Hostname: page-component-7c8c6479df-7qhmt Total loading time: 0 Render date: 2024-03-28T16:55:13.924Z Has data issue: false hasContentIssue false

Capgras syndrome in Dementia with Lewy Bodies

Published online by Cambridge University Press:  05 December 2012

Papan Thaipisuttikul
Affiliation:
Comprehensive Center on Brain Aging, Alzheimer Disease Center, New York University Langone Medical Center, New York, NY
Iryna Lobach
Affiliation:
Comprehensive Center on Brain Aging, Alzheimer Disease Center, New York University Langone Medical Center, New York, NY
Yael Zweig
Affiliation:
Comprehensive Center on Brain Aging, Alzheimer Disease Center, New York University Langone Medical Center, New York, NY
Ashita Gurnani
Affiliation:
Comprehensive Center on Brain Aging, Alzheimer Disease Center, New York University Langone Medical Center, New York, NY
James E. Galvin*
Affiliation:
Comprehensive Center on Brain Aging, Alzheimer Disease Center, New York University Langone Medical Center, New York, NY
*
Correspondence should be addressed to: James E. Galvin, MD, MPH, Comprehensive Center on Brain Aging, Alzheimer Disease Center, New York University Langone Medical Center, 145 East 32nd St, 2nd Floor, New York 10016, NY. Phone: +212-263-3210; Fax: +212-263-3273. Email: James.Galvin@nyumc.org.

Abstract

Background: Capgras syndrome is characterized by the recurrent, transient belief that a person has been replaced by an identical imposter. We reviewed clinical characteristics of Dementia with Lewy Bodies (DLB) patients with Capgras syndrome compared to those without Capgras.

Methods: We identified 55 consecutive DLB patients (11 cases with Capgras syndrome (DLB-C) and 44 cases without evidence of Capgras (DLB). Semi-structured interviews with the patient and an informant, neurological exams, and neuropsychological testing were performed. Caregivers were assessed for caregiver burden and depression. Primary comparisons were made between DLB-C and DLB. Exploratory analyses using stepwise logistic regression and bootstrap analyses were performed to determine clinical features associated with Capgras.

Results: DLB-C patients experienced more visual hallucinations and self-reported anxiety, had higher scores on the Neuropsychiatric Inventory, and were less likely to be treated with cholinesterase inhibitors at time of initial evaluation. Extrapyramidal symptoms and depression were not associated with Capgras. Caregivers of DLB-C patients had higher caregiver burden. DLB-C was associated with self-reported anxiety (OR = 10.9; 95% CI = 2.6–47.6). In a bootstrap analysis, clinical findings that were predictors of Capgras included visual hallucinations (log(OR) = 18.3; 95% CI = 17.9–19.3) and anxiety (log(OR) = 2.9; 95% CI = 0.31–20.2).

Conclusions: Our study suggests that Capgras syndrome is common in DLB and usually occurs in the presence of anxiety and visual hallucinations, suggesting related etiopathogenesis. Early appreciation of Capgras syndrome may afford the opportunity to alleviate caregiver burden and improve patient and caregiver outcomes.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, IV-TR edition. Washington, DC: American Psychiatric Association.Google Scholar
Barton, J. J. (2011). Disorders of higher visual processing. Handbook of Clinical Neurology, 102, 223261.CrossRefGoogle ScholarPubMed
Boeve, B. F.et al. (2011). Validation of Mayo Sleep Questionnaire to screen for REM sleep behavior disorder in an aging and dementia cohort. Sleep Medicine, 12, 445453.CrossRefGoogle Scholar
Borson, S.et al. (1999). The clock drawing test: utility for dementia detection in multiethnic elders. Journal of Gerontology A: Biological Sciences and Medical Sciences, 54, M534M540.Google ScholarPubMed
Bourget, D. and Whitehurst, L. (2004). Capgras syndrome: a review of psychological correlates and presenting clinical features in cases involving physical violence. Canadian Journal of Psychiatry, 49, 719725.CrossRefGoogle Scholar
Brandt, J., Corwin, J. and Krafft, L. (1992). Is verbal recognition memory really different in Huntington's and Alzheimer's disease. Journal of Clinical and Experimental Neuropsychology, 14, 773784.CrossRefGoogle ScholarPubMed
Carr, D. B., Gray, S., Baty, J. and Morris, J. C. (2000). The value of informant vs. individual's complaints of memory impairment in early dementia. Neurology, 55, 17241726.CrossRefGoogle Scholar
Conway, A. R.et al. (2005). Working memory span tasks: a methodological review and user's guide. Psychonomic Bulletin Review, 12, 769786.CrossRefGoogle ScholarPubMed
Cummings, J. L.et al. (1987). Neuropsychiatric aspects of multi-infarct dementia and dementia of the Alzheimer type. Archives of Neurology, 44, 389393.CrossRefGoogle ScholarPubMed
Ferman, T. J.et al. (2004). DLB fluctuations: specific features that reliably differentiate DLB from AD and normal aging. Neurology, 62, 181187.CrossRefGoogle ScholarPubMed
Fienberg, T. E. and Roane, D. M. (2005). Delusional misidentification. Psychiatric Clinics of North America, 28, 665683.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle Scholar
Frazer, S. J. and Roberts, J. M. (1994). Three cases of Capgras’ syndrome. British Journal of Psychiatry, 164, 557559.CrossRefGoogle ScholarPubMed
Galvin, J. E.et al. (2010a). Lewy body dementia: caregiver burden and unmet needs. Alzheimer's Disease and Associated Disorders, 24, 177181.CrossRefGoogle ScholarPubMed
Galvin, J. E.et al. (2010b). Lewy body dementia: the caregiver experience of clinical care. Parkinsonism & Related Disorders, 16, 388392.CrossRefGoogle ScholarPubMed
Harciarek, M. and Kertesz, A. (2008). The prevalence of misidentification syndromes in neurodegenerative diseases. Alzheimer's Disease and Associated Disorders, 22, 163169.CrossRefGoogle ScholarPubMed
Harding, A. J., Broe, A. and Halliday, G. M. (2002). Visual hallucinations in Lewy body disease relate to Lewy bodies in the temporal lobe. Brain, 125, 391403.CrossRefGoogle ScholarPubMed
Haslam, M. T. (1973). A case of Capgras syndrome. American Journal of Psychiatry, 130, 493494.Google ScholarPubMed
Herbert, R., Bravo, , Preville, G. and , M. (2000). Reliability, validity, and reference values of the Zarit Burden Interview for assessing informal caregivers of community-dwelling older persons with dementia. Canadian Journal on Aging, 19, 494507.CrossRefGoogle Scholar
Johns, M. W. (1991). A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep, 14, 540545.CrossRefGoogle ScholarPubMed
Josephs, K. A. (2007). Capgras syndrome and its relationship to neurodegenerative disease. Archives of Neurology, 64, 17621766.CrossRefGoogle ScholarPubMed
Kaufer, D. I.et al. (2000). Validation of the NPI-Q: a brief clinical form of the neuropsychiatric inventory. Journal of Neuropsychiatry and Clinical Neuroscience, 12, 233239.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9 validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606613.CrossRefGoogle ScholarPubMed
Leggett, A. N.et al. (2011). Stress and burden among caregivers of patients with Lewy Body Dementia. The Gerontologist, 51, 7685.CrossRefGoogle ScholarPubMed
MacKay, A., Connor, L. T. and Storandt, M. (2005). Dementia does not explain correlation between age and scores on Boston Naming Test. Archives of Clinical Neuropsychology, 20, 129133.CrossRefGoogle Scholar
McKeith, I. G.et al. (2005). Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology, 65, 18631872.CrossRefGoogle ScholarPubMed
Merrin, E. L. and Silberfarb, P. M. (1976). The Capgras phenomenon. Archives of General Psychiatry, 33, 965968.CrossRefGoogle ScholarPubMed
Morris, J. C. (1993). The Clinical Dementia Rating (CDR) - current version and scoring rules. Neurology, 43, 24122414.CrossRefGoogle ScholarPubMed
Reitan, R. M. (1958). Validity of the Trail Making test as an indicator of organic brain damage. Perception and Motor Skills, 8, 271276.CrossRefGoogle Scholar
Roane, D. M.et al. (1998). Delusional misidentification in association with parkinsonism. Journal of Neuropsychiatry and Clinical Neuroscience, 10, 194198.CrossRefGoogle ScholarPubMed
Rosenberg, C. K.et al. (2001). Dementia with Lewy Bodies and Alzheimer's disease. Acta Neuropathologica, 102, 621626.CrossRefGoogle ScholarPubMed
Snaith, R. P. (2003). The Hospital Anxiety and Depression Scale. Health and Quality of Life Outcomes, 1, 29.CrossRefGoogle ScholarPubMed
Todd, J., Dewhurst, K. and Wallis, G. (1981). The syndrome of Capgras. British Journal of Psychiatry, 139, 319327.CrossRefGoogle ScholarPubMed
Troyer, A. K.et al. (1998). Clustering and switching on verbal fluency tests in Alzheimer's and PD disease. Journal of the International Neuropsychological Society, 4, 137143.CrossRefGoogle Scholar
Wechsler, D. (1955). Manual: Wechsler Adult Intelligence Scale. New York: Psychological Corporation.Google Scholar
Wechsler, D. (1987). Wechsler Memory Scale-Revised Manual. San Antonio, TX: Psychological Corporation.Google Scholar
Weinstein, E. A. and Burnham, D. L. (1991). Reduplication and the syndrome of Capgras. Psychiatry, 54, 7888.CrossRefGoogle ScholarPubMed