P4–367: Capgras‐like visual decomposition in Lewy body dementia (LBD) with therapeutic response to donepezil: Two clinical cases with neuropsychological and neuroimaging correlates
Year: 2013
Type: article
Study design: Case Report
Abstract: Brain cholinergic dysfunction is widespread and profound in Lewy Body Dementia (LBD). Defects in visual spatial cognition, including hallucinations and perception deficits, are common in LBD. Prosopagnosia, the inability to recognize faces, is common in neurodegenerative disease. Capgras syndrome is a pathological belief that a known person, usually a close relative, has been replaced by an imposter. Neuropsychological test results interrogating the visual association cortex, including the Beery Test of Developmental Integration, Clock Drawing Test, Judgment of Line Orientation Test and Benton Facial Recognition Test, may underscore these visual processing deficits. Diffusion Tensor Imaging (DTI) may show deficits in visual processing pathways such as the visuo-amygdaloid pathway. At this time there is no known treatment to target such visual hallucinations specifically. Antipsychotics have severe risks and side effects in this patient group. We present 2 cases of LBD who presented to an outpatient university based dementia clinic with Capgras-like visual decomposition of faces. Both patients had neuropsychological test results that evidenced visual/perceptive deficits. Both patients showed response to a therapeutic trial of Donepezil demonstrated as marked reduction of the number and length of the Capgras-like symptoms with almost complete resolution. One patient had recurrence of the Capgras syndrome after several weeks on the Donepezil 10 mg and responded again to the escalation of the dose to 23 mg. The Capgras-induced agitation also resolved and we could avoid the use of atypical antipsychotics. Brain cholinergic dysfunction may contribute to visual deficits including Capgras-like visual decomposition of faces in LBD. Cholinesterase inhibitors may be useful to target visual deficits in LBD. Further double-blind studies are needed to confirm the utility of cholinesterase inhibitors.
Source: Alzheimer s & Dementia
Institution: Jacobs Institute
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2328332364