Perceived criminal behavior in frontotemporal dementia: A 10-year retrospective analysis of forensic cases in Türkiye

Frontotemporal dementia (FTD) is associated with a disproportionately high risk of behavior perceived as criminal, yet systematic forensic data from non-Western settings remain scarce. This retrospective descriptive study characterized the sociodemographic, clinical, and criminological profile of 32 patients with a documented FTD diagnosis referred to the Council of Forensic Medicine in Türkiye for criminal responsibility assessment between November 2015 and November 2025, with the sample stratified according to whether the offense occurred before or after FTD diagnosis. The cohort was predominantly male (93.8%), with a mean age at offense of 60.75 years (SD = 12.44). Offenses were distributed across economic (34.4%), violent (34.4%), and sexual (31.3%) categories, and strangers constituted the most frequent victim group (50.0%). More than half of the offenses were classified as planned (53.1%) on the basis of documented pre-offense preparatory behavior, such as procuring or transporting an instrument or lying in wait; however, behaviors appearing superficially planned may nonetheless reflect stimulus-driven conduct and should not be equated with preserved volitional criminal intent. Among patients whose offense occurred prior to diagnosis (46.9%), the mean interval between the offense and subsequent diagnosis was 3.07 years (SD = 1.87), and in the post-diagnosis group, sexual offenses were nearly twice as prevalent as in the pre-diagnosis group (41.2% vs. 20.0%). This first systematic forensic characterization of FTD patients in Türkiye highlights a high rate of pre-diagnostic offenses and a diagnostic overlap with primary psychiatric disorders, collectively underscoring the need for greater neurological expertise in forensic psychiatric evaluations involving older adults with atypical behavioral presentations.