Comprehensive Center on Brain Aging, Alzheimer Disease Center, New York University Langone Medical Center, New York, NY, USA.
Int Psychogeriatr. 2013 May;25(5):843-9. doi: 10.1017/S1041610212002189. Epub 2012 Dec 5.
Capgras syndrome is characterized by the recurrent, transient belief that a person has been replaced by an identical imposter. We reviewed clinical characteristics of Dementia with Lewy Bodies (DLB) patients with Capgras syndrome compared to those without Capgras.
We identified 55 consecutive DLB patients (11 cases with Capgras syndrome (DLB-C) and 44 cases without evidence of Capgras (DLB). Semi-structured interviews with the patient and an informant, neurological exams, and neuropsychological testing were performed. Caregivers were assessed for caregiver burden and depression. Primary comparisons were made between DLB-C and DLB. Exploratory analyses using stepwise logistic regression and bootstrap analyses were performed to determine clinical features associated with Capgras.
DLB-C patients experienced more visual hallucinations and self-reported anxiety, had higher scores on the Neuropsychiatric Inventory, and were less likely to be treated with cholinesterase inhibitors at time of initial evaluation. Extrapyramidal symptoms and depression were not associated with Capgras. Caregivers of DLB-C patients had higher caregiver burden. DLB-C was associated with self-reported anxiety (OR = 10.9; 95% CI = 2.6-47.6). In a bootstrap analysis, clinical findings that were predictors of Capgras included visual hallucinations (log(OR) = 18.3; 95% CI = 17.9-19.3) and anxiety (log(OR) = 2.9; 95% CI = 0.31-20.2).
Our study suggests that Capgras syndrome is common in DLB and usually occurs in the presence of anxiety and visual hallucinations, suggesting related etiopathogenesis. Early appreciation of Capgras syndrome may afford the opportunity to alleviate caregiver burden and improve patient and caregiver outcomes.
卡普格拉综合征的特征是反复出现、短暂的信念，即一个人已被一个相同的冒名顶替者所取代。我们回顾了路易体痴呆（DLB）伴有卡普格拉综合征（DLB-C）和不伴有卡普格拉综合征（DLB）的患者的临床特征。
我们确定了 55 例连续的 DLB 患者（11 例患有卡普格拉综合征（DLB-C），44 例无卡普格拉证据（DLB）。对患者和知情者进行了半结构化访谈、神经检查和神经心理学测试。评估了照料者的负担和抑郁情况。对 DLB-C 和 DLB 进行了主要比较。使用逐步逻辑回归和引导分析进行了探索性分析，以确定与卡普格拉相关的临床特征。
DLB-C 患者经历更多的视幻觉和自我报告的焦虑，神经精神病学问卷评分较高，初始评估时更不可能接受胆碱酯酶抑制剂治疗。锥体外系症状和抑郁与卡普格拉无关。DLB-C 患者的照料者负担更高。DLB-C 与自我报告的焦虑相关（OR=10.9；95%CI=2.6-47.6）。在引导分析中，与卡普格拉相关的临床发现包括视幻觉（log（OR）=18.3；95%CI=17.9-19.3）和焦虑（log（OR）=2.9；95%CI=0.31-20.2）。
我们的研究表明，卡普格拉综合征在 DLB 中很常见，通常发生在焦虑和视幻觉的情况下，提示其发病机制相关。早期认识卡普格拉综合征可能有机会减轻照料者的负担，并改善患者和照料者的结局。
