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Letters   |    
Face-Selective Hyper-Animacy and Hyper-Familiarity Misperception in a Patient With Moderate Alzheimer’s Disease
Jan Van den Stock, Ph.D; Beatrice de Gelder, Ph.D; Koen Van Laere, M.D., Ph.D.; Mathieu Vandenbulcke, M.D., Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:E52-E53. doi:10.1176/appi.neuropsych.12120390
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Brain and Emotion Laboratory Leuven (BELL), Division of Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
Cognitive and Affective Neuroscience Laboratory, Tilburg University, Tilburg, the Netherlands
Division of Nuclear Medicine, UZ Gasthuisberg, Leuven, Belgium

Correspondence: Jan Van den Stock; jan.vandenstock@med.kuleuven.be

Copyright © 2013 by the American Psychiatric Association

Extract

To the Editor: “Ms. IS” was diagnosed with moderate Alzheimer’s disease (AD) and displayed a particular delusion: she was convinced that a toy doll was her living baby. Neuropsychological investigations showed that familiarity recognition was increased for unfamiliar faces, while normal for famous faces and both famous and unfamiliar buildings. IS recognized more pictures of humans and dolls as “living” when the face was visible, compared with when the face was not visible. FDG-PET showed severe prefrontal hypometabolism in addition to the associated AD pattern. The findings illustrate that face-selective hyper-animacy and hyper-familiarity processing constitute the neuropsychological deficits as originating factors in IS’s delusion.

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FIGURE 1. Stimulus Examples and Results of Neuropsychological Experiments and Functional Neuroimaging

[A]: The toys that were sequentially presented to Ms. IS (from left to right). She recognized all toys as living and familiar, except the one in the white rectangle. [B, top]: results of animacy categorization experiment showing the number of categorizations as a function of category (human and doll) and viewpoint (front and back). The red bar indicates chance level (*p=0.013). [B, bottom]: examples of stimuli presented to the patient with the instruction to categorize as living or non-living (from left to right: front view of human; front view of toy doll; back view of human; back view of toy doll). [B, right]: results of the animacy categorization experiment. [C]: stereotactic surface projections showing medial (left) and lateral (right) views of the left (L) and right (R) hemisphere of an [18F]Fluorodeoxyglucose Positron Emission Tomography (FDG PET) brain scan of the patient, with areas of significant hypometabolism superimposed. Color coding refers to Z-scores with respect to normal dataset of 30 control subjects.

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References

Shanks  MF;  Venneri  A:  The emergence of delusional companions in Alzheimer’s disease: an unusual misidentification syndrome.  Cogn Neuropsychiatry 2002; 7:317–328
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Van den Stock  J;  de Gelder  B;  De Winter  FL  et al:  A strange face in the mirror: face-selective self-misidentification in a patient with right lateralized occipito-temporal hypo-metabolism.  Cortex 2012; 48:1088–1090
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Crawford  JR;  Howell  DC:  Comparing an individual's test score against norms derived from small samples.  Clin Neuropsychol 1998; 12:482–486
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Coltheart  M;  Langdon  R;  McKay  R:  Delusional belief.  Annu Rev Psychol 2011; 62:271–298
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Amodio  DM;  Frith  CD:  Meeting of minds: the medial frontal cortex and social cognition.  Nat Rev Neurosci 2006; 7:268–277
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