Neurodegeneration behind bars: from molecules to jurisprudence

The prison population is aging and developing neurodegenerative disorders at a faster pace than the general population. Hidden among this group of recidivist, career criminals, there is a subpopulation of first offenders with frontotemporal dementia behavioral variant (bvFTD). The pathological hallmark of this condition is frontotemporal lobar degeneration (FTLD), which early on spares cognition, yet predisposes to criminal violations. From the neurobiological perspective, bvFTD originates in a large-scale brain network in charge of motivation and concern, the salience network (SN). From the judiciary perspective, bvFTD is challenging because patients often retain the “appreciation” of right and wrong, yet may be organically incapable to act accordingly. Equally challenging are the dispositions in regards to bvFTD patients: return to the community, risking further violations, vs. incarceration with dismal punitive or rehabilitative benefit. In this article, we advocate for screening of all first offenders who are 55 years of age or older via neuropsychological testing and/or positron emission tomography (PET) and should bvFTD be diagnosed, their placement in, yet to be developed, palliative programs in state or private facilities