Criminality in Huntington Disease

Huntington disease (HD) is an inherited neurodegenerative condition associated with varying degrees of motor, cognitive, and behavioral abnormalities. Although aggression, irritability, lack of insight, and poor impulse are well-recognized nonmotor manifestations of the disease, very little is known about their association with criminality, which is broadly defined as acts that are punishable by law.

We explored the prevalence of criminality in patients with HD seen between January 1, 2017, and December 31, 2021, within a large academic medical center in the state of Illinois. To determine rates of criminality, we examined "criminal behavior" (defined as illegal actions that do not necessarily lead to criminal prosecution) through a retrospective medical record review of keywords or phrases related to criminality. We also examined "crime" (defined as the presence of a criminal record) in this same sample of patients through a search of official publicly available online databases from the state of Illinois and the federal government.

Of the 210 patients included, 97 (46.2%) had criminal behavior documented in their medical records. Based on public database information, 89 patients (42.4%) had a criminal record and 26 patients (12.4%) had been arrested. Traffic violations were committed by 94.4% of the cohort and were the most common infractions. Most of these violations were petty offenses and only punishable by fines. Physical aggression toward caregivers was the most common criminal behavior identified in medical records. This tended to occur in advance stages of the disease and rarely led to criminal charges. Crime occurred at any point in the disease course of HD, including before and after the development of clinical signs and the formal diagnosis of HD.

The presence of criminality was not infrequent in our cohort, but rarely did this result in criminal charges and rarely did these charges result in arrests or incarcerations. Discussions surrounding driving safety and management of physical aggression toward caregivers should be part of regular outpatient visits with patients with HD. Ultimately, it is unknown whether criminality is a common feature of HD, and assessments need to be developed to determine its true prevalence.