Capgras delusion for animals and inanimate objects in Parkinson’s Disease: a case report

Abstract

BackgroundCapgras delusion is a delusional misidentification syndrome, in which the patient is convinced that someone that is well known to them, usually a close relative, has been replaced by an impostor or double. Although it has been frequently described in psychotic syndromes, including paranoid schizophrenia, over a third of the documented cases of Capgras delusion are observed in patients with organic brain lesions or neurodegenerative disease, including Parkinson’s Disease. Variants of Capgras involving animals or inanimate objects have also been described. The etiology of Capgras in Parkinson’s remains unclear, but may arise from a combination of factors, such as frontal lobe dysfunction and dopaminergic medication.Case presentationWe present the case of a 53-year old right-handed female with Parkinson’s disease who developed Capgras delusion during treatment with dopamine agonists and Levodopa/Carbidopa. She became convinced that her pet dogs and the plants in her garden had been substituted by identically looking ones. Our patient was initially treated with Quetiapine, with no improvement, and subsequently treated with Clozapine, which lead to partial regression of her symptoms. Neuropsychological Evaluation showed Mild Cognitive Impairment in Executive Functions.ConclusionsGiven the clinical history, onset and evolution of symptoms we believe our patient’s delusion resulted from the overlap of dopaminergic medication and Mild Cognitive Impairment in executive functions. Zoocentric Capgras, the variant we describe, has been rarely described in scientific literature, and we believe it is of interest due to its unusual characteristics.

Rapid Eye Movements in Sleep Furnish a Unique Probe Into Consciousness

“…Reduplicative paramnesia involves the delusional belief that a place or location has been duplicated. Delusional misidentification (delusion of doubles) of pets and inanimate objects was also reported ( Berson, 1983 ; Anderson and Williams, 1994 ; Wright et al, 1994 ; Ellis et al, 1996 ; Darby and Caplan, 2016 ). Prosopagnosia consists in the inability to recognize familiar faces ( Duchaine and Nakayama, 2006 ; Corrow et al, 2016 ), “including, in some cases, one’s own face reflected in a mirror” — personal identity as visually given disappears from conscious experience ( Metzinger, 2003 ).…”

“…These delusions and prosopagnosia are rare but coexist in some cases, and are commonly associated with brain diseases ( Berson, 1983 ; Anderson, 1988 ; Förstl et al, 1991 ; Anderson and Williams, 1994 ; Weinstein, 1994 ; Wright et al, 1994 ; Ellis and Lewis, 2001 ; Debruyne et al, 2009 ). This indicates a shared neural infrastructure that constitutes the generative model of self and world – including other persons, pets, objects and places (and underlies familiarity perception) ( Darby et al, 2017 ).…”

“Capgras” Delusions Involving Belongings, Not People, and Evolving Visual Hallucinations Associated with Occipital Lobe Seizures

“…To our knowledge, this is the first case to describe the cooccurrence of these symptoms in a patient with occipital lobe epilepsy. Other similar cases reviewed in the literature occurred in the context of primary psychiatric disorder diagnoses, dementia, and other neurodegenerative conditions [ 12 – 16 ].…”

Capgras syndrome associated with limbic encephalitis in a patient with diffuse large B-cell lymphoma

“…There is no consensus on specific lesion topography responsible for the clinical manifestations of DMS, but it is believed to arise from structural lesions of the very complex face processing areas, 23 as well as from a disconnection between the temporal cortex and the limbic system. 15 In a review article, Devinsky et al claimed that misidentification syndromes, particularly reduplicative paramnesia and Capgras syndrome, result from neurologic damage to bifrontal lobes and/or right hemisphere of the brain.…”