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Neuroimaging Abnormalities in Neurological Patients with Criminal Behavior

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Neuroimaging Abnormalities in Neurological Patients with Criminal Behavior Current Neurology and Neuroscience Reports (2018) 18:47 https://doi.org/10.1007/s11910-018-0853-3 BEHAVIOR (H S KIRSHNER, SECTION EDITOR) Neuroimaging Abnormalities in Neurological Patients with Criminal Behavior R. Ryan Darby1 # Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Purpose of Review Criminal behavior occurs in previously law-abiding neurological patients, including patients with traumatic brain injury, focal brain lesions, and dementia. Neuroimaging abnormalities in these patients allow one to explore the potential neuroanatomical correlates of criminal behavior. However, this process has been challenging because (1) It is difficult to determine the temporal relationship between criminal behavior and neurological disease onset; (2) Abnormalities in several different brain regions have been associated with criminal behavior; and (3) It is difficult to quantify neuroimaging abnormalities in individual subjects. Recent Findings Recent studies have begun to address these concerns, showing that neuroimaging abnormalities in patients with criminal behavior localize to a common brain network, rather than a single specific brain region. New methods have been developed to identify atrophy patterns in individual patients, but have not yet been used in neurological patients with criminal behavior. Summary Future advances will be important for making sure that neuroimaging data is used in a responsible manner in legal cases involving criminal behavior. Keywords Criminal . Moral . Brain lesions . Neurology . Frontal lobe . Brain networks Introduction he was killed by police [2]. At autopsy, he was found to have a malignant tumor in his right temporal lobe, prompting ques- Neurological diseases can cause profound changes to behav- tions about the degree to which his brain injury contributed to ior. In 1838, a railroad worker named Phineas Gage had an his behavior. iron rod blasted through the front of his brain. Remarkably, he In 1991, Herbert Weinstein, a 65-year-old with no prior survived without notable deficits to his motor skills, language, history of violence, strangled his wife after an argument, and or memory. Yet, his personality and behavior changed mark- then threw her body from a window to make her death appear edly. He was described as “fitful, irreverent, indulging at times like a suicide [2, 3, 4•]. On a structural MRI scan, he was in the grossest profanities (which was not previously his cus- found to have a large cyst in the left frontal lobe, with associ- tom), manifesting little deference for his fellows, impatient of ated hypometabolism in the cortex adjacent to the cyst on restraint or advice when it conflicts with his desires.” [1]. FDG-PET. His defense attorneys argued that he should be In 1966, Charles Whitman developed headaches, obsessive not be held responsible for his crime because the frontal cyst writing, and disturbing, violent thoughts culminating in the had resulted in a mental defect that made him unable to fully murder of his wife, mother, and 14 innocent bystanders before conform his behavior to the law. The study of these and other patients with criminal behav- This article is part of the Topical Collection on Behavior ior as a result of brain injury, referred to as “acquired sociopathy” [5]or“pseudo-psychopathy” [6], allows one to * R. Ryan Darby test associations between specific brain regions and moral [email protected] behavior. Additionally, because there are similarities between patients with acquired sociopathy and criminals without clear 1 Department of Neurology, Division Behavioral Neurology, Vanderbilt University Medical Center, A-0118 Medical Center brain pathology, these cases have lent insight into antisocial North, Nashville, TN 37232, USA behavior more generally [7]. 47 Page 2 of 7 Curr Neurol Neurosci Rep (2018) 18:47 The Weinstein case illustrates that neuroimaging abnormal- Two meta-analyses have looked at the incidence of traumat- ities associated with criminal behavior are being applied be- ic brain injury (TBI) in criminals. Farrer et al. (2011) found a yond scientific questions to individual legal cases. pooled incidence of TBI in approximately 41% of incarcerated Neuroimaging, neuropsychological, and/or neurological exam prisoners, compared to population estimates of TBI in non- testing has been included in at least 800 criminal cases in the criminals ranging from 2 to 38% [10]. However, these popula- USA over the last two decades [8•]. This includes 366 defen- tion estimates were based on separate papers using different dants in capital punishment cases and 80 other defendants populations and screening methods; almost none of the studies given life sentences [8•]. One hundred fifty-four cases made actually assessed the prevalence of TBI in matched non-prison explicit neurological diagnoses, including 63 cases with a di- populations within the same study. A more recent meta-analysis agnosis of dysfunction in a particular cortical lobe, 44 with came to a similar cautionary conclusion; while they found a organic brain damage, 14 with organic brain disease, and 33 pooled incidence of 46% for TBI in prison populations, the with mental retardation [8•]. Even in other cases without an authors noted that many of the studies included were highly explicit neurological diagnosis, evidence was often presented flawed [11]. First, most relied on self-reports of TBI, which to prove that the defendant had brain damage (271 cases) or a may be inaccurate. Second, most studies are unable to deter- head injury (178 cases) [8•]. mine whether a propensity for violence and risky behavior Despite the increasing use of neuroimaging in the court- (drug/alcohol abuse) led to increased incidence of TBI. In fact, room, its use remains controversial due to the difficulty in most studies found a high association between drug/alcohol determining the relationship between neuroimaging abnor- abuse and both TBI and criminality, complicating the interpre- malities, abnormal behavior, and legal responsibility. This ar- tation. This also highlights the difficulty in determining the ticle attempts to use neurological patients as a starting point to temporal relationship between criminal behavior and head trau- address these difficulties. Neurological patients offer an ad- ma, as antisocial behavior may predispose one to head trauma vantage because of the ability in many cases to clearly define rather than head trauma leading to antisocial behavior. Finally, abnormalities on neuroimaging and to fit changes in behavior the severity of TBI between studies varied, ranging from mild that may be legally relevant to behavioral changes known to loss of consciousness (LOC) to more prolonged coma. be associated with specific diseases. First, I will review evi- Importantly, mild TBI is not typically associated with neuroim- dence for the association between neurological diseases and aging findings and the significance of any findings to subse- criminal behavior by examining the incidence of neurological quent behavioral changes is often unknown. diseases in criminals and the incidence of criminal behavior in Several other studies have tested for neuroimaging abnor- neurological patients. Next, I will discuss the crucial gaps in malities in prison populations specifically. In a study of 287 the literature, focusing on important scientific questions that male prisoners incarcerated for violent (125) vs. nonviolent will need to be addressed for neuroimaging findings in neuro- (162) crimes who had MRI scans done for other clinical pur- logical patients to be applicable to legal questions. Finally, I poses, the incidence of abnormalities was high: 46% of pa- will discuss new insights and future directions in the use of tients with violence and 26% of nonviolent offenders had neuroimaging to understand criminal behavior in neurological abnormalities on neuroimaging, compared to just 8% in an patients, with potential implications for the use of neuroimag- age-matched non-criminal sample [12]. In a follow-up focus- ing in the law more broadly. ing on 148 patients in a forensic mental health prison, the incidence of brain pathology was 46% [13]. Both studies uti- lized a semi-structured, blinded assessment of neuroimaging Incidence of Neurological Abnormalities abnormalities, which may be prone to bias and prohibits more in Criminals precise localization of neuroimaging abnormalities. Further, it is impossible to determine the temporal association between The degree to which neurological disease contributes to crim- these neuroimaging abnormalities and the onset of criminality. inal behavior is difficult to estimate. Some studies have inves- Nevertheless, these studies provide compelling evidence of an tigated the incidence of neurological disease in persons who increased incidence of neuroimaging abnormalities in crimi- have already committed crimes. For instance, in one study, nal populations compared to non-criminal populations. 64.5% of murderers were found to have frontal lobe dysfunc- tion on examination, and approximately 47% had reportedly abnormal neuroimaging [9]. However, results were complicat- Criminal Behavior in Neurological Patients ed by the fact that nearly all had evidence of paranoid delu- sions and the majority had experienced some form of physical Traumatic Brain Injury and/or sexual abuse, making it unclear the degree to which neurological disease, psychiatric disease, and/or social factors In patients with non-penetrating TBI, violence or crime occurs contributed
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