The emergence of delusional companions in Alzheimer's disease: an unusual misidentification syndrome.
BACKGROUND
Misidentifications in the course of organic diseases, including Alzheimer's disease (AD), have been associated with right sided brain dysfunction. The reasons for this association might be clarified by investigating the contribution of neurobiological, cognitive and emotional factors to distinctive types of misidentification.


METHODS
This study reports the cases of three patients with AD presenting a novel misidentification delusion in which objects with intrinsically comforting associations, soft toys, were experienced as sentient and triggered associated behaviours. Investigations included regional cerebral blood flow (rCBF) measurements with HMPAO SPECT and a comprehensive clinical and neuropsychological assessment.


RESULTS
All three patients showed a distinctive pattern of rCBF with dysfunction centred in the right parietal area and severe visuospatial and visuoperceptive processing deficits, with relatively preserved memory and language abilities.


CONCLUSIONS
These findings support the hypothesis that this type of misidentification delusion may be facilitated by right sided regional brain dysfunction involving visuoperceptual processing. Other historical and cognitive data from these patients suggests that the appearance of the symptom may be determined by the coexistence of a more widespread disorder of reality processing, which interacts with cognitive and psychogenic factors.
Shanks
Michael F
MF
Royal Cornhill Hospital, Aberdeen, UK.
Venneri
Annalena
A