Capgras syndrome in Lewy Body Dementia
Sarah Dulaney and Jennifer Merrilees led another seminar on ethical concerns in the care and management of people with Capgras syndrome which is common in, though not exclusive to, patients with Lewy Body Dementia. It can lead people to believe that those close to them have been replaced by imposters, or render them unable to recognize themselves, or their surroundings, pets, plants, etc. Drawing from conclusions in Meeri Kim’s article (The Washington Post, 2018) and Thaipisutikul et al.’s paper (International Psychogeriatrics, 2013), ethical concerns present in cases of Capgras reflect the effects of caregiver burden and the high rates of visual hallucinations and symptoms of anxiety in patients, which can lead to experiences of guilt or conflicts in value systems for behaving in certain ways as a result of being unable to remember loved ones.
As Capgras is associated with regions of the brain involved in visual processing and emotional response, we discussed potential coping mechanisms like triggering remembering through non-visual sensations, using phone calls to trigger voice recognition, or having a friend or family member call the patient to help reduce any anxiety associated with not being able to visually recognize others. We also spent some time analyzing three case studies of patients with Capgras where we identified considerations of care based on the bioethical principles of autonomy, beneficence, and non-maleficence. These included maintaining the patients’ best interests in relation to patient and caregiver safety and convenience, navigating between quantity versus quality of life when considering treatment options, and acknowledging the potential financial burden of adequate care.