Late-Onset Sex Offending and the Assessment of Behavioral Variant Frontotemporal Dementia (bvFTD)

Behavioral variant frontotemporal dementia (bvFTD) is a common neuropsychiatric disorder, which is often missed or misdiagnosed by both neurologists and psychiatrists as a cause of emotional and behavioral problems. Inappropriate emotional responses and maladaptive behavior, including criminal behaviors, may be the first obvious expression of bvFTD caused by altered moral feelings, loss of empathy, disinhibition, and compulsive behavior. New onset sex offenses, including indecent expo-sure, sexually inappropriate comments, and unwanted sexual advances have been documented in early bvFTD. These behaviors may escalate with progressive disease and lead to harsh penalties. The presence of inappropriate sexual behaviors in older individuals with no prior history should raise concern about the presence of bvFTD in forensic examinations. In addition to the forensic examina-tion, diagnostic evaluation requires psychological testing (including tests of social and affective cogni-tion) and imaging studies. In sex offenders, a diagnosis of bvFTD has significant implications for risk assessments, requirements regarding supervision and management, and as evidence for mitigation. In this article, we review the neuropsychiatry of bvFTD, how the pathophysiology may contribute to sex offenses, and important psycholegal considerations for the forensic psychiatrist when evaluating bvFTD.

Automated summary

Behavioral variant frontotemporal dementia (bvFTD) is often misdiagnosed as a cause of emotional and behavioral problems, leading to inappropriate emotional responses and maladaptive behaviors. In early stages, bvFTD may manifest as new onset sex offenses, such as indecent exposure and sexually inappropriate comments. It is important to consider the presence of bvFTD in forensic examinations and conduct thorough diagnostic evaluation for risk assessments and management.