Reflections of the self: atypical misidentification and delusional syndromes in two patients with Alzheimer's disease

Article Abstract:

Psychotic symptoms such as hallucinations and delusions are common in Alzheimer's disease (AD). Misidentification syndromes such as Capgras are more rare. In Capgras syndrome, patients develop the delusion that important persons such as a spouse or a child have been replaced by a 'bad' impostor. AD patients have also been shown to misidentify their own mirror reflections. Two cases are presented, in which AD patients were able to identify their mirror images, but felt their reflections included a second person with a separate identity. The first patient was a 61-year-old married white woman who had been diagnosed with AD three years earlier. At the mirror, she would see two women reflected - herself and another. She believed the other woman wanted to replace her. The second patient was a 55-year-old black man with an AD diagnosis of about 18 months. Sometimes he would become angry at his mirror image. At other times, he would laugh with it. He could recognize his own reflection, but often saw another man who was 'bad.' Both patients improved with structured care and support. In the first case, the woman's moods were related to her delusions. When she was feeling isolated, criticized and depressed, she often saw the bad woman. In the second case, the patient's reactions and moods fluctuated between friendly and hostile. The psychodynamic implications of these good versus bad mirror images are typically discussed in terms of 'splitting,' a phenomenon in which unwanted parts of the self are split off, denied, and projected outward. However, neurological examinations of both patients revealed deficits of the frontal and temporal lobes. It is thought that such cases point to the need to view certain psychoses as both biological and psychological in nature. (Consumer Summary produced by Reliance Medical Information, Inc.)

Alzheimer's disease

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Delusional misidentification, AIDS and the right hemisphere

Article Abstract:

Capgras syndrome is a rare phenomenon in which patients have the delusion that familiar people have been replaced by identical-looking impostors. The syndrome is usually attributed to psychological causes, although recent reports have implicated organic brain disease in some Capgras syndrome patients. A case report of Capgras syndrome in a 30-year-old patient with AIDS is presented. While hospitalized, he was found to have several abnormal beliefs about the identity of people close to him, and believed two of his friends and his mother had been replaced by alien impostors. He also believed that his surroundings had been replicated. This latter delusion, diagnosed as reduplicative paramnesia, is typically considered to be an organic disorder, while Capgras syndrome is considered to be a psychiatric one. However, the only clinical difference between the disorders is that in one the delusion involves people, and in the other it involves places. Neurological findings in this patient included a lesion in the right parietal region of his brain, an area previously associated with impairment for the recall of complex visual patterns, which has been reported in previous cases of Capgras syndrome. Although neuropsychiatric complications of HIV-infection often lead to confusion, paranoia and dementia, misidentification syndromes have not previously been reported. Findings in this case strongly suggest that brain deficits contribute to the Capgras syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, AIDS (Disease)

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