Case Studies
Because many people with FTD are not aware of their
illness, they may become frustrated at limitations and
constraints that they do not understand and consider to
be unfair. As a result the person may strike out or
resist assistance. Shouting, name calling or physical
abuse may result from a frustrating situation or may
sometimes occur suddenly, with no apparent reason.
A man was involved in a road accident as a pedestrian
victim, but didn’t inform his wife or anyone else of the
incident. It wasn’t until he subsequently developed
pneumonia that chest x-rays showed up previous cracked
ribs, which were attributable to having occurred at around
the time of the accident.
In order to manage anxiety in parents, teachers and
children , local community police support officers were
called to attend and reassure parents and children as a
result of a man with bvFTD repeatedly approaching and
speaking to children outside a local school.
People with FTD have been banned from attending
supermarkets [ and other public shopping areas] on the
basis of their socially inappropriate behavioural patterns
Often the bans have been imposed without any effort
being made to consult with or inform NOK, causing
confusion and further offences due to friends and family
not being aware of the problem.
Inappropriate displays of emotion, sexual advances and
direct requests for sex are commonly made towards
friends of the family, children, and indeed complete
strangers.
Despite having informed the DVLA that she was no
longer competent to drive, a lady with FTD would take
the cars of visitors as well as family members.
Pilots have continued to fly charter planes, surgeons have
continued to operate on patients, public transport
operatives have continued to drive HGVs with
frontotemporal dementia [because no diagnosis was
apparent on standard memory testing assessments].
What to look out for
Forensic practitioners or medics acting on their
behalves need to be aware of the following 'red
flags' about possible underlying frontotemporal
dementia :
* a history of clear cut change in conduct toward antisocial
from previously law-abiding
* fatuous, poorly organised criminal behaviour - e.g., shop
lifting, speaking to or touching people in public, no
attempt to conceal activities, repeated same offence
* presentation in middle or later life
* associated cognitive issues, might be signalled by
declining work performance or word finding problems
* co-occurrence with other specific behavioural features,
particularly altered eating behaviour (sweet tooth, gluttony),
obsessions (e.g., around time), hoarding of odd items,
altered sense of humour especially more childish
* any suggestion of physical symptoms, e.g., loss of
dexterity, altered speech, slowness, poor balance (but
these would occur in only a small minority of cases early
on)
* any suggestion of paranoia or other bizarre beliefs or
experiences that might represent delusions or hallucinations
Dementia is a term for progressive problems in thinking or
behaviour – this may involve:
Behaviour, the main problem in frontotemporal
dementia
Language, the main problem in semantic
dementia and progressive non-fluent aphasia
Memory, the main problem in Alzheimer’s disease
Police contact and
frontotemporal dementia
Frontotemporal dementia [FTD] is a disease that
causes changes in behaviour and personality,
language and/or motor skills, and a deterioration in a
persons ability to function.
It represents an estimated 10%-20% of all dementia
cases and is one of the most common young onset
dementias [meaning it occurs in a younger population].
* other people in the family who developed dementia, motor
neuron disease or psychiatric trouble in middle life (before
age 60)
The FTDSG is under the umbrella of The National Brain
Appeal [ formerly National Hospital for Neurology and
Neurosurgery Development Foundation], registered charity
number 290173.
Visit www.ftdsg.org for more information
People with dementia who fall within the precincts of the
police or judicial system, rarely attract headline news.
Rather, it is with a sense of shame that families manage
the involvement, and with a reticence to discuss the
intricacies of the contact.
Frontotemporal dementia [FTD] is a disease that
causes changes in behaviour and personality,
language and/or motor skills, and a deterioration in a
persons ability to function.
Onset of FTD often occurs in a person’s 50s and 60s;
the average age at diagnosis is about 57. Thus FTD can
affect work and family in a way that dementia in older
people does not
The hallmark of FTD is a gradual, progressive decline
in behaviour and/or language. As the disease
progresses, these deficits cause significant
impairment in social and or occupational functioning.
FTD represents an estimated 10%-20% of all dementia
cases and is recognised as one of the most common
young onset dementias.
FTD is characterised by progressive atrophy of several
different areas of the brain, particularly the frontal and/
or temporal lobes, the parts of the brain that control
‘executive function’ such as decision making,
personality, social behaviour and language.
Currently there are no treatments available to stop the
progression of FTD.
The course of the disease ranges from 2 to over 20
years.
Because of the nature of these symptoms and the fact
that the person is ‘too young’ for dementia to be
considered, FTD is often misdiagnosed as a
psychiatric problem or movement disorder.
Subtypes of FTD are identified clinically according to
the symptoms that appear first and most
predominantly.
Clinical diagnoses include behavioural variant FTD
(bvFTD), primary progressive aphasia (PPA) which
affects language, and the movement disorders
progressive supranuclear palsy (PSP) and corticobasal
degeneration (CBD).
The consequences of contact with the police or judiciary is
typically exhaustive and stressful, encumbering emotional,
social and sometimes financial implications as a result.
Whilst there are many other diagnoses within the
dementia spectrum which cause specific and
identifiable changes to a person’s behaviour,
behavioural variant FTD, because of its symptoms,
is the most likely diagnosis to lead to contact with
the police.
Given that between them, the police service and the
judiciary have the only 24 hour, 7 day a week mobile
emergency community response capacity, along with an
unparalleled authority, it is clear that an understanding of
the implications of a diagnosis of dementia MUST be
understood and countered for within these services.
Symptoms
The first symptom is usually a change in personality or
behaviour (which is out of character for the person) – the
symptoms may come on very slowly and may not be
noticed as definitely abnormal at first. The symptoms include:
Loss of inhibitions or increased extroversion. The person
may talk to strangers, make inappropriate remarks in public
or be rude or impatient. They may also become aggressive.
Impulsive behaviour .
Apathy or withdrawal from social activities.
Loss of empathy.
Changes in sexual behaviour: either more/less or
inappropriate interest.
A history of work based problems: disciplinary warnings etc
People may be very easily distracted.
They often develop fixed routines or become obsessive
about things, particularly time (‘clock watching’). Some
people begin to hoard things.
People may also develop a sweet tooth or a preference for
unusual foods. They may also overeat leading to a gain in
weight or drink excessive amounts of alcohol.
Decreased amount of speech or repetitive speech.
Often the person will be unaware of the true extent of the
problems and lack insight.
Areas of green show atrophy of the frontal lobes
The contact that people with dementia have with the police
and judiciary is typically connected to issues of:
crime or crime prevention
public safety
aggression /violence
shoplifting
impulsive behaviour
wandering
memory loss
false allegations
disinhibition [ incl. sexually inappropriate behaviour]
driving offences and accidents
It may also be because the person with dementia is
themselves a victim .