Kawai Yoshinari
Department of Neurology, Oyamada Memorial Spa Hospital.
Brain Nerve. 2018 Nov;70(11):1181-1191. doi: 10.11477/mf.1416201163.
Delusional misidentification syndromes (DMSs) are a fascinating group of disorders involving a fixed, false belief about the identity of persons, places, and objects in one's environment. DMSs include Capgras syndrome, Frégoli syndrome, intermetamorphosis, the syndrome of subjective doubles, and reduplicative paramnesia. Although DMSs have been described in patients with focal neurological lesions, they are more commonly associated with neurodegenerative diseases, specifically dementia with Lewy bodies. Lesion network mapping was used to identify brain regions functionally connected to the lesion locations in patients with lesion-induced DMSs. The left retrosplenial cortex and the right ventral frontal cortex/anterior insula were functionally connected to almost all lesion locations. In a model of Capgras symptom as a mirror of prosopagnosia, there are two routes of visual recognition; one covert and one overt. Capgras symptom represents an interruption to the covert route with an intact overt route. This model, however, does not explain other DMSs. Therefore, propose a new model where the delusional belief content in DMSs results from dysfunctional linking between externally perceived objects and appropriately retrieved internal autobiographical memories associated with an object.
妄想性身份识别障碍（DMSs）是一组引人入胜的疾病，涉及对自身环境中的人物、地点和物体身份的固定、错误信念。DMSs包括卡普格拉综合征、弗雷戈里综合征、变身症、主观替身综合征和替身错觉症。虽然DMSs已在局灶性神经病变患者中被描述，但它们更常与神经退行性疾病相关，特别是路易体痴呆。病变网络映射被用于识别病变诱发的DMSs患者中与病变位置功能相连的脑区。左侧压后皮质和右侧腹侧额叶皮质/前岛叶与几乎所有病变位置功能相连。在将卡普格拉症状视为面孔失认症镜像的模型中，存在两条视觉识别途径；一条是隐蔽的，一条是公开的。卡普格拉症状代表隐蔽途径的中断，而公开途径完好无损。然而，该模型无法解释其他DMSs。因此，提出一个新模型，即DMSs中的妄想信念内容是由外部感知对象与与该对象相关的适当检索到的内部自传体记忆之间的功能失调联系所致。
