Delusions that a loved one has been replaced can signal dementia

Dementia: Dr Sara on benefits of being in nature

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Dementia is the name given for a range of conditions that affect the brain. Each of these conditions prevents the brain cells – or neurons – from functioning properly, which will impact memory, thoughts and speech. The most common types of dementia are Alzheimer’s disease, vascular dementia, frontotemporal dementia and Lewy body dementia.

Between 10 and 15 percent of people with dementia will have Lewy body dementia.

It is a progressive condition, meaning it gets more severe over time.

However, in its early stages it is often mistaken for Alzheimer’s disease.

One key point that separates Lewy body from other forms of dementia is how it usually has more of an effect on the person’s behaviour rather than their memory.

Dementia UK explains: “Memory is often less affected than with other types of dementia but people may be at more risk of mood and behaviour changes such as apathy, anxiety, depression, delusions and paranoia.”

This can manifest as “delusions of misidentification”.

Delusions of misidentification

Approximately 20 percent of people with Lewy body dementia will experience delusions of misidentification.

Dementia UK says: “There are two main types; Capgras syndrome and clonal pluralisation.

“Capgras syndrome is where someone familiar is not recognised and the person is seen as an imposter.

“One type of Capgras is known as Fregoli syndrome in which the person sees a familiar face or faces in a crowd or in a place where they wouldn’t expect to see them and believes they are being followed.

“Clonal pluralisation, which is less common, is where the person believes there are exact copies of other people or themselves.

“Both types of delusion are caused by changes in different parts of the brain due to the presence of Lewy bodies, which are abnormal clumps of protein that gather inside brain cells.”

Managing these delusions

Seeing someone experience Capgras syndrome or clonal pluralisation can be very upsetting.

But it is important to accept “this is part of the condition and is not personal or malicious”.

Dementia UK adds: “As a family member or friend, look out for changes in behaviour which may indicate someone is not recognising you properly – such as being more secretive or looking at you suspiciously.

“It can be particularly difficult to know how to respond to Capgras, especially if the person who is offering support is the person who is being misidentified and therefore seen as not to
be trusted.

“If the person has some insight, it may be possible to question or challenge the delusion.”

It warns: “However, if the idea seems quite fixed, care should be taken not to increase the person’s distress by trying to reason or persuade them of the reality.”

Other symptoms of Lewy body dementia include:

  • Recurring visual hallucinations
  • Disturbed sleep, known as Rapid Eye Movement (REM) sleep disorder, with restlessness and intense dreams/nightmares
  • Sudden changes and fluctuations in alertness – people may stare blankly into space, seem Drowsy and lethargic and spend a lot of time sleeping
  • Slow movement, difficulty walking, shuffling, or appearing rigid
  • Tremors – usually in the hands while at rest
  • Problems with balance, leading to falls
  • Bladder and bowel problems
  • Difficulties with swallowing
  • Mood and behaviour changes such anxiety and depression
  • Changes in blood pressure
  • Changes in body temperature
  • Impaired sense of smell.

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