Login Register Cart 0
Generic placeholder image

Current Alzheimer Research

Editor-in-Chief

ISSN (Print): 1567-2050
ISSN (Online): 1875-5828

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe Translate in Chinese
Systematic Review Article

Capgras Syndrome in Dementia: A Systematic Review of Case Studies

Author(s): Charikleia Margariti and Margareta-Theodora Mircea*

Volume 21, Issue 5, 2024

Published on: 15 October, 2024

Page: [312 - 323] Pages: 12

DOI: 10.2174/0115672050335918240919073012

Price: $65

TIMBC 2026
Abstract

Background: In an ageing population, dementia has become an imminent healthcare emergency. Capgras syndrome, the most common delusion of misidentification (DMS), is frequently found alongside dementia. Previous research showed that Capgras syndrome has significant negative effects on people living with dementia and their carers due to its complex presentation and impact on their lives. This qualitative systematic review explores the evidence base of the effective management and treatment of Capgras syndrome in dementia.

Aims: As per our knowledge, this is the first systematic review exploring the symptomatology of Capgras syndrome across different types of dementia. Additionally, it aims to identify the treatments used and their efficacy.

Methods: Four databases (EMBASE, MEDLINE, PsycINFO, and CINHAL) were screened in March, 2023. Twenty-six studies met the inclusion criteria and were included in the review. Thematic analysis was performed to explore and synthesise the qualitative findings of the studies.

Results: Three conceptual themes were identified: diagnostic tools, Capgras syndrome symptomatology, and Capgras syndrome treatment. Results showed that Capgras syndrome in dementia is not diagnosed and treated in a standardised manner. Following the pharmacological intervention, 28% of cases showed resolution of symptoms, and another 28% experienced improvement. However, 7% of cases reported worsening symptoms, and 10.7% experienced no change. While some patients had positive outcomes with specific medications, others either did not respond or experienced a deterioration of their condition.

Conclusion: The results highlight that there is no single treatment approach for Capgras syndrome in people living with dementia. This underscores the need for person-centred care, where treatment is tailored to individual needs. The review also reveals a heavy reliance on antipsychotic medications and a noticeable lack of psychosocial interventions. Given the limited benefits and significant risks associated with antipsychotics, future research should prioritise developing and testing psychosocial approaches. Additionally, establishing standardised diagnostic criteria and consistent outcome measures for Capgras syndrome in dementia is crucial for evaluating treatment effectiveness and improving care.

Keywords: Capgras syndrome, dementia, systematic review, treatment, symptomatology, case study.

« Previous Next »
[1]
Dementia. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/dementia
[2]
What is dementia? 2023. Available from: https://www.dementiauk.org/information-and-support/about-dementia/what-is-dementia/
[3]
Edelstyn NMJ, Oyebode F. A review of the phenomenology and cognitive neuropsychological origins of the Capgras syndrome. Int J Geriatr Psychiatry 1999; 14(1): 48-59.
[PMID: 10029936]
[4]
Ballard C, Neill D, O’Brien J, McKeith IG, Ince P, Perry R. Anxiety, depression and psychosis in vascular dementia: Prevalence and associations. J Affect Disord 2000; 59(2): 97-106.
[http://dx.doi.org/10.1016/S0165-0327(99)00057-9] [PMID: 10837878]
[5]
Harciarek M, Kertesz A. The prevalence of misidentification syndromes in neurodegenerative diseases. Alzheimer Dis Assoc Disord 2008; 22(2): 163-9.
[http://dx.doi.org/10.1097/WAD.0b013e3181641341] [PMID: 18525289]
[6]
Förstl H, Almeida OP, Owen AM, Burns A, Howard R. Psychiatric, neurological and medical aspects of misidentification syndromes: A review of 260 cases. Psychol Med 1991; 21(4): 905-10.
[http://dx.doi.org/10.1017/S0033291700029895] [PMID: 1780403]
[7]
Peritogiannis V. Capgras syndrome and vascular dementia. J Neuropsychiatry Clin Neurosci 2010; 22(1): 123.e30.
[http://dx.doi.org/10.1176/jnp.2010.22.1.123.e30] [PMID: 20160238]
[8]
Pereira GCM, Oliveira GC. Prevalence of Capgras syndrome in Alzheimer’s patients: A systematic review and meta-analysis. Dement Neuropsychol 2019; 13(4): 463-8.
[http://dx.doi.org/10.1590/1980-57642018dn13-040014] [PMID: 31844501]
[9]
Harwood DG, Barker WW, Ownby RL, Duara R. Prevalence and correlates of Capgras syndrome in Alzheimer’s disease. Int J Geriatr Psychiatry 1999; 14(6): 415-20.
[PMID: 10398349]
[10]
Mizrahi R, Starkstein SE, Jorge R, Robinson RG. Phenomenology and clinical correlates of delusions in Alzheimer disease. Am J Geriatr Psychiatry 2006; 14(7): 573-81.
[http://dx.doi.org/10.1097/01.JGP.0000214559.61700.1c] [PMID: 16816010]
[11]
Josephs KA. Capgras syndrome and its relationship to neurodegenerative disease. Arch Neurol 2007; 64(12): 1762-6.
[http://dx.doi.org/10.1001/archneur.64.12.1762] [PMID: 18071040]
[12]
Metin B, Arikan MK, Kalem SA, Tarhan N. A case of capgras syndrome with frontotemporal dementia. Cogn Behav Neurol 2019; 32(2): 134-8.
[http://dx.doi.org/10.1097/WNN.0000000000000191] [PMID: 31205125]
[13]
Lipkin B. Capgras syndrome heralding the development of dementia. Br J Psychiatry 1988; 153(1): 117-8.
[http://dx.doi.org/10.1192/bjp.153.1.117] [PMID: 3224233]
[14]
Marantz AG, Verghese J. Capgras’ syndrome in dementia with Lewy bodies. J Geriatr Psychiatry Neurol 2002; 15(4): 239-41.
[http://dx.doi.org/10.1177/089198870201500410] [PMID: 12489921]
[15]
Thaipisuttikul P, Lobach I, Zweig Y, Gurnani A, Galvin JE. Capgras syndrome in dementia with Lewy bodies. Int Psychogeriatr 2013; 25(5): 843-9.
[http://dx.doi.org/10.1017/S1041610212002189] [PMID: 23211760]
[16]
Fishbain DA. The frequency of Capgras delusions in a psychiatric emergency service. Psychopathology 1987; 20(1): 42-7.
[http://dx.doi.org/10.1159/000284478] [PMID: 3628676]
[17]
Young AW, Reid I, Wright S, Hellawell DJ. Face-processing impairments and the Capgras delusion. Br J Psychiatry 1993; 162(5): 695-8.
[http://dx.doi.org/10.1192/bjp.162.5.695] [PMID: 8149127]
[18]
Alexander MP, Stuss DT, Benson DF. Capgras syndrome. Neurology 1979; 29(3): 334-9.
[http://dx.doi.org/10.1212/WNL.29.3.334] [PMID: 571979]
[19]
Ellis HD, Young AW. Accounting for delusional misidentifications. Br J Psychiatry 1990; 157(2): 239-48.
[http://dx.doi.org/10.1192/bjp.157.2.239] [PMID: 2224375]
[20]
Pandis C, Agrawal N, Poole N. Capgras’ delusion: A systematic review of 255 published cases. Psychopathology 2019; 52(3): 161-73.
[http://dx.doi.org/10.1159/000500474] [PMID: 31326968]
[21]
Fiacconi CM, Barkley V, Finger EC, et al. Nature and extent of person recognition impairments associated with Capgras syndrome in Lewy body dementia. Front Hum Neurosci 2014; 8: 726.
[http://dx.doi.org/10.3389/fnhum.2014.00726] [PMID: 25309399]
[22]
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.
[http://dx.doi.org/10.1136/bmj.n71.]
[23]
Joanna Briggs Institute. Joanna briggs institute critical appraisal checklist for studies reporting prevalence data. Adelaide. JBI Library Syst Rev 2017; 2017: 1.
[24]
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77-101.
[http://dx.doi.org/10.1191/1478088706qp063oa]
[25]
Mendez MF. Delusional misidentification of persons in dementia. Br J Psychiatry 1992; 160(3): 414-6.
[http://dx.doi.org/10.1192/bjp.160.3.414] [PMID: 1562874]
[26]
Wrigley M. Capgras’ syndrome in a patient with dementia. Br J Psychiatry 1987; 151(2): 273-4.
[http://dx.doi.org/10.1192/S0007125000216371] [PMID: 3690129]
[27]
ØStergaard PK. Capgras syndrome in senile dementia of the Alzheimer type. J Am Geriatr Soc 1985; 33(11): 811.
[http://dx.doi.org/10.1111/j.1532-5415.1985.tb04197.x] [PMID: 4056277]
[28]
Baldwin RC, Snowden JS, Mann DMA. Delusional misidentification in association with cortical lewy body disease—A case report and overview of possible mechanisms. Int J Geriatr Psychiatry 1995; 10(10): 893-8.
[http://dx.doi.org/10.1002/gps.930101014]
[29]
Edelstyn NMJ, Oyebode F, Barrett K. The delusions of Capgras and intermetamorphosis in a patient with right-hemisphere white-matter pathology. Psychopathology 2001; 34(6): 299-304.
[http://dx.doi.org/10.1159/000049328] [PMID: 11847489]
[30]
Förstl H, Almeida OP, Iacoponi E. Capgras delusion in the elderly: The evidence for a possible organic origin. Int J Geriatr Psychiatry 1991; 6(12): 845-52.
[http://dx.doi.org/10.1002/gps.930061204]
[31]
Jedidi H, Daury N, Capa R, et al. Brain metabolic dysfunction in Capgras delusion during Alzheimer’s disease: A positron emission tomography study. Am J Alzheimers Dis Other Demen 2015; 30(7): 699-706.
[http://dx.doi.org/10.1177/1533317513495105] [PMID: 23813791]
[32]
Margetić B. Capgras syndrome associated with Bromazepam in a patient with vascular dementia. Clin Neuropharmacol 2020; 43(6): 202.
[http://dx.doi.org/10.1097/WNF.0000000000000418] [PMID: 33060533]
[33]
Oyebode F, Edelstyn NMJ, Patel A, Riddoch MJ, Humphreys GW. Capgras syndrome in vascular dementia: Recognition memory and visual processing. Int J Geriatr Psychiatry 1996; 11(1): 71-3.
[http://dx.doi.org/10.1002/(SICI)1099-1166(199601)11:1<71::AID-GPS322>3.0.CO;2-C]
[34]
Tsai SJ, Hwang JP, Yang CH, Liu KM, Lo Y. Capgras’ syndrome in a patient with vascular dementia: A case report. Kaohsiung J Med Sci 1997; 13(10): 639-42.
[PMID: 9385782]
[35]
Mi Y, Qin Q, Xing Y, Tang Y. Capgras syndrome as the core manifestation of early-onset Alzheimer’s disease. J Alzheimers Dis 2022; 87(1): 155-60.
[http://dx.doi.org/10.3233/JAD-215565] [PMID: 35253758]
[36]
Ng KP, Wong B, Xie W, Kandiah N. Capgras syndrome in the young: Schizophrenia or Alzheimer disease? Alzheimer Dis Assoc Disord 2020; 34(1): 94-6.
[http://dx.doi.org/10.1097/WAD.0000000000000360] [PMID: 31913960]
[37]
Oulis P, Dimitrakopoulos S, Konstantakopoulos G, Tsaltas E, Kollias K. Capgras delusion in paranoid schizophrenia complicated by vascular dementia. J Neuropsychiatry Clin Neurosci 2012; 24(3): E28.
[http://dx.doi.org/10.1176/appi.neuropsych.11070162] [PMID: 23037670]
[38]
Ray S, Park D, Burdick D, et al. Delusional Misidentification Syndrome for “Self” in two patients with Parkinson`s Disease. 2017. Available from: https://www.mdsabstracts.org/abstract/delusional-misidentification-syndrome-for-self-in-two-patients-with-parkinsons-disease/
[39]
Shiotsuki H, Motoi Y, Nakamura SI, Mizuno Y, Hattori N. Dopamine deficiency may lead to capgras syndrome in Parkinson’s disease with dementia. J Neuropsychiatry Clin Neurosci 2010; 22(3): 352.e14-5.
[http://dx.doi.org/10.1176/jnp.2010.22.3.352.e14] [PMID: 20686153]
[40]
Kaufman KR, Newman NB, Dawood A. Capgras delusion with violent behavior in Alzheimer dementia: Case analysis with literature review. Ann Clin Psychiatry 2014; 26(3): 187-91.
[PMID: 24812655]
[41]
Reimers K, Emmert N, Shah H, Benedict RHB, Szigeti K. Capgras-like visual decomposition in Lewy body dementia with therapeutic response to donepezil. Neurol Clin Pract 2014; 4(6): 467-9.
[http://dx.doi.org/10.1212/CPJ.0000000000000068] [PMID: 25566416]
[42]
Roane DM, Rogers JD, Robinson JH, Feinberg TE. Delusional misidentification in association with parkinsonism. J Neuropsychiatry Clin Neurosci 1998; 10(2): 194-8.
[http://dx.doi.org/10.1176/jnp.10.2.194] [PMID: 9608408]
[43]
Koga S, Dickson DW, Wszolek ZK. Capgras syndrome in dementia with Lewy bodies: A possible association of severe cortical Lewy body pathology. Neurol Neurochir Pol 2021; 55(6): 592-4.
[http://dx.doi.org/10.5603/PJNNS.a2021.0086] [PMID: 34846065]
[44]
Edelstyn NMJ, Oyebode F, Barrett K. Delusional misidentification: A neuropsychological case study in dementia associated with parkinson’s disease. Neurocase 1998; 4(3): 181-8.
[http://dx.doi.org/10.1080/13554799808410620]
[45]
Kumar V. Capgras syndrome in a patient with dementia. Br J Psychiatry 1987; 150(2): 251.
[http://dx.doi.org/10.1192/bjp.150.2.251] [PMID: 3651683]
[46]
Cannas A, Meloni M, Mascia MM, et al. Capgras syndrome in Parkinson’s disease: Two new cases and literature review. Neurol Sci 2017; 38(2): 225-31.
[http://dx.doi.org/10.1007/s10072-016-2765-9] [PMID: 27848117]
[47]
Migliorelli R, Tesón A, Sabe L, Petracchi M, Leiguarda R, Starkstein SE. Prevalence and correlates of dysthymia and major depression among patients with Alzheimer’s disease. Am J Psychiatry 1995; 152(1): 37-44.
[http://dx.doi.org/10.1176/ajp.152.1.37] [PMID: 7802118]
[48]
Koc AE, Hocaoglu C. What is capgras syndrome? Diagnosis and treatment approach. Anxiety Disorders - The New Achievements. IntechOpen 2021; pp. 1-16.
[http://dx.doi.org/10.5772/intechopen.91153.]
[49]
Bienenfeld D, Brott T. Capgras’ syndrome following minor head trauma. J Clin Psychiatry 1989; 50(2): 68-9.
[PMID: 2914883]
[50]
Brighetti G, Bonifacci P, Borlimi R, Ottaviani C. “Far from the heart far from the eye”: Evidence from the Capgras delusion. Cogn Neuropsychiatry 2007; 12(3): 189-97.
[http://dx.doi.org/10.1080/13546800600892183] [PMID: 17453900]
[51]
Cahill S, Shapiro M. ‘I think he might have hit me once’: Aggression towards caregivers in dementia care. Aust J Ageing 1993; 12(4): 10-5.
[http://dx.doi.org/10.1111/j.1741-6612.1993.tb00612.x]
[52]
Coyne AC, Reichman WE, Berbig LJ. The relationship between dementia and elder abuse. Am J Psychiatry 1993; 150(4): 643-6.
[http://dx.doi.org/10.1176/ajp.150.4.643] [PMID: 8465884]
[53]
Cooper C, Selwood A, Blanchard M, Livingston G. Abusive behaviour experienced by family carers from people with dementia: the CARD (caring for relatives with dementia) study. J Neurol Neurosurg Psychiatry 2010; 81(6): 592-6.
[http://dx.doi.org/10.1136/jnnp.2009.190934] [PMID: 19955110]
[54]
World Health Organization. Global status report on the public health response to dementia,. 2021. Available from: https://iris.who.int/bitstream/handle/10665/344701/9789240033245-eng.pdf
[55]
Lindeza P, Rodrigues M, Costa J, Guerreiro M, Rosa MM. Impact of dementia on informal care: A systematic review of family caregivers’ perceptions. BMJ Support Palliat Care 2024; 14(e1): e38-49.
[http://dx.doi.org/10.1136/bmjspcare-2020-002242] [PMID: 33055092]
[56]
Miwa H, Mizuno Y. Capgras syndrome in Parkinson’s disease. J Neurol 2001; 248(9): 804-5.
[http://dx.doi.org/10.1007/s004150170097] [PMID: 11596786]
[57]
Cascade E, Kalali AH, Mehra S, Meyer JM. Real-world data on atypical antipsychotic medication side effects. Psychiatry (Edgmont) 2010; 7(7): 9-12.
[PMID: 20805913]
[58]
Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: Meta-analysis of randomized placebo-controlled trials. JAMA 2005; 294(15): 1934-43.
[http://dx.doi.org/10.1001/jama.294.15.1934] [PMID: 16234500]
[59]
Scott I, Cooper C, Leverton M, et al. Effects of nonpharmacological interventions on functioning of people living with dementia at home: A systematic review of randomised controlled trials. Int J Geriatr Psychiatry 2019; 34(10): 1386-402.
[http://dx.doi.org/10.1002/gps.5127] [PMID: 31026082]
[60]
Spiegel DR, Laroia R, Samuels D. A possible case of Capgras syndrome after a right anterior cerebral artery cerebrovascular accident treated successfully with mirtazapine. J Neuropsychiatry Clin Neurosci 2008; 20(4): 494.
[http://dx.doi.org/10.1176/jnp.2008.20.4.494] [PMID: 19196939]
[61]
Jariwala PC, Shah ND, Dave KR, Mehta RY. Delusional misidentification syndromes in patients of paranoid schizophrenia: case series and review. Telangana J Psychiatry 2017; 3(2): 125-9.
[62]
de Pauw KW. Psychodynamic approaches to the Capgras delusion: A critical historical review. Psychopathology 1994; 27(3-5): 154-60.
[http://dx.doi.org/10.1159/000284864] [PMID: 7846232]
[63]
Coltheart M, Langdon R, McKay R. Schizophrenia and monothematic delusions. Schizophr Bull 2007; 33(3): 642-7.
[http://dx.doi.org/10.1093/schbul/sbm017] [PMID: 17372282]
[64]
Enoch MD, Ball HN. Uncommon Psychiatric Syndromes. CRC Press 2001.
[65]
Banerjee S. The use of antipsychotic medication for people with dementia: Time for action. Available from: https://www.psychrights.org/research/digest/nlps/BanerjeeReportOnGeriatricNeurolepticUse.pdf

Rights & Permissions Print Cite
Article Metrics
37
1
Wayfinder Image
TIMBC 2026
© 2025 Bentham Science Publishers | Privacy Policy