Objective:  We report two patients with Parkinson’s disease(PD) and Capgras syndrome (CS) with confusion of identify not just of close acquaintances but also of “self”.

Background:  

Capgras syndrome(CS) is a rare delusional misidentification syndrome (DMS) which can be seen in neurodegenerative diseases such as Dementia with Lewy bodies (DLB) and Parkinson’s disease (PD) with or without dementia. Typically, this involves misidentification of close family members.

Methods: Retrospective chart review of two patients with PD dementia and delusional misidentification for self.

Results: A 74 year old man with a 5 year history of PD and one year history of Parkinson`s disease dementia (PDD) believed that his wife was an imposter replacing his “real” wife, and that his house was a duplicate of itself.  He also thought there was “another him.” There was no history of substance abuse, head injury, or psychiatric illness. MRI scan revealed only enlarged ventricles and cortical sulci consistent with age related tissue loss. Medications included escitalopram, carbidopa/levodopa, and alprazolam, with no recent dose changes. Neuropsychological testing over the last three years revealed progressive impairment of memory/learning, processing speed, verbal fluency, and other executive functions. Of note, he had recently started traveling more for his job. He was diagnosed with Capgras syndrome, and administered quetiapine 25 mg at bedtime, which was effective in managing his delusions.

A 78 year old female diagnosed 4 years ago with PDD confused her husband with his his 20-year younger self, and could not connect his relationship to her.  She also believed that she was a “surrogate medication taker” for other patients. Neuropsychological testing revealed a MoCA score of 21/27, with impaired world list recall. Executive function testing showed adequate performance on trailmaking, intact clock drawing, and average range WAIS-IV Matrix Reasoning.  MRI displayed mild periventricular and subcortical white matter changes. Family declined antipsychotic medications. Increase in rivastigmine dose did not improve symptoms.  

Conclusions: Patients with delusional misidentification of “self “can have confusion and emotional detachment from self which can decrease medication compliance, increase caregiver burden and Quetiapine may be helpful in managing this syndrome in PD patients.

References: 1.Josephs K.A. Capgras Syndrome and Its Relationship to Neurodegenerative Disease.  Arch Neurol. 2007 ;64(12): 1762-1766.

2.Shiotsuki H., Motoi Y. et al:  Dopamine Deficiency May Lead to Capgras Syndrome in Parkinson’s Disease with Dementia The Journal of Neuropsychiatry and Clinical Neurosciences. 2010 ;22(3): 352.e14–352.e15.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/delusional-misidentification-syndrome-for-self-in-two-patients-with-parkinsons-disease/