title: Capgras syndrome in Dementia with Lewy Bodies.
abstract: BACKGROUND
  Capgras syndrome is characterized by the recurrent, transient belief that a person has been replaced by an identical imposter.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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Comprehensive Center on Brain Aging, Alzheimer Disease Center, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Papan
authors.initials: P
authors.lastname: Thaipisuttikul
authors.forename: Iryna
authors.initials: I
authors.lastname: Lobach
authors.forename: Yael
authors.initials: Y
authors.lastname: Zweig
authors.forename: Ashita
authors.initials: A
authors.lastname: Gurnani
authors.forename: James E
authors.initials: JE
authors.lastname: Galvin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002194:Capgras Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D017028:Caregivers / Q000523:psychology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003702:Delusions / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006212:Hallucinations / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D020961:Lewy Body Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires
chemical_list: D002800:Cholinesterase Inhibitors