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Case 20 - Not Recognizing the Impostor

from Part 4 - Failure of Pattern Recognition

Published online by Cambridge University Press:  03 November 2020

Keith Josephs
Affiliation:
Mayo Clinic Alzheimer’s Disease Research Center
Federico Rodriguez-Porcel
Affiliation:
Medical University of South Carolina
Rhonna Shatz
Affiliation:
University of Cincinnati
Daniel Weintraub
Affiliation:
University of Pennsylvania
Alberto Espay
Affiliation:
University of Cincinnati
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Summary

This 68-year-old right-handed woman was evaluated for parkinsonism. Over the prior nine months, she had progressively become more withdrawn from her husband, whom she had been married to for 45 years. Initially, she would intermittently startle when her husband came into the room. Later, she started to sleep in a separate bed and avoided changing her clothes in front of him. When her husband asked her if there was anything wrong, she avoided him without any explanation. She progressively became verbally and physically aggressive toward him, which led to an intervention by her children. When they asked her if there were interpersonal issues between her and their father, she reported that he was not her husband. She acknowledged the resemblance but insisted that he was actually an impostor. Her children’s attempts to prove her wrong only made her more agitated. She was taken to the emergency room, where, after ruling out infections, toxic exposures, and stroke, she was given diagnosis of a psychotic disorder and was started on an antipsychotic, risperidone 2 mg daily. While this helped with her agitation, she became slower in her thinking. Her level of attention would fluctuate, and sometimes it appeared as if she were in a daze. In addition, a bilateral hand tremor emerged, and she started to shuffle.

Type
Chapter
Information
Common Pitfalls in Cognitive and Behavioral Neurology
A Case-Based Approach
, pp. 64 - 66
Publisher: Cambridge University Press
Print publication year: 2020

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References

American Psychological Association. 2013. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychological Association.Google Scholar
Ducharme, S., Bajestan, S., Dickerson, B. C. and Voon, V. 2017. Psychiatric presentations of C9orf72 mutation: what are the diagnostic implications for clinicians? J Neuropsychiatry Clin Neurosci 29(3) 195205.CrossRefGoogle ScholarPubMed
Ffytche, D. H. et al. 2017. The psychosis spectrum in Parkinson disease. Nat Rev Neurol 13(2) 8195.CrossRefGoogle ScholarPubMed
Josephs, K. A. 2007. Capgras syndrome and its relationship to neurodegenerative disease. Arch Neurol 64(12) 17621766.CrossRefGoogle ScholarPubMed
Lanctôt, K. L. et al. 2017. Neuropsychiatric signs and symptoms of Alzheimer’s disease: new treatment paradigms. Alzheimers Dement 3(3) 440449.CrossRefGoogle ScholarPubMed
Perini, G. et al. 2016. Misidentification delusions: prevalence in different types of dementia and validation of a structured questionnaire. Alzheimer Dis Assoc Disord 30(4) 331337.CrossRefGoogle ScholarPubMed
Reeves, S. J., Gould, R. L., Powell, J. F. and Howard, R. J. 2012. Origins of delusions in Alzheimer’s disease. Neurosci Biobehav Rev 36(10) 22742287.CrossRefGoogle ScholarPubMed
Reinhardt, M. M. and Cohen, C. I. 2015. Late-life psychosis: diagnosis and treatment. Curr Psychiatry Rep 17(2) 1.CrossRefGoogle ScholarPubMed

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