Neuroimaging Abnormalities in Neurological Patients with Criminal Behavior

  • R. Ryan Darby
Behavior (H S Kirshner, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Behavior


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.


Future advances will be important for making sure that neuroimaging data is used in a responsible manner in legal cases involving criminal behavior.


Criminal Moral Brain lesions Neurology Frontal lobe Brain networks 


Compliance with Ethical Standards

Conflict of Interest

R. Ryan Darby declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance

  1. 1.
    Harlow J. Recovery from the passage of an iron bar through the head. Publ Massachusetts Med Soc. 1868;2:327–47.Google Scholar
  2. 2.
    Batts S. Brain lesions and their implications in criminal responsibility. Behav Sci Law [Internet]. 2009 [cited 2014 Sep 18];272:261–72. Available from:
  3. 3.
    Edersheim JG, Brendel RW, Price BH. Neuroimaging, diminished capacity and mitigation. In: Simpson JR, editor. Neuroimaging forensic psychiatry from clin to court. First. Wiley; 2012. p. 163–93.Google Scholar
  4. 4.
    • Jones O, Schall JD, Shen F. Law And Neuroscience [Internet]. New York, NY: wolters kluwer law and business; 2014. Available from: Comprehensive textbook on how neuroscience research can impact the legal field.
  5. 5.
    Saver JL, Damasio AR. Preserved access and processing of social knowledge in a patient with acquired sociopathy due to ventromedial frontal damage. Neuropsychologia [Internet]. 1991;29:1241–9. Available from: CrossRefGoogle Scholar
  6. 6.
    Blumer D, Benson DF. Personality changes with frontal lobe lesions. In: Benson DF, Blumer D, editors. Psychiatr Asp Neurol Dis. New York; 1975. p. 151–70.Google Scholar
  7. 7.
    Blair RJ. Neurocognitive models of aggression, the antisocial personality disorders, and psychopathy. J Neurol Neurosurg Psychiatry [Internet] 2001 [cited 2016 Sep 22];71:727–31. Available from:
  8. 8.
    • Denno DW. The myth of the double-edged sword: an empirical study of neuroscience evidence in criminal cases. Bost Coll Law Rev. 2015;56:493–552. Comprehensive review of how neuroscience evidence is used in criminal cases. Google Scholar
  9. 9.
    Blake PY, Pincus JH, Buckner C. Neurologic abnormalities in murderers. Neurology. 1995;45:1641–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Farrer TJ, Hedges DW. Prevalence of traumatic brain injury in incarcerated groups compared to the general population: a meta-analysis. Prog Neuro-Psychopharmacol Biol Psychiatry [Internet]. Elsevier Inc.; 2011;35:390–4. Available from:
  11. 11.
    Durand E, Chevignard M, Ruet A, Dereix A, Jourdan C, Pradat-Diehl P. History of traumatic brain injury in prison populations: a systematic review. Ann Phys Rehabil Med [Internet]. Elsevier Masson SAS; 2017;60:95–101. Available from:
  12. 12.
    Schiltz K, Witzel JG, Bausch-Hölterhoff J, Bogerts B. High prevalence of brain pathology in violent prisoners: a qualitative CT and MRI scan study. Eur Arch Psychiatry Clin Neurosci [Internet]. 2013;263:607–16. Available from:
  13. 13.
    Witzel JG, Bogerts B, Schiltz K. Increased frequency of brain pathology in inmates of a high-security forensic institution: a qualitative CT and MRI scan study. Eur Arch Psychiatry Clin Neurosci. Springer Berlin Heidelberg; 2016;266:533–41.Google Scholar
  14. 14.
    Fazel S, Lichtenstein P, Grann M, Langstrom N. Risk of violent crime in individuals with epilepsy and traumatic brain injury: a 35-year Swedish population study. PLoS Med. 2011;8:e1001150.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Timonen M, Miettunen J, Hakko H, Zitting P, Veijola J, von Wendt L, et al. The association of preceding traumatic brain injury with mental disorders, alcoholism and criminality: the Northern Finland 1966 Birth Cohort Study. Psychiatry Res [Internet]. 2002;113:217–26. Available from:
  16. 16.
    Grafman J, Schwab K, Warden D, Pridgen A, Brown HR, Salazar AM. Frontal lobe injuries, violence, and aggression: a report of the Vietnam head injury study. Neurology [Internet]. 1996;46:1231–8. Available from:
  17. 17.
    Elbogen EB, Wolfe JR, Cueva M, Sullivan C, Johnson J. Longitudinal predictors of criminal arrest after traumatic brain injury: results from the traumatic brain injury model system national database. J Head Trauma Rehabil. 2015;30:E3–13.CrossRefPubMedGoogle Scholar
  18. 18.
    •• Darby RR, Horn A, Cushman F, Fox MD. Lesion network localization of criminal behavior. Proc Natl Acad Sci [Internet]. 2017;201706587. Available from: First systematic mapping of neuroimaging abnormalities in criminals with focal brain lesions showing network localization for criminal behavior.
  19. 19.
    Braun CMJ, Léveillé C, Guimond A. An orbitofrontostriatopallidal pathway for morality: evidence from postlesion antisocial and obsessive-compulsive disorder. Cogn Neuropsychiatry [Internet]. 2008;13:296–337. Available from:
  20. 20.
    Pardini M, Krueger F, Hodgkinson C, Raymont V, Ferrier C, Goldman D, et al. Prefrontal cortex lesions and MAO-A modulate aggression in penetrating traumatic brain injury. Neurology [Internet]. 2011;76:1038–45. Available from: CrossRefGoogle Scholar
  21. 21.
    Anderson SW, Bechara A, Damasio H, Tranel D, Damasio AR. Impairment of social and moral behavior related to early damage in human prefrontal cortex. Nat Neurosci [Internet]. 1999;2:1032–7. Available from: CrossRefGoogle Scholar
  22. 22.
    Taber-Thomas BC, Asp EW, Koenigs M, Sutterer M, Anderson SW, Tranel D. Arrested development: early prefrontal lesions impair the maturation of moral judgement. Brain [Internet]. 2014 [cited 2015 Nov 20];137:1254–61. Available from:
  23. 23.
    Anderson SW, Barrash J, Bechara A, Tranel D. Impairments of emotion and real-world complex behavior following childhood- or adult-onset damage to ventromedial prefrontal cortex. J Int Neuropsychol Soc [Internet]. 2006;12:224–35. Available from: Google Scholar
  24. 24.
    Anderson SW, Damasio H, Tranel D. Neuropsychological impairments associated with lesions caused by tumor or stroke. Arch Neurol [Internet]. 1990;47:397–405. Available from: CrossRefGoogle Scholar
  25. 25.
    •• Glenn AL, Raine A. Neurocriminology: implications for the punishment, prediction and prevention of criminal behaviour. Nat Rev Neurosci [Internet]. Nature Publishing Group; 2013;15:54–63. Available from: Excellent review on how neuroscience is being used to understand criminal behavior.
  26. 26.
    Miller BL, Darby A, Benson DF, Cummings JL, Miller MH. Aggressive, Socially disruptive and antisocial behaviour associated with fronto-temporal dementia. Br J Psychiatry [Internet]. 1997 [cited 2014 Sep 18];170:150–4. Available from:
  27. 27.
    Mendez MF, Chen AK, Shapira JS, Miller BL. Acquired sociopathy and frontotemporal dementia. Dement Geriatr Cogn Disord [Internet]. 2005 [cited 2014 May 4];20:99–104. Available from:
  28. 28.
    Diehl-Schmid J, Perneczky R, Koch J, Nedopil N, Kurz A. Guilty by suspicion? Criminal behavior in frontotemporal lobar degeneration. Cogn Behav Neurol [Internet]. 2013 [cited 2014 Oct 12];26:73–7. Available from:
  29. 29.
    Liljegren M, Naasan G, Temlett J, Perry DC, Rankin KP, Merrilees J, et al. Criminal behavior in frontotemporal dementia and Alzheimer disease. JAMA Neurol [Internet]. 2015 [cited 2015 Apr 27];72:295–300. Available from:
  30. 30.
    Mendez MF, Anderson E, Shapira JS. An investigation of moral judgement in frontotemporal dementia. Cogn Behav Neurol [Internet]. 2005;18:193–7. Available from: CrossRefGoogle Scholar
  31. 31.
    Jensen P, Fenger K, Bolwig TG, Sørensen SA. Crime in Huntington’s disease: a study of registered offences among patients, relatives, and controls. J Neurol Neurosurg Psychiatry [Internet]. 1998;65:467–71. Available from: CrossRefGoogle Scholar
  32. 32.
    Dewhurst K, Oliver JE, McKnight AL. Socio-psychiatric consequences of Huntington’s disease. Br J Psychiatry [Internet]. 1970;116:255–8. Available from: CrossRefGoogle Scholar
  33. 33.
    Solla P, Bortolato M, Cannas A, Mulas CS, Marrosu F. Paraphilias and paraphilic disorders in Parkinson’s disease: a systematic review of the literature. Mov Disord [Internet]. 2015;30:604–13. Available from: CrossRefGoogle Scholar
  34. 34.
    Shinagawa S, Shigenobu K, Tagai K, Fukuhara R, Kamimura N, Mori T, et al. Violation of laws in frontotemporal dementia: a multicenter study in Japan. J Alzheimers Dis [Internet]. 2017;57:1221–7. Available from: CrossRefGoogle Scholar
  35. 35.
    McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR, Kawas CH, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement [Internet]. 2011 [cited 2014 Jul 9];7:263–9. Available from:
  36. 36.
    Rascovsky K, Hodges JR, Knopman D, Mendez MF, Kramer JH, Neuhaus J, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain [Internet]. 2011 [cited 2015 Jun 2];134:2456–77. Available from:
  37. 37.
    Weintraub D, Claassen DO. Impulse control and related disorders in Parkinson’s disease [Internet]. 1st ed. Int. Rev. Neurobiol. Elsevier Inc.; 2017. Available from:
  38. 38.
    Poldrack RA, Monahan J, Imrey PB, Reyna V, Raichle ME, Faigman D, et al. Predicting violent behavior: what can neuroscience add? Trends Cogn Sci [Internet]. Elsevier Ltd; 2018;22:111–23. Available from:
  39. 39.
    Boes AD, Prasad S, Liu H, Liu Q, Pascual-Leone A, Caviness VS, et al. Network localization of neurological symptoms from focal brain lesions. Brain [Internet]. 2015 [cited 2015 Aug 12];138:3061–75. Available from:
  40. 40.
    Laganiere S, Boes AD, Fox MD. Network localization of hemichorea-hemiballismus. Neurol Int. 2016;86:2187–95. Available from: Google Scholar
  41. 41.
    Darby RR, Fox MD. Reply: Capgras syndrome: neuroanatomical assessment of brain MRI findings in an adolescent patient. Brain [Internet]. 2017;140:e44. Available from:; CrossRefGoogle Scholar
  42. 42.
    Darby RR, Laganiere S, Pascual-Leone A, Prasad S, Fox MD. Finding the imposter: brain connectivity of lesions causing delusional misidentifications. Brain [Internet]. 2017;140:497–507. Available from: CrossRefGoogle Scholar
  43. 43.
    Fasano A, Laganiere SE, Lam S, Fox MD. Lesions causing freezing of gait localize to a cerebellar functional network. Ann Neurol [Internet]. 2017 [cited 2017 Feb 13];81:129–41. Available from:
  44. 44.
    Fischer DB, Boes AD, Demertzi A, Evrard HC, Laureys S, Edlow BL, et al. A human brain network derived from coma-causing brainstem lesions. Neurology [Internet]. 2016;87:2427–34. Available from: CrossRefGoogle Scholar
  45. 45.
    Huo Y, Aboud K, Kang H, Cutting LE, Landman BA. Mapping lifetime brain Volumetry with covariate-adjusted restricted cubic spline regression from cross-sectional multi-site MRI. In: Ourselin S, Joskowicz L, Sabuncu MR, Unal G, Wells W, editors. Med image Comput Comput assist Interv [internet], vol. 9900: Cham, Springer International Publishing; 2016. p. 81–8. Available from:
  46. 46.
    Jack CR, Petersen RC, Xu YC, Waring SC, O’Brien PC, Tangalos EG, et al. Medial temporal atrophy on MRI in normal aging and very mild Alzheimer’s disease. Neurology. 1997;49:786–94.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Perry DC, Brown JA, Possin KL, Datta S, Trujillo A, Radke A, et al. Clinicopathological correlations in behavioural variant frontotemporal dementia. Brain. 2017;140:3329–45.CrossRefPubMedGoogle Scholar
  48. 48.
    Ossenkoppele R, Pijnenburg YAL, Perry DC, Cohn-Sheehy BI, Scheltens NME, Vogel JW, et al. The behavioural/dysexecutive variant of Alzheimer’s disease: clinical, neuroimaging and pathological features. Brain [Internet]. 2015;138:2732–49. Available from: CrossRefGoogle Scholar
  49. 49.
    Ossenkoppele R, Cohn-Sheehy BI, La Joie R, Vogel JW, Möller C, Lehmann M, et al. Atrophy patterns in early clinical stages across distinct phenotypes of Alzheimer’s disease. Hum Brain Mapp. 2015;36:4421–37.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    La Joie R, Perrotin A, Barre L, Hommet C, Mezenge F, Ibazizene M, et al. Region-specific hierarchy between atrophy, hypometabolism, and -amyloid (A ) load in Alzheimer’s disease dementia. J Neurosci [Internet]. 2012;32:16265–73. Available from: CrossRefGoogle Scholar
  51. 51.
    Collins JA, Montal V, Hochberg D, Quimby M, Mandelli ML, Makris N, et al. Focal temporal pole atrophy and network degeneration in semantic variant primary progressive aphasia. Brain [Internet]. 2016;86:aww313. Available from: Google Scholar
  52. 52.
    Phillips JS, Da Re F, Dratch L, Xie SX, Irwin DJ, McMillan CT, et al. Neocortical origin and progression of gray matter atrophy in nonamnestic Alzheimer’s disease. Neurobiol Aging [Internet]. 2018;63:75–87. Available from: CrossRefGoogle Scholar
  53. 53.
    Wasserman D, Johnston J. Seeing responsibility: can neuroimaging teach us anything about moral and legal responsibility? Hastings Cent Rep [Internet]. 2014 [cited 2014 Sep 9];Spec No:S37–49. Available from:
  54. 54.
    Meltzer CC, Sze G, Rommelfanger KS, Kinlaw K, Banja JD, Wolpe PR. Guidelines for the ethical use of neuroimages in medical testimony: report of a multidisciplinary consensus conference. Am J Neuroradiol. 2014;35:632–7.CrossRefPubMedGoogle Scholar
  55. 55.
    Darby RR, Dickerson BC. Dementia, decision making, and capacity. Harv Rev Psychiatry [Internet]. 2017;25:270–8. Available from: Scholar
  56. 56.
    • Darby RR, Edersheim J, Price BH. What patients with behavioral-variant frontotemporal dementia can teach us about moral responsibility. AJOB Neurosci [internet]. Routledge; 2016;7:193–201. Available from: Discussion on the ethical and legal challenges associated with FTD patients who commit crimes. What patients with behavioral-variant frontotemporal dementia can teach us about moral responsibility.
  57. 57.
    Darby RR. Separating agency from deeds in immoral neurological patients: a potential challenge to the ADC model. AJOB Neurosci. Taylor & Francis; 2014;5:25–7.Google Scholar
  58. 58.
    Aharoni E, Mallett J, Vincent GM, Harenski CL, Calhoun VD, Sinnott-Armstrong W, et al. Predictive accuracy in the neuroprediction of rearrest. Soc Neurosci [Internet]. 2014;9:332–6. Available from: CrossRefGoogle Scholar
  59. 59.
    • Aharoni E, Vincent GM, Harenski CL, Calhoun VD, Sinnott-Armstrong W, Gazzaniga MS, et al. Neuroprediction of future rearrest. Proc Natl Acad Sci [Internet]. 2013;110:6223–8. Available from: Article showing how neuroimaging markers are being used to predict future recidivism in criminals. CrossRefGoogle Scholar
  60. 60.
    Steele VR, Claus ED, Aharoni E, Vincent GM, Calhoun VD, Kiehl KA. Multimodal imaging measures predict rearrest. Front Hum Neurosci [Internet]. 2015;9:1–13. Available from: Scholar
  61. 61.
    Darby RR, Pascual-Leone A. Moral enhancement using non-invasive brain stimulation. Front Hum Neurosci [Internet]. 2017;11:77. Available from: Scholar
  62. 62.
    Levy N, Douglas T, Kahane G, Terbeck S, Cowen PJ, Hewstone M, et al. Are you morally modified? The moral effects of widely used pharmaceuticals. Philos Psychiatr Psychol. 2015;21:111–25.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurology, Division Behavioral NeurologyVanderbilt University Medical CenterNashvilleUSA

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