Brain and Nerve No to Shinkei Volume 55, Issue 9 (September 2003)

A Case of Probable Dementia with Lewy Bodies Presenting with Geographic Mislocation and Nurturing Syndrome Kazumi Hirayama 1 , Kenichi Meguro 1 , Masumi Shimada 2 , Satoshi Yamaguchi 1 , Hiroshi Ishii 2 , Atsushi Yamadori 1 1Division of Neuropsychology, Department of Disability Medicine, Tohoku University Graduate School of Medicine 2Tajiri SKIP Center Keyword: nurturing syndrome , geographical mislocation , reduplicative paramnesia , misidentification syndrome , dementia with Lewy bodies pp.782-789
Published Date 2003/9/1
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A 83-year-old right handed man developed nurturing syndrome and geographical mislocation (misidentification of places) as a result of dementia with Lewy bodies. He showed parkinsonism, fluctuating cognition, repeated falls, systematic delusions (delusional jealousy with vivid feeling of witness), rapid eye movement sleep behavior disorder, and mild dementia. His brain MRI showed atrophy of bilateral temporal tips and amygdala. A FDG-PET showed decrease of glucose metabolism in right frontal lobe and left temporo-parietal areas. He showed constructional disability, frontal lobe dysfunction, mild deterioration of immediate memory, mild anterograde amnesia, and retrograde amnesia for recent events. Aphasia, apraxia, agnosia, confabulation, or deterioration of facial perception was not noted. He could state the genealogy, ages and recent whereabouts of his relatives, and could state the locations and geographical relationships of his neighboring buildings. He insisted that his fatherユs existence, who had died 52 years ago, although he talked about the episode of his death just before. One month after having a dream that his sickroom was in a fictitious branch of our hospital which located in his neighboring temple, he developed a delusion that his ward was actually in the temple. The former disorder seems to correspond to the nurturing syndrome described by Venneri et al.(2000), and the latter one suggested us that his dream was causally involved in the formation of geographical mis-localization. After Ramachandranユs explanation for Capgrasユ syndrome, we hypothesized that mis-arousal of familiarity evoked by visual perception or memory was attributable to the dysfunction of amygdala, and failure of consistency-checking was caused by the dysfunction of the right frontal lobe.

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Brain and Nerve 脳と神経
55巻9号 (2003年9月)
電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院