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syndrome, in which the patient is convinced that someone that is well known to them, usually a close relative, has been replaced by an impostor or double.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.
Highlights
Capgras 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syndrome, in which the patient is convinced that someone that is well known to them, usually a close relative, has been replaced by an impostor or double
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
Capgras delusion is a delusional misidentification syndrome, in which patients become convinced that someone close to them has been replaced by an impostor
Summary
Capgras is a relatively rare delusion, and is mostly described in patients with concomitant brain lesions or neurodegenerative disease, including PD [11,12,17]. Current neuroimaging data show that face perception involves a core-processing network of cortical modules, each of which is specialized in different functions involved in face processing [18,19,20]. Overall it is a highly specialized network, and differs from other visual information processing [21,22,23]. Learning Recall Recognition Visual memory Visuo-spatial span (forward) Rey-Osterrieth Complex figure Test (RCFT) Recall Attention and executive functions Digit span (backward) Visuo-spatial span (backward) Multiple Features Target Cancellation (MFTC) Time Correct items False alarm Accuracy Stroop color naming Time interference Error interference Trail Making Test Part A Part B B-A Phonemic fluency Cognitive Estimation Test (CET) Errors “Bizarre” errors Modified Five Point Test Drawings Number of strategies Language and perception Semantic fluency Famous face naming test Benton facial recognition test Clock drawing Rey-Osterrieth Complex figure Test (RCFT) Copy Visual Object and Space Perception Battery (V.O.S.P.) Object perception Screening Incomplete letters Silhouettes
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