevented from completion without undue distress. Finally, among the bvFTD patients, the repetitive behaviors were always associated with impulsive or disinhibited behaviors, such as inappropriate verbal or physical behavior. CONCLUSIONS These findings suggest that the repetitive behaviors in bvFTD are repetitive impulsions, possibly from specific involvement of frontostriatal-anterior temporal pathology.
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Affiliation(s)
- Negar Moheb
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
| | - Kanida Charuworn
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
| | - Mark M. Ashla
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
| | - Randy Desarzant
- Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles
| | - Diana Chavez
- Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles
| | - Mario F. Mendez
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles; Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles
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Hamm B, Khokhar N, Jimenez XF. Refractory Self-Injurious Behavior in Severe Intellectual Disability Responsive to Topiramate: A Case Report. PSYCHOSOMATICS 2017; 58:209-212. [PMID: 28189287 DOI: 10.1016/j.psym.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Brandon Hamm
- Department of Psychiatry, A. Cleveland Clinic, Cleveland, OH.
| | - Naveed Khokhar
- Department of Psychiatry, A. Cleveland Clinic, Cleveland, OH
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Maloney EM, Djamshidian A, O'Sullivan SS. Phenomenology and epidemiology of impulsive-compulsive behaviours in Parkinson's disease, atypical Parkinsonian disorders and non-Parkinsonian populations. J Neurol Sci 2017; 374:47-52. [DOI: 10.1016/j.jns.2016.12.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/27/2016] [Indexed: 12/12/2022]
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A Functional Gradient in the Rodent Prefrontal Cortex Supports Behavioral Inhibition. Curr Biol 2017; 27:549-555. [PMID: 28190729 DOI: 10.1016/j.cub.2016.12.052] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 12/01/2016] [Accepted: 12/24/2016] [Indexed: 11/21/2022]
Abstract
The ability to plan and execute appropriately timed responses to external stimuli is based on a well-orchestrated balance between movement initiation and inhibition. In impulse control disorders involving the prefrontal cortex (PFC) [1], this balance is disturbed, emphasizing the critical role that PFC plays in appropriately timing actions [2-4]. Here, we employed optogenetic and electrophysiological techniques to systematically analyze the functional role of five key subareas of the rat medial PFC (mPFC) and orbitofrontal cortex (OFC) in action control [5-9]. Inactivation of mPFC subareas induced drastic changes in performance, namely an increase (prelimbic cortex, PL) or decrease (infralimbic cortex, IL) of premature responses. Additionally, electrophysiology revealed a significant decrease in neuronal activity of a PL subpopulation prior to premature responses. In contrast, inhibition of OFC subareas (mainly the ventral OFC, i.e., VO) significantly impaired the ability to respond rapidly after external cues. Consistent with these findings, mPFC activity during response preparation predicted trial outcomes and reaction times significantly better than OFC activity. These data support the concept of opposing roles of IL and PL in directing proactive behavior and argue for an involvement of OFC in predominantly reactive movement control. By attributing defined roles to rodent PFC sections, this study contributes to a deeper understanding of the functional heterogeneity of this brain area and thus may guide medically relevant studies of PFC-associated impulse control disorders in this animal model for neural disorders [10-12].
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Abstract
Patients with different types of dementia may exhibit pathological eating habits, including food fads, hyperphagia, or even ingestion of inanimate objects. Several findings reveal that such eating alterations are more common in patients with frontotemporal dementia (FTD) than other types of dementia. Moreover, eating alterations may differ between the two variants of the disease, namely the behavioral variant and semantic dementia (SD). In this review, we summarized evidences regarding four areas: eating and body weight alterations in FTD, the most common assessment methods, anatomical correlates of eating disorders, and finally, proposed underlying mechanisms. An increasing understanding of the factors that contribute to eating abnormalities may allow first, a better comprehension of the clinical features of the disease and second, shed light on the mechanism underlying eating behaviors in the normal population.
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Affiliation(s)
| | - Vincenzo Silani
- b Department of Neurology and Laboratory of Neuroscience , IRCCS Istituto Auxologico Italiano, Dino Ferrari Centre , Milan , Italy.,c Department of Pathophysiology and Transplantation , Università degli Studi di Milano , Milan , Italy
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Birkhoff JM, Garberi C, Re L. The behavioral variant of frontotemporal dementia: An analysis of the literature and a case report. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 47:157-163. [PMID: 27143117 DOI: 10.1016/j.ijlp.2016.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/18/2016] [Indexed: 06/05/2023]
Abstract
The aim of this case report is to underline the importance of possible legal consequences of the behavioral variant of frontotemporal dementia (bvFTD). This disease is associated with antisocial behavior, impulse control disorder and cognitive and personality impairment, which are often the earliest manifestations of the bvFTD. One of the antisocial behaviors possibly associated with this neurodegenerative disease is pathological stealing. This case report is about a 50-year-old Italian man who had a regular life until 2010. In 2010 and 2011, some critical events occurred: he lost his job, his father-in-law, to whom he was particularly close, died, and his wife had a serious illness. He began to show symptoms of depression, a significant weight loss, apathy, poor self-care, and lack of interest in the activities of his family. He became disengaged from his prior activities, emotionally detached from his family and developed compulsive hoarding. Moreover, he had uninhibited behaviors, a memory retrieval deficit, executive dysfunctions and impulsive behaviors. In January 2012, the subject began stealing objects, particularly components of computer, without premeditation or concern for resulting legal actions. He was then diagnosed affected by bvFTD. He was charged with theft and attempted theft and the Court asked for a psychiatric evaluation, in order to analyze the effect of the neurodegenerative disease on his behavior. To answer to the Court, the Authors analyzed his history of life and made a mental examination. The subject was considered mentally insane at the time of his crimes. This is an example of the practical application in judicial cases of the latest knowledge and evidence in the literature about the frontotemporal dementia, a disease associated with antisocial behaviors that could create tensions with the criminal law. The focus of the paper is to explain how the behavioral symptoms of bvFTD can have legal implications and how to deal with legal aspects of the behaviors induced by a neuro-psychiatric condition, such as bvFTD.
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Affiliation(s)
- Jutta Maria Birkhoff
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese-Como, Italy
| | - Cesare Garberi
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese-Como, Italy
| | - Laura Re
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese-Como, Italy.
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