Selective impairment in the retrieval of family relationships in person identification: A case study of delusional misid

1. Selective impairment in the retrieval of family relationships in person identification: A case study of delusional misidentification Abe, N., Ishii, H., Fujiia, T., Uenoa, A., Leea, E., Ishiokaa, T. and Moria, E. (2007). Selective impairment in the retrieval of family relationships in person identification: A case study of delusional misidentification. Neuropsychologia 45(13), 2902-9.

2. Who is this person? • 74-year-old, right handed woman • 12th grade education and living with two daughters • 8 year history of progressive memory decline • Taking donepezil hydrochloride for Alzheimer’s • 2004 - loss of appetite and weight loss, put on antidepressants • Frequently mistook daughter for neighbor or elementary school friend • Nov. she began to walk with droopy posture and to fall frequently • When sent to the hospital she began to mistake her daughters for her sisters and could not be swayed in her opinion • She was alert and cooperative with no cognitive fluctuations or visual hallucinations

3. What went wrong and the nature of the damage? • MRI showed enlargement of lateral ventricles, expanded sylvian fissures, and closing of the cerebrospinal fluid space at high convexity • Suggested idiopathic normal pressure hydrocephalus (iNPH) • Atrophy of the bilateral hippocampus and parahippocampal gyrus was evident • A ventricle-peritoneal shunt was put in and improved her gait and slightly reduced the frequency of the DMS (Delusional misidentification syndromes)

4. What was impaired? • Intelligence, attention, anterograde memory, and executive function • Relatively preserved language abilities and could communicate with others with no difficulty • Severe topographical disorientation on tests of autobiographical memory for place and of identifying specific locations on a blank map • Anterograde Memory: • Famous people test • Public event test • Dead of Alive test • Autobiographical and personal semantic memory

5. Dead or alive test Occupation 1960s 6/8 1970s 7/8 1980s 6/8 1990s 6/8 Alive 6/8 Dead or alive 1960s 0/8 1970s 0/8 1980s 0/8 1990s 0/8 Alive 7/8 Famous people test 1st Names 12/20 Definitions 19/20 2nd Names 13/20 Definitions 19/20 Distracters 20/20 Public event test Recall 1960s 1/8 1970s 0/8 1980s 0/8 1990s 0/8 Recognition 1960s 5/8 1970s 4/8 1980s 2/8 1990s 6/8 Autobiographical incidents Childhood 6/9 Early adult life 5/9 Recent event 6/9 Personal semantic memory Childhood 7/21 Early adult life 8/21 Recent event 15/21

6. What was impaired? • Deficits in facial recognition when presented with pictures of her family • No trouble naming famous people or novel faces • Environment influenced DMS • Could recall names when shown photos and pick out the correct photo when given the name • Could recall correct semantic knowledge about the person • Deficit in recalling family relationships • Had conceptual knowledge about family relationships • Deficit in identifying her daughters and husband • Core deficit is a failure to update semantic memory through the encoding of new episodic memory related to her family members who have lived with her later in life. • AD could contribute to the problem • This specific form of DMS seems to be linked to the dysfunctions in the medial temporal lobe and the right prefrontal cortex • Weakened reality monitoring

7. Discussion What can we learn? • Diagnosis goes along with other studies and previous knowledge What is the outlook? • Did not specify the outlook or if there was a follow-up What was unclear? • Why were no tests done after surgery? QUESTIONS?