Journal of Alzheimers Disease & Parkinsonism
Open Access

Abstract

Patients in each domain of dementia may experience hallucinations, delusions or misidentification syndromes. One form of misidentification syndrome, called Capgras syndrome, also known as Imposter syndrome, occurs when a patient believes that their primary caretaker is duplicated and searches for the “real” person (Sinkman, 2008). This phenomenon occurs when the pathway between the occipital face area of the brain and the amygdala is obstructed. Typically seen in patients with schizophrenia or bipolar disorder, Capgras syndrome is also significantly prevalent in patients with dementia (Cummings, Miller, Hill, & Neshkes, 1987). The patient recognizes the significant person, but the emotional connection from the amygdala does not receive the signal that the recognized face is the actual significant individual; therefore, continues to search for the person who meets the “significant” criteria. The delusion is frightening to the patient and upsetting to the caretaker, who is usually the spouse or close relative. In patients with vascular dementia (VaD), somatic impairments in vision and/or ambulation can exacerbate fear during Capgras episodes. The importance of caretakers to undertake a subjective and supportive perspective within the patient’s experience during a Capgras episode cannot be overstated. Validation therapy, which contradicts the natural inclination to reason the objective reality, must be exercised to restore a sense of safety to the patient’s reality. Compassionate and creative measures, such as voice, tactile, and natural supports, are what comprise the most effective techniques in validation interventions for VaD patients with Capgras syndrome.

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