What is Capgras Syndrome?

The Capgras delusion (or syndrome) is a particular kind of phenomenon in which a person perceives that a spouse or other closely-regarded person has been replaced by an imposter — identical in all ways, but yet not the same.  It is most commonly seen in cases of paranoid schizophrenia, but has recently been identified in persons with brain injury or certain neurodegenerative diseases (such as Lewy Body Dementia).   There have also been reported incidences in conjunction with diabetes, hypothyroidism, and migraine attacks.  One study has indicated that up to 17% of persons with Lewy Body Disease exhibit Capgras syndrome.

Joseph Capgras, a French psychiatrist, first described the disorder given his name in 1923.  In a paper co-written by Jean Reboul-Lachaux, the name they originally gave the syndrome translates into English as “the illusion of look-alikes.”  It was originally seen as a purely psychiatric disorder, related to schizophrenia.  It was also considered a disorder of women, seen in hysteria.  (This is no longer the case.)  In the 1980s, scientists began to look at the brain lesions that often occur along with the syndrome, and it has been redefined as a neurological disorder due to organic brain lesions or degeneration.

Research has suggested that there are two different processes involved in facial recognition, one conscious and one unconscious.  One study in 1984 showed that patients with prosopagnosia (the inability to recognize faces consciously) still showed emotional arousal when shown pictures of familiar persons.  Later studies identified persons with Capgras syndrome who could consciously recognize faces, but who showed no physiological response tied to emotion.  Hence, it has been hypothesized that the syndrome may result from a disconnect between the temporal cortex, usually responsible for recognizing faces, and the limbic system (specifically the amygdala and the inferotemporal cortex) involved in emotions.

Some scientists have gone on to clarify this point.  Part of what causes a person to be familiar to us is not only what he/she looks or sounds like, but also what we know about that person’s personality or other idiosyncrasies.  When we are no longer able to access our recollections of those peculiarities that make a person an individual, then it becomes more difficult to recognize them.  It has also been suggested that the person who displays Capgras syndrome may also have difficulty linking episodic memories in order to access long-term memory.

In a study first reported in December, 2012, 55 patients with LBD were evaluated — 11 of whom also had Capgras syndrome.  There was no significant difference noted between the two groups with regards to dementia ratings and neuropsychological functioning.  However all of the persons who exhibited Capgras syndrome showed visual hallucinations.  Anxiety was determined to increase the risk of the syndrome by a factor of ten.  And, as might be expected, the caregivers of those individuals who displayed Capgras syndrome reported a higher caregiver burden and a higher level of depression.   (Frequently, the caregiver is the target of the delusion, and also spends the greater amount of time with the person who has dementia.)

Dr. James E. Galvin, of the New York University Medical Center, spear-headed this study and also served as senior author.  He speculated that early diagnosis of LBD and Capgras syndrome might allow for pharmacological treatment and alleviation of both the syndrome and the caregiver burden associated with it.  And, indeed, 80% of those participating in the study had initially been treated with cholinesterase inhibitors.  However, at some point those with Capgras syndrome had stopped using the drugs for reasons that were not supplied by the authors.  It should be noted that persons who take this class of medications often complain of gastrointestinal upset or heightened attention.

So, how does a caregiver deal with a person who shows Capgras syndrome?  Often what families and others attempt to do is exactly what is liable to do the least good — argue with the person.  This is something that I learned soon after I started spending a significant amount of time with persons who have dementia, regardless of the causative factor for the cognitive decline.  Once a person reaches a certain stage, their ability to reason begins to deteriorate as well.  Contributing to this is the newly-developed difficulty in expressing their thoughts as well as understanding those of other people.  One of the more typical reactions to this difficulty is irritation and anger, directed at the communication partner or at the self.  So, what happens when you try to argue with this person is that he/she only grows more and more angry, and the entire situation deteriorates until everyone involved is only that much more frustrated.

Here’s something you can try, instead of arguing or trying to show the person the “error of his ways:”

1.  Try to get into the person’s reality.  Imagine, for a moment, what it would feel like to truly believe that this person standing in front of you claiming to be your husband is actually a stranger.  All those years of trust, and companionship, and love, that you counted on so much, have suddenly gone out the window.  The whole world is falling apart around you, now you have to deal with this as well?  And if this person is no longer who you thought he was, what else and who else has changed?

2.  Again, don’t try to argue with the person.  Any “facts” you provide to show that they’re mistaken will only be forgotten in a short amount of time.  And the person isn’t really just being stubborn; there’s a very real process taking place in the brain that causes this behavior.  A process they can not prevent or stop.  Neither is it the fault of the caregiver, no insult or offense is meant even if may seem so.

3.  Try to create an environment for your loved one that is as comfortable and familiar as possible.  If he/she has recently moved into a care center, try to bring in familiar objects from home.  Visit often, and speak of shared experiences, talk about photographs that stimulate pleasant memories, engage the person in familiar activities.  If you care for the person at home, take long walks in the yard and talk about all those years she loved to work in her garden.  Have her sit next to you and help as much as possible when you’re fixing dinner.  Play beloved hymns on the radio.  Hopefully, as the rest of the environment becomes more familiar, the effects of Capgras syndrome will diminish as well.

Some other things you can do to help the person with Capgras syndrome are to acknowledge her feelings.  Don’t ridicule her or scold her.  Remind her that you care about her very much, and would never let any harm come to her.  Tell her that you have told the imposter to go away.  Or, try telling her that her husband had to go away for a little while, and sent you in his place to take care of her.  George will be back soon, and then everything will be just fine.  Try using her other senses to connect with her, such as speaking to her from another room when you get home.  Tell her about your day, and ask her about hers.  Then, after she’s had a chance to recognize your voice, enter the room and let her associate what she sees with what she hears.

http://www.wikipedia.com

http://www.lbda.org/content/capgras-syndrome-dlb-associated-anxiety-and-hallucinations

http://psychcentral.com/lib/dementia-and-capgras-syndrome-handling-behavior-and-emotional-fallout/00015219

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  1. June 15, 2014 at 8:05 PM

    I had never heard of this syndrome before. Fascinating information, thanks for sharing.

    • June 16, 2014 at 7:20 AM

      You’re very welcome. I have encountered some of the unique hallucinations experienced by some persons with LBD, but haven’t run across this particular one. Sounds like this sort of thing is either becoming more common, or is just more recognized.

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