“Rothman was charged with health-care fraud and health-care fraud conspiracy. He faced up to 20 years in prison. Four of the indicted defendants pleaded guilty, and four, including Rothman, chose to go to trial.

Shortly before the jury was set to assemble, Rothman’s attorney filed a motion stating that his client was incompetent to stand trial. Five months before his arrest, Rothman had been diagnosed with Alzheimer’s disease. The legal process that followed would last 11 years—a costly demonstration of just how unprepared the criminal justice system is to handle people with dementia.”

Some forms of dementia can trigger behaviors that society classifies as criminal. It’s not that these conditions create an intention to violate the law—most dementia-related violations are not what neurologists call “instrumental behaviors,” which are calculated in advance and executed according to a plan. Rather the radical changes in a person’s behavior and demeanor can erase their sense of social norms. They steal. They grope. They shout abusive language at fellow customers in the grocery store. Stacey Wood, a professor of psychology at Scripps College, recalled a patient who began hugging customers at a convenience store and didn’t stop until the manager called the police. “Mostly we’re talking about impulse-control problems,” says Wood, who has provided expert testimony in many cases involving defendants and victims with dementia. “They just have terrible judgment.”

“People with dementia can also lose self-conscious emotions or “where you see yourself through others,” says Mario Mendez, director of the Behavioral Neurology Program at the David Geffen School of Medicine at U.C.L.A. When that capacity evaporates, a person no longer feels shame or guilt about breaking with acceptable social patterns. The loss of these capacities may help explain the most common crimes among Alzheimer’s patients—public urination, theft, traffic violations, sexual advances and trespassing…Not everyone with dementia steals or runs red lights, of course, but it appears that people with this diagnosis are more susceptible to criminal behavior.”

“In the U.C.S.F. study that identified high rates of criminal behavior among people with dementia, those rates were highest among the subset of patients with FTD: 64 of 171 patients, or 37 percent. “Patients with FTD can commit criminal violations while retaining the ability to know the moral rules and conventions,” Mendez wrote in a 2011 paper describing the predilection of people with FTD to break the law.”

“Most correctional systems offer no geriatric or dementia care services. Prison memory wards, such as the one that opened in 2019 at the Federal Medical Center Devens in Massachusetts, could help keep vulnerable inmates safe. But such interventions drive home a contradiction: If prisons are meant for rehabilitation, Arias explains, then why keep people locked up when they no longer understand why they are even there?”

Read more in Scientific American.

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