Mirrored-self Misidentification: Two Cases of Focal Onset Dementia

Abstract

We present two patients in whom the mirror sign, the inability to recognize one's own reflected image, was a stable and persisting symptom signalling the onset of a progressive dementing illness. Extensive neuropsychological testing was conducted with both patients, with particular emphasis on face processing and the understanding of reflected space. Both patients were also investigated with structural imaging techniques (computed tomography and magnetic resonance imaging). Although the neuroimaging results were not strongly lateralizing for either patient, neuropsychological testing revealed striking right hemisphere dysfunction with relatively intact left hemisphere cognitive function in both patients. Of particular interest was the patients' dissociation on tests of face processing; one patient, FE, had significant face processing deficits while the other patient, TH, had relatively intact face processing. Further testing with TH revealed striking deficits in his ability to interpret reflected space. The results of the face processing tests are discussed in the context of current models of normal face processing, with particular emphasis on the affective component in face recognition. We propose that a combination of cognitive deficits underlie the mirror sign delusion, including perceptual, affective and reasoning impairments, and also discuss the contributions of cortical and subcortical lesions in these two patients and in delusions in general.

Two aspects of impaired consciousness in Alzheimer's disease

“…For example, lesions in the temporoparietal junction have been related to mirrored self-misidentification in demented patients (Breen et al, 2001). In healthy subjects, activation of temporoparietal junctions was observed in neuroimaging studies when contrasting first-and third-person perspectives in various types of tasks involving: intention attribution (Vogeley et al, 2001), 3D visuospatial perspective (Vogeley et al, 2004), action imagination (Ruby and Decety, 2001), truthfulness judgment (Ruby and Decety, 2003), or emotional assessment (Ruby and Decety, 2004).…”

Self-face recognition activates a frontoparietal “mirror” network in the right hemisphere: an event-related fMRI study

“…Likewise, evidence from patients with frontotemporal dementia suggests that those with asymmetric loss of function in the RH show dramatic changes in self-concept, defined as temporally stable, trans-situational consistencies in behavior, dress, or political or religious ideology (Miller et al, 2001). Similarly, patients exhibiting the syndrome referred to as bmirror signQ, or the inability to recognize one's own reflected image, reportedly show striking RH dysfunction with relatively spared LH function, as revealed by neuropsychological testing (Breen et al, 2001).…”

Teachers’ Interpretations and Power in a High-Stakes Test: A CLA Perspective

“…As one of the educational parties, teachers might get succumbed to the impacts of social, psychological and environmental factors such as school requirements, society's expectations, local policies, mandated curriculum, the practices of peers, workload, and the availability of resources, (e.g., Breen, Caine, & Coltheart, 2001;Khonamiri & Salimi, 2010 ). Such practices may implicitly serve the expectations of the system since teachers are required by parents and even local agents to do so.…”