57. BREAKING THE ILLUSION: SUCCESSFUL RESOLUTION OF CAPGRAS SYNDROME WITH RIVASTIGMINE TREATMENT IN LEWY BODY DEMENTIA

Abstract

Introduction

Capgras Syndrome is a rare delusional misidentification syndrome characterized by the false belief that a familiar person has been replaced by an identical imposter. While primarily associated with psychotic disorders, it can also occur in the context of neurocognitive disorders. Treatment options for Capgras Syndrome remain limited, with few reported cases of successful management. Here we report a case of complete resolution of Capgras Syndrome in a patient with Lewy Body dementia (LBD) following treatment with rivastigmine.

Methods

An 82-year-old male, initially presented with memory decline and poor sleep. He exhibited confusion and disorganized behavior following a cruise trip to South America in January 2020.

Neuropsychological testing revealed neurodegenerative disorder, and subsequent evaluation led to a diagnosis of LBD. The patient's symptoms included the belief that he was living in a duplicate version of his home and his wife has been replaced by an imposter, consistent with Capgras Syndrome.

Treatment with rivastigmine patch was initiated, with subsequent switch to oral formulation due to tolerance issues.

After nine months of treatment, the patient reported complete resolution of Capgras Syndrome symptoms.

Additional neuropsychological testing found improvement in attention, visuospatial, story memory, and divided attention, and declines in verbal abstraction and word list recognition, since his previous testing in 2020.

Results

This case highlights the importance of exploring treatment options beyond standard psychotropic medications in neurodegenerative disorders. The resolution of Capgras Syndrome with rivastigmine underscores the need for further research into cholinergic modulation in managing psychotic symptoms associated with LBD.

Conclusions

Our case highlights the successful treatment of Capgras Syndrome in a patient with LBD using rivastigmine. Further research is needed to elucidate the underlying mechanisms and optimize treatment strategies for this rare but debilitating condition. Cholinesterase inhibitors may offer a promising therapeutic approach for Capgras Syndrome, but additional studies are necessary to confirm their efficacy and safety profile.