It was a rather curious moment. If you recall last Sunday’s post, I mentioned that Mom was unable to recognize the people in the photos next to her door - including herself; this was followed by her inability to recognize a just snapped shot of herself and yours truly. This was prompted by her not able to figure out how the picture on the cover of the jigsaw matched with the pieces - she saw two different pictures. She was able to explain what she saw, and yes, they were the same, but she claimed they were quite different. Why?
Well, after she told me it wasn’t me in the photo with her, nor was it herself, I wondered what caused this, as well as what the clinical term might be. Well, I found it and I’m going to share with you, today.
Prosopagnosia is a condition in which the patient is impaired enough to be unable to recognize faces. I remember there was an episode of “The Good Wife” in which this was highlighted with a client. There is also involved in Mom’s Lewy Body Dementia the condition of Capgras Syndrome, in which the patient is unable to recognize faces, as well. However, my understanding is that with Capgras the patient misidentifies a person and believes them to be an imposter - not believing they are who they claim to be; this can be reversed, at times, when the person misidentified leaves and returns. With Prosopagnosia, this doesn’t seem to be the case.
Prosopagnosia is caused by Frontotemporal Dementia, which allows us to realize that Mother’s dementia has claimed that region of her brain. This is something normally attributed to severe trauma to the frontal lobe of the brain, which gave me pause at first. But upon further examination I began to look at speech and whether or not this could also be a condition from FTD (Frontotemporal Dementia), also known as Pick’s Disease.
Oddly, though, LBD (Lewy Body Dementia) and others are quite dissimilar to FTD. While the alpha-synuclein acids may be affecting the cerebral cortex and working their way through the brain, and while they may affect the frontotemporal lobe, the two dementias are not connected.
I think back to the year 1964 when we had our horrific auto accident driving to Seattle from Yakima. Mom was hospitalized for days - what forms of trauma I haven’t a clue, as I was a wee tot riding in the front with Dad and herself. I remember waking up in the ambulance next to Dad, and then in the hospital with my three brothers. We weren’t that hurt, but Mom seemed to be. The car was totalled. Did she suffer frontotemporal trauma? Could this be another layer to her dementia, aided and abetted by the LBD? Interesting question, but I tend to think not.
While she might be demonstrating signs of prosopagnosia and language deficit (the latter is quite common with dementia sufferers), it would be difficult to tie them in with FTD, although there may still be a link and I’m not completely able to see it. Oh well. Just a thought and a follow up with some interesting questions at this time…
But I did learn something interesting! Prosopagnosia and Capgras are very similar conditions with differing types of dementia. What Mom must be experiencing is Capgras - or a variant thereof. But who am I to tell?
Some Interesting Reading:
Marantz, Andrew G, and Joe Verghese. "Capgras' syndrome in dementia with Lewy bodies." Journal of geriatric psychiatry and neurology 15.4 (2002): 239-241
Gibb, WR et al. "Cortical Lewy body dementia: clinical features and classification." Journal of Neurology, Neurosurgery & Psychiatry 52.2 (1989): 185-192.
Read, Stephen L et al. "SPECT in dementia: clinical and pathological correlation." Journal of the American Geriatrics Society 43.11 (1995): 1243-1247.
Electrodermal discrimination of familiar but not unfamiliar … (this discusses Prosopagnosia and Capgras).
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