The responsibility of persons with brain disorders who commit offenses may depend on how their disorders alter brain mechanisms for culpability. Criminal behavior can result from brain disorders that alter social cognition including a neuromoral system of intuitive moral emotions that are absolute (deontological) normative codes and that includes an emotion-mediated evaluation of intentionality. This neuromoral system has its hub in the ventromedial prefrontal cortex (VMPFC) with other frontal, anterior temporal-amygdalar, insular, and right temporoparietal connections. Among brain disorders, investigators report offenses in persons with brain tumors, epilepsy, and traumatic brain injury, but it is those with a form of dementia with VMPFC pathology, behavioral variant frontotemporal dementia (bvFTD), who are most prone to criminal behavior. This review presents four new patients with bvFTD who were interviewed after committing offenses. These patients knew the nature of their acts and the wrongness of the type of action but lacked substantial capacity to experience the criminality of their conduct at the intuitive, deontological, moral emotional level. Disease in VMPFC and its amygdalar connections may impair moral emotions in these patients. These findings recommend evaluation for the experience of moral emotions and VMPFC-amygdala dysfunction among persons with antisocial behavior, with or without brain disease.

患有脑部疾病的人犯罪的责任可能取决于他们的疾病如何改变大脑的犯罪机制。犯罪行为可能是由改变社会认知的大脑疾病引起的，包括直觉道德情感的神经道德系统，这些道德情感是绝对的（义务论）规范代码，并且包括对意向性的情感介导的评估。该神经道德系统的中枢位于腹内侧前额叶皮层 (VMPFC)，与其他额叶、前颞杏仁核、岛叶和右颞顶叶连接。在脑部疾病中，调查人员报告了脑肿瘤、癫痫和脑外伤患者的犯罪行为，但那些患有 VMPFC 病理学痴呆症、行为变异型额颞叶痴呆 (bvFTD) 的人最容易发生犯罪行为。本综述介绍了四名新的 bvFTD 患者，他们在犯罪后接受了采访。这些患者知道自己行为的本质以及行为类型的错误，但缺乏在直觉、义务论、道德情感层面体验其行为的犯罪性的实质性能力。VMPFC 及其杏仁核连接的疾病可能会损害这些患者的道德情绪。这些发现建议对有或没有脑部疾病的反社会行为者的道德情绪体验和 VMPFC-杏仁核功能障碍进行评估。