a1 Comprehensive Center on Brain Aging, Alzheimer Disease Center, New York University Langone Medical Center, New York, NY
Background: Capgras syndrome is characterized by the recurrent, transient belief that a person has been replaced by an identical imposter.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.
(Received May 25 2012)
(Revised June 20 2012)
(Reviewed November 08 2012)
(Accepted November 12 2012)
(Online publication December 05 2012)
c1 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.