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Capgras Syndrome: When Dementia Misidentifies a Face

DIAGNOSIS: In Lewy body dementia and Alzheimer’s, people can lose their ability to recognize faces. If this leads to a false belief, such as a person being an imposter, the diagnosis is Capgras Syndrome. It can be incredibly stressful for everyone involved. Learn the latest from Western University.

A new study from Western University provides researchers and clinicians with insight into a particularly debilitating memory problem that is present in some patients suffering from neurodegeneration caused by Lewy body dementia or Alzheimer’s disease.

Mis-identification Syndrome

This disorder, known as Capgras Syndrome (or sometimes Misidentification Syndrome), is characterized by the delusional belief that a person with whom the patient shares a close emotional bond, typically the spouse, has been replaced by an imposter or look-alike.

In their study, Western researchers demonstrated that person recognition difficulties experienced by patients with Capgras Syndrome are not restricted to the person who is the target of their delusion, and can affect recognition of other well-known individuals, such as famous TV and sports personalities.

Spared Recognition

For faces, such difficulties even extended to recognizing the intensity of emotional facial expressions. Interestingly, name recognition was spared, however.

The study, which was funded by the London and Middlesex Alzheimer Society, was led by Chris Fiacconi, a postdoctoral fellow at Western’s Brain and Mind Institute, and his collaborators Stefan Köhler and Elizabeth Finger. The findings were published in the journal Frontiers in Human Neuroscience.

Of Caregivers & Imposters

The disorder places an enormous burden on patient care in dementia, given that the imposter is usually also the primary caregiver.

“Very little is known about Capgras Syndrome,” says Fiacconi. “Our results suggest that it arises as a consequence of a missing emotional response that normally accompanies recognition of close family members and other well-known individuals, when we see their faces or hear their voices,” adds Fiacconi.

“This missing emotional response is likely the result of abnormal functioning in the autonomic nervous system. We are now examining this theory with psychophysiological recordings in the Köhler Memory Lab.”

Read the full-length study for no charge at:
Nature and extent of person recognition impairments associated with Capgras syndrome in Lewy body dementia,
Chris M. Fiacconi, Victoria Barkley, Elizabeth C. Finger, Nicole
Carson, Devin Duke, R. Shayna Rosenbaum, Asaf Gilboa and Stefan Köhler, Frontiers in Human Neuroscience, doi: 10.3389/fnhum.2014.00726, published online 24 September 2014.


  • Western University
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December 29, 2014 8:45 am

About a year and a half ago, I started having problems with facial recognition. Everyone, including my neurologist, is downplaying it or making lame excuses for it, but to me it's further proof that I am in the earliest stages of Alzheimer's, or possibly this Lewy body dementia…

Reply to  Helen
January 6, 2018 10:45 pm

I lost my beloved grandma due to Alzheimer's disease five years ago… and unfortunately she wasn't able to recognise my husband while having visited her in the hospital. But she could recognise me till the last minute… I miss her even today. 🙁 The anniversary of her lost was just on first of January.

July 31, 2019 11:48 pm

My mom passed away a year ago. I was her only daughter and for 11 years, after my dad died, I was her rock. For the last three years though, she thought I was her (departed) sister. She recognized my voice on the phone but didn't recognize me in person. I was the only person that this happened to. Even though I knew it was because of her alzheers disease, I still have to say that it hurt like crazy.

September 18, 2019 1:12 pm

My husband has LBD and I thought was experiencing Capgras but after describing it to several people in the LBD community, I was told he is experiencing reduplicate paraamnesia. He thinks there are two of me and asks “where is the other woman I call my wife?” Or “you go down to visit your friend but the other one comes back”.
I haven’t seen this mentioned in the LBD literature.

B. Berger

B. Berger

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