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I’m not sure by normal course of development if you mean how did they get it or what happens next? I think there is some agreement that brain damage is what causes it.
But the symptoms can be varied as different parts of the brain are affected. I don’t read where there is much a doctor can treat besides the symptoms that are a result of having so much confusion in ones life.

My FIL had a form of the Capgrass delusion syndrome. His was the Reduplicative paramnesia. He thought he had two homes that were exactly alike, furnished alike etc. He had a bad fall that resulted in a brain injury. He seemed to have a full recovery after months in a hospital ICU and then rehab. This issue of the two homes didn’t show up for several years, after he had another fall that necessitated a hip replacement. Nine years after the first fall, he fell again and died.

Here is a link to the help topic on Capgrass on this forum. You might find it and the comments left by posters helpful.

https://www.agingcare.com/articles/caring-for-a-loved-one-with-capgras-syndrome-197688.htm

Also Wikipedia has a good article on Capgrass and the other delusions that are caused by brain injury.

Additionally, you can use the search symbol (magnifying glass) on this forum and search for Capgrass and you will see many other threads on Capgrass. It sometimes helps to know you are not alone.

I am sorry you and your wife are having to deal with this.
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KPWCSC Aug 2022
Your comment... "Also Wikipedia has a good article on Capgrass and the other delusions that are caused by brain injury."

Please NEVER use Wikipedia as a resource for Medical Questions. Wikipedia authors are not experts. Reading Wikipedia is the same as reading comments here... opinions based on our personal experience or what we have heard (which is not a bad thing) but not based on years of research experience.

Always look for medical websites such as NIH, Mayo, Universities or Hospitals that are doing research etc.

Otherwise, you may be reading opinions rather than facts from experts. Anytime I have shared something I learned on the internet, providers assumed it came from Wikipedia and I had to quote my source or the discussion ended right there. In fact, anytime you plan to share something from the internet with your provider it helps to show them a printed copy so they will see it came from a reliable website.
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"Background Capgras syndrome is characterized by a delusional belief that a person has been replaced by an imposter. It has been described in psychiatric and neurological (neurodegenerative and nonneurodegenerative) diseases."

"Capgras is a symptom that is as painful for the person with dementia to experience as it is for their family to see happening. Understand that Capgras and other symptoms, such as hallucinations, other delusions, anxiety, and depression, are symptoms due to brain changes and not how the person truly feels.Jul 20, 2016"

To be honest, this is a normal thing with people suffering from a Dementia which is a neurological disorder. How it develops? Probably has to do with how the Dementia progresses because the brain literally dies. Hopefully another member has experienced this.
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Katefalc Aug 2022
My husband suffered from Capgras syndrome. He had mixed dementia/question of Alzheimer’s and I was the perceived impostor. It was extremely difficult for both him and for me and the matter what I said or did he never believed that I was his wife . He thought there were two of us and we were identical and one was his wife and one was his girlfriend. At times he would stand up and say I have to get home my wife is going to be looking for me and I’m so ashamed that I’ve been with you. You can imagine how that made me feel but then I had to keep remembering that it was his brain that was broken and not some thing that he had done in his past or that I did. At one point when I was taking him for a drive to the shore, he tried to jump from a moving car to get away from me because he thought that guy, his ex girlfriend was holding him hostage and he needed to return to his wife. The heartbreak was unending and finally I could no longer keep him home because he was trying to leave constantly day and night to return to his beloved wife whom he adored. We were married for 53 years we were high school sweethearts, and he was the love of my life as well, and he was never untrue to me and always a gentleman and very loving and considerate. This broke my heart as I could see his anxiety around this issue. He just passed away two months ago and although I know that he’s at peace now, I miss him every moment of every day, and I miss being able to go to the veterans hospital to see him and just hold his hand, or just give him a kiss. God bless you and good luck this is a horrible disease. Please consider donations to the Harvard brain and tissue donation research program. You can Google it online. We need so much more research on this topic to be able to protect our children and grandchildren if they should develop this in the future. Much love💜💜
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Are the doctors sure it is in ALZ and not LBD or mixed dementia? Capgrass is rarer (but not unheard of) in ALZ vs LBD or mixed dementia.

https://jamanetwork.com/journals/jamaneurology/fullarticle/794900

MIL had/has (comes and goes in waves) it.
She has time warps/replays that are also part of the symptoms.
She is sometimes very aggressive when a wave is at its worst.

There is no "normal course" for Capgras. It is totally unpredictable. If you haven't contacted your LO's doctor, do so immediately. Capgras makes even the darkest parts of caregiving even more difficult. The caregiver burden is greater with CS. Get outside help as soon as possible.

From healthline.com:

"Caring for someone with CS can be emotionally demanding, especially if you’re the one they perceive as an imposter. To help someone with CS, here are some strategies to try:

Enter their realm of reality when possible. It can help if you try to understand how terrifying it must be.
Avoid arguing with them or trying to correct them.
Help them feel safe. If you’re unsure what to do, you can ask the person what they need or talk with a healthcare professional.
Acknowledge their feelings.
If possible, have the “imposter” leave the room. If this is you and you’re the caregiver, let someone else take over until the episode is over.
Rely on sound. If you know someone is prone to CS, you can make sure the first way they register your appearance is with sound. Greet them out loud before you see them when possible."

While none of the above worked for MIL hopefully, some of it will for you!

Other great information:

https://parkinsonsdisease.net/clinical/capgras-tips-for-caregivers

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004517/

https://www.google.com/search?client=firefox-b-1-d&q=capgras+and+caregiving
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randal: Perhaps you could attain the answer to your question on https://www.alz.org/ OR search Capgras on the internet as many sites come up.
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