Abstract

We report a patient with dementia due to B-12 deficiency and syphilis who presented to a forensic hospital after killing his ex-wife with a gun. Despite current awareness on the occurrence of aggression and violence in patients with dementia, there has been no report discussing dementia secondary to an infectious or nutritional origin causing homicide or severe violent behavior. We discuss possible mechanisms and several predisposing factors for violent behavior in the elderly. We also discuss use and access of a gun in demented patients and its complications. We recommend availability of neuropsychiatric assessments in the elderly, limitation of gun access to demented patients and inquiry about weapon possession in the elderly.

References

1.
Haller
E
,
Binder
R
,
McNiel
D E
.
Violence in geriatric patients with Dementia
.
Bul Am Acad Psy and
1989
;
17
(
2
):
183
-
8
.
2.
Shah
A K
.
Violence and psychogeriatric inpatients
.
Int J Geriatr Psychiatry
1992
;
7
:
39
-
44
.
3.
Petrie
W M
,
Lawson
E C
,
Hollender
M C
.
Violence in geriatric patients
.
JAMA
1982 Jul;
248
(
4
):
443
-
4
.
4.
Birkett
D P
.
Violence in geropsychiatry
.
Psychiatric Annals
1997 Nov;
27
:
752
-
6
.
5.
Cummings
J L
.
Neuropsychiatric aspects of alzheimer's disease and other dementing illnesses
. In:
Yudofsky
S C
,
Hales
R E
, editors.
Synopsis of neuropsychiatry
.
Washington, DC
,
American psychiatric press, Inc.
:
1994
:
469
-
82
.
6.
Moore
D P
,
Jefferson
J W
.
Handbook of medical psychiatry
.
St. Louis
,
Mosby
;
1996
.
7.
Miller
B L
,
Chang
L
,
Oropilla
G
,
Mena
I
.
Alzheimer's disease and frontal lobe dementias
. In:
Coffey
C E
,
Cummings
J L
, editors.
Textbook of geriatric neuropsychiatry
.
Washington, DC
,
American psychiatric press, inc.
;
1994
:
523
-
47
.
8.
Ticehurst
S B
,
Ryan
M G
,
Hughes
F
.
Homicidal behavior in elderly patients admitted to a psychiatric hospital
.
Dementia
 1013-7424
1992
;
3
:
86
-
90
.
9.
Hamel
M
,
Gold
D P
,
Andres
D
,
Reis
M
,
Dastoor
D
,
Grauer
H
, et al
Predictors and consequences of aggressive behavior by community-based dementia patients
.
The Gerontologist
1990
;
30
(
2
):
206
-
11
.
10.
Tardiff
K
,
Sweillam
A
.
The relation of age to assaultive behavior in mental patients
.
Hosp Community Psychiatry
1979 Oct;
30
(
10
):
709
-
10
.
11.
Swearer
J M
,
Drachman
D A
,
O'Donnel
B F
,
Mitchell
A L
.
Troublesome and disruptive behaviors in dementia
.
J Am Geriatr Soc
1988 Sept;
36
(
9
):
784
-
90
.
12.
Rovner
B W
.
Behavioral and psychiatric disability in alzheimer's disease
.
J Geriatr Psychiatry
1992
;
25
:
247
-
55
.
13.
Cohen-Mansfield
J
.
Agitated behaviors in the elderly: II. Preliminary results in the cognitively deteriorated
.
J Am Geriatr Soc
1986
;
34
:
722
-
7
.
14.
Cummings
J
.
Dementia syndromes: neurobehavioral and neuropsychiatric features
.
J Clin Psychiatry
1987
;
48
(
suppl.
):
3
-
80
.
15.
Nasman
B
,
Bucht
G
,
Eriksson
S
.
Behavioral symptoms in the institutionalized elderly-relationship to dementia
.
Int J Geriatr Psychiatry
1993
;
8
:
843
-
9
.
16.
Chou
K R
,
Kaas
M J
,
Richie
M F
.
Assaultive behavior in geriatric patients
.
J Gerontol Nursing
1996 Nov;
22
(
11
):
30
-
8
.
17.
Taylor
P J
,
Parrot
J M
.
Elderly offenders
.
Br J Psychiatry
1988
;
152
:
340
-
6
.
18.
Ticehurst
S B
,
Gale
I G
,
Rosenberg
S J
.
Homicide and attempted homicide by patients suffering from dementia: two case reports
.
Aust NZ J Psychiatry
1994
;
28
:
136
-
40
.
19.
Lukehart
S A
,
Holmes
K K
.
Syphilis
. In:
Fauci
A S
,
Braunwald
E
,
Isselbacher
K J
,
Wilson
J D
,
Martin
J B
,
Kasper
D L
,
Hauser
S L
, et al., editors.
Harrison's Principles of Internal Medicine
.
New York
,
McGraw Hill
;
1998
:
1023
-
33
.
20.
Beal
M F
,
Martin
J B
.
Nutrition and metabolic diseases of the nervous system
. In:
Fauci
A S
,
Braunwald
E
,
Isselbacher
K J
,
Wilson
J D
,
Matin
J B
,
Kasper
D L
,
Hauser
S L
, et al., editors.
Harrison's Principles of Internal Medicine
.
New York
,
McGraw Hill
;
1988
:
2451
-
7
.
21.
Bottiglieri
T
.
Folate, vitamin B-12, and neuropsychiatric disorders
.
Nutr Rev
1996 Dec;
54
(
12
):
382
-
90
.
22.
Scharre
D W
.
Neuropsychiatric aspects of neoplastic, demyelinating, infectious, and inflammatory brain disorders
. In:
Coffey
C E
,
Cummings
J L
, editors.
Textbook of geriatric neuropsychiatry
.
Washington, DC
,
American psychiatric press, Inc.
1994
:
523
-
47
.
23.
Rosner
R
,
Wiederlight
M
,
Schneider
M
.
Geriatric felons examined at a forensic psychiatry clinic
.
J Forensic Sci
1985 July;
30
(
3
):
730
-
40
.
24.
Bergman
S
,
Amir
M
.
Crime and delinquency among aged in Israel, an experience survey
.
The Isr Ann Psychiatr Relat Discip
1973 March;
11
(
1
):
33
-
48
.
25.
Mendez
M F
.
Dementia and guns
.
J Am Geriatr Soc
1996 April;
44
(
4
):
409
-
10
.
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