The Recognition of Mom's Capgras

I mentioned in Sunday's Post that I should probably research Capgras (pronounced: Caw-Graw) Syndrome further.   Back in September 2014 I had done a little investigating on the topic, as I found it fascinating as well as alarming - should it happen with Mama.  Well, little did I realize, it has been happening for a while - though not in its complete form.

You see, according to the literature (see below) what happened Sunday on I-205 when Mom panicked and began looking around for me is an occurrence of Capgras.   That she understood when I stated I was myself this stopped the delusion.  

Other times in the past, she has referred to me in the third-person, telling me things I'd done or was doing with others.  When I would state that I was me she would acquiesce and give a little laugh of embarrassment, but I could never be sure it stuck. 

More often, of late, she has asked, "Where's Tony?" while I've been sitting and conversing with her.  While it could be unsettling to most, I find myself taking it in stride, knowing her mind isn't working quite right.  I do know others who might be insulted, but it isn't an ego-based realization; rather it's working with someone whose brain isn't functioning as once it did.  

Interestingly enough, in my research I was able to come across another phenomenon, Reduplicative Paramnesia.  This is a state in which the patient believes a place or location has been duplicated (see September's article in which Mom was convinced she'd been moved overnight).  

One friend has suggested I keep a name tag on me to help Mom remember who I am.  This won't work.  It's not that Mom looks at me and tells me about what Tony is up to, but she's also recalling her dreams in which Tony is quite active.  That I'm an interested third-party bears no water in the pool.  

This time, as I did my research, I discovered more about anxiety being one of the triggers for Capgras Syndrome.   

Did you also know that this syndrome occurs in Bipolar patients and those suffering from Schizophrenia?

Nor did I until I read it! 

Now, Capgras can also occur (though not as frequently) with Alzheimer's patients.  

Did you also know that women suffer from this 3:2 over men? and those aren't only those with dementia, but with the other conditions, as well.  Hmmmm.  

Well, I hope you learnt something more, today.  I did.  I'll still have to dig deeper.   Perhaps more brain study would help understand the how and why more - that's what I'd like to comprehend better. 

References:  

Capgras Syndrome:  The Delusion of Substitution

Capgras Syndrome in Dementia with Lewy Bodies

Capgras and Dementia:  The Imposter Syndrome

Perception, emotion and delusions: Revisiting the Capgras Delusion.  Elisabeth Pacherie  (very clinical and technical - incredibly dry, but full of interesting facts)

Reduplicative Paramnesia

Capgras Syndrome 

Capgras Syndrome - A Symptom We Hope to Not Encounter Again!

We've already spoken of the different symptoms of Lewy Body Dementia (LBD), confusion, REM Sleep Disorder, Confusion, Hallucinations, etc.  But one that I find fascinating, and nearly thought Mom was beginning to experience was Capgras Syndrome - or the delusion that someone  (usually a person who is very close and endeared to the patient) is an imposter, posing as someone else.  For instance, if I were to sit down next to Mom, she would ask me where I was, as I was not who I was - I was an imposter!   I'm really hoping this doesn't happen, but if it does, then I pray I'm able to handle it with aplomb.

According to the National Institutes on Aging, Capgras Syndrome is:
Capgras syndrome is characterized by the recurrent, transient belief that a person has been replaced by an identical imposter.   (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713629/.  09/15/2014.)

This is identified in approximately 17-20% of Dementia Patients.  It is not only seen in LBD patients, but Alzheimer's as well.  However, it is seen as a symptom of LBD, and due to Mom's anxiety, and her propensity for hallucinations, especially of late, she falls into the category of those who may develop the syndrome.   

According to the literature found on PsychCentral, Mom actually did have an occurrence.  This was when she called me in a panic, to tell how she was being held hostage in a house that was not hers!  She wanted to sneak out to her car and drive around to find her own home, but I convinced her to find a bed and sleep it off - she'd have better luck in the morning (it was dark outside, and Lord knows what could have happened had she been in this state and driving!).  She obliged.  

Another time was when she was convinced she had been moved, overnight, from Port Angeles to Cedar Hills in Portland.  She told me the house was similar, and she still had the view of the Straits of Juan de Fuca, and the movers had done such a nice job it was very nearly as it was at her "old house." This actually went on a few days, until her friend called her and then went over convincing her she was actually at home in Port Angeles (Whew!)  So, the next day she phoned and told me they had moved her back overnight.  This incident provided us with a little dilemma - she'd call and want us to come over for coffee or dinner. We (my brother and I) would have to decline, which disappointed her and made her a little bitter.  But what else could we do?  Port Angeles is about 4 hours away!

Mom did present this delusion at other times as when on Christmas morning she thought we were eating at my house, but then changed to their old Portland home, and finally, exasperated, thought I was playing tricks on her when I told her we were really in her own home, there in PA.  There were mild episodes that, at one point in time, seemed innocent, but I had no real idea what was truly occurring.  

     Here's an anctidote from PsychCentral:

At 3 a.m., wearing pajamas and socks, an 89-year-old man with Lewy Body Dementia was found by a security guard four floors below his apartment. His walker was later found abandoned on the second floor. Agitated and confused, he insisted repeatedly that he was looking for his “other” apartment. “I know we have two, exactly alike, one that we sleep in at night,” he said. “But I can’t find the other one.”

        and another

A 65-year-old woman diagnosed with early-onset Alzheimer’s Disease had what had become a typical spat with her spouse of 40 years. He argued, furious and insulted, “I’m your husband! Don’t you know me?!” “You look exactly like him,” she said quietly, “but I know that you’re not him.” Nothing could convince her otherwise, though the man told her many things only her husband would know. “You are one of the two imposters that come around here, not my husband,” she insisted.

This gives an idea of what to expect.  Although Mom is on medication, I'm hoping the doctor might be able to re-evaluate her dosages to bypass any further incidents - but my hopes may be in vain.  

Should this syndrome present itself in the future (near or far), i'll feel a little more prepared...

The Week Ending 9/14/2014

What a bumpy ride this week was!

Mom reacts to silliness

Tuesday, I went to pick Mother up for the funeral.  She wasn't dressed poorly, but not how I would want my mother to look at a funeral (very casual clothes).  But, considering the circumstances, there was very little time for figuring a change of clothes for her.  So, off we went.

The funeral was right down the street from Mom's residence, which made it all the easier.  As we walked in, she was reunited with two classmates from St. Mary's Academy.  She knew who they were, but didn't have a great deal to say to them, except that she remembered them.

During the rite, she inquired where Dad had gone.  I probed for more information and was informed that he had come with us and then just a moment before had just left.  I told her he had a couple of errands to run, but would try to be back in good time.  She bought it.  Whew!

After the funeral, which was nice and small, we went to the reception where we sat with her classmates and the departed's sister (who had delivered the eulogy).

Mom kept asking them the same questions about where they lived and when they graduated.  They handled it wonderfully.  They asked where Mom lived, and I told them at St. Anthony's.  Then they seemed to understand.

This was very good for Mom.  She had some good mental stimulation and it was outside the box for her - going down memory lane with people she'd not seen almost 67 years ago.  Wow!

When I returned her, she was full from the cake and punch, so she wanted to nap.

I then checked in with the staff.  They informed me she was under the belief I was sleeping in her bed with her every night, but getting up early to return at some point - she was waiting in her room every morning for my entry; I told the staff to tell her to go ahead and do whatever until I returned.

The staff also informed me that she had really declined in the previous two weeks.  Her hallucinations were more pronounced and she was not sleeping as well.

Thursday, the RLC came to visit armed with Trivial Pursuits.  The reports were positive.  Everyone had strong suits, and it provided a great deal of fodder for chatting.  It was a great change from the weekly Scrabble game.

Today, Sunday, I went in early to take Mom to Mass.  She was in a mood.  One of the staff, who she normally likes and enjoys was receiving Mom's wrath!  Mom was insulting and muttering evil under her breath.  What I wasn't aware of was this happened daily for the past week and a half!  My fear was Mom was beginning to suffer from capgras, or the delusion that someone is not really who they are (when they truly are!).  But, I was wrong.  Phew!

As I put Mom's stockings on her feet, she began cursing at me and called me a very disgusting name.  I looked up and told her that if she ever spoke to me like that again I would leave immediately.  This helped close her yap.   On the lighter side, her feet have begun to shrink in girth - her shoes are beginning to fit much better.

Finally, we were able to leave.  On the way to Mass, she told me to never threaten her again.  I stated that what she said was absolutely inappropriate and for her to remember that if she insulted me then it boomeranged back to her, as I was supposedly her genetic product.  Again, she went silent.  And then the day began to brighten.

Walking to and from Mass and the car, I noted that her shuffling is much greater.  Her balance was improved, but she is truly shuffling.

We went to Jean's for a lovely lasagne lunch and a wonderful visit.  After lunch and pineapple sherbet, we left.  Mom told me that Jean's family had had that piece of property for generations, and developed it.  She told me how wise Jean's grandfather had been to set that piece of property aside for his children and grandchildren.  I thought, 'What a wonderful delusion that I must share with Jean!' as this was far from true, but in Mom's reality it is.

I dropped her off and she went down for a nap.  She was truly exhausted.  So, after I placed the orchid back in the window, and the beautiful dahlias Jean had given her next to it, I parted.

Wondering what adventures this next week will bring!