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  Capgras delusion in posterior cortical atrophy: A quantitative multimodal imaging single case study

Schroeter, M. L., Albrecht, F., Ballarini, T., Leuthold, D., Legler, A., Hartwig, S., et al. (2020). Capgras delusion in posterior cortical atrophy: A quantitative multimodal imaging single case study. Frontiers in Aging Neuroscience, 12: 133. doi:10.3389/fnagi.2020.00133.

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Schroeter, Matthias L.1, 2, 3, Author              
Albrecht, Franziska1, Author              
Ballarini, Tommaso1, Author              
Leuthold, Dominique2, Author
Legler, Angela2, Author
Hartwig, Simone2, Author
Tiepolt, Solveig3, Author
Villringer, Arno1, 2, Author              
1Department Neurology, MPI for Human Cognitive and Brain Sciences, Max Planck Society, ou_634549              
2Clinic for Cognitive Neurology, University of Leipzig, Germany, ou_persistent22              
3Department of Nuclear Medicine, University of Leipzig, Germany, ou_persistent22              


Free keywords: Balint’s syndrome; Capgras delusion; Delusional misidentification syndrome; MRI; Posterior cortical atrophy
 Abstract: Although Alzheimer's disease presents homogeneous histopathology, it causes several clinical phenotypes depending on brain regions involved. Beside the most abundant memory variant, several atypical variants exist. Among them posterior cortical atrophy (PCA) is associated with severe visuospatial/visuoperceptual deficits in the absence of significant primary ocular disease. Here, we report for the first time a case of Capgras delusion-a delusional misidentification syndrome, where patients think that familiar persons are replaced by identical "doubles" or an impostor-in a patient with PCA. The 57-year-old female patient was diagnosed with PCA and developed Capgras delusion 8 years after first symptoms. The patient did not recognize her husband, misidentified him as a stranger, and perceived him as a threat. Such misidentifications did not happen for other persons. Events could be interrupted by reassuring the husband's identity by the patient's female friend or children. We applied in-depth multimodal neuroimaging phenotyping and used single-subject voxel-based morphometry to identify atrophy changes specifically related to the development of the Capgras delusion. The latter, based on structural T1 magnetic resonance imaging, revealed progressive gray matter volume decline in occipital and temporoparietal areas, involving more the right than the left hemisphere, especially at the beginning. Correspondingly, the right fusiform gyrus was already affected by atrophy at baseline, whereas the left fusiform gyrus became involved in the further disease course. At baseline, glucose hypometabolism as measured by positron emission tomography (PET) with F18-fluorodesoxyglucose (FDG-PET) was evident in the parietooccipital cortex, more pronounced right-sided, and in the right frontotemporal cortex. Amyloid accumulation as assessed by PET with F18-florbetaben was found in the gray matter of the neocortex indicating underlying Alzheimer's disease. Appearance of the Capgras delusion was related to atrophy in the right posterior cingulate gyrus/precuneus, as well as right middle frontal gyrus/frontal eye field, supporting right frontal areas as particularly relevant for Capgras delusion. Atrophy in these regions respectively might affect the default mode and dorsal attention networks as shown by meta-analytical co-activation and resting state functional connectivity analyses. This case elucidates the brain-behavior relationship in PCA and Capgras delusion.


Language(s): eng - English
 Dates: 2019-09-192020-04-212020-05-29
 Publication Status: Published online
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: -
 Identifiers: DOI: 10.3389/fnagi.2020.00133
Other: eCollection 2020
PMID: 32547387
PMC: PMC7272572
 Degree: -



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Project name : -
Grant ID : SCHR 774/5-1
Funding program : -
Funding organization : German Research Foundation
Project name : -
Grant ID : FKZ O1GI1007A
Funding program : German Consortium for Frontotemporal Lobar Degeneration
Funding organization : German Federal Ministry of Education and Research
Project name : -
Grant ID : PDF-IRG-1307
Funding program : -
Funding organization : Parkinson’s Disease Foundation
Project name : -
Grant ID : MJFF-11362
Funding program : -
Funding organization : Michael J. Fox Foundation

Source 1

Title: Frontiers in Aging Neuroscience
  Abbreviation : Front Aging Neurosci
Source Genre: Journal
Publ. Info: Lausanne : Frontiers Research Foundation
Pages: - Volume / Issue: 12 Sequence Number: 133 Start / End Page: - Identifier: ISSN: 1663-4365
CoNE: https://pure.mpg.de/cone/journals/resource/1663-4365