12 NEWS
12 NEWS
16 JUNE 2023 ausdoc . com . au
Rare case of groundhog daze
Antony Scholefield MEMORY impairment is relatively common in dementia , but Australian doctors have reported an unusual case of recollective confabulation coupled with the rare phenomenon known as déjà vécu .
Unlike déjà vu — the fleeting sensation of false familiarity that many will have experienced at least once in their lifetimes — déjà vécu describes a persistent false
Join perception that novel encounters have occurred before .
Neurologists from Sydney ’ s Royal Prince Alfred Hospital have described a patient in his 80s with gradual onset of recollective confabulation but no other delusion-like symptoms or hallucinations .
For instance , the elderly man — who lived alone and was independent — kept thinking his ebook reader
was malfunctioning because it seemed to show the same content over and over .
When he contacted the manufacturer , they insisted the device was functioning normally .
“ Similarly , he asked a technician to repair his television because he falsely perceived that it was playing the same news repeatedly ,” the doctors wrote in BMJ Case Reports .
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In the patient ’ s own words , every day was “ a repeat of the day before ”.
He continued : “ Wherever I go , the same people are on the side of the road , the same cars behind me with the same people in them , … wearing the same clothes , carrying the same bags , saying the same things . “ Nothing is new .” The case authors said he had little insight into his
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All this , delivered straight to your inbox . delusion state and could not be convinced by family members of his misperceptions despite having good autobiographical memory .
Within two years of symptom onset , he also had impaired verbal memory and executive function on neuropsychological assessment .
The doctors explained that reports of déjà vécu had appeared as far back as 1896 , yet the most comprehensive case series , involving just 13 patients , was only published a decade ago .
Like their patient , these 13 cases had relatively good autobiographical memory but “ overconfidence ” in their recognition memory despite the external evidence that they were dealing with delusions .
In the present case , brain MRI showed mild generalised atrophy and small vessel disease , while CSF was positive for oligoclonal bands .
The doctors also conducted neurological fluorodeoxyglucose ( FDG )– PET / CT , which showed hypometabolism in the left temporal lobe and bilateral frontal lobes , with the right “ more pronounced than left ”.
The test results pointed to probable Alzheimer ’ s disease but with atypical features , which the authors suggested were a possible explanation for the specific symptom of déjà vécu .
“ The pattern of FDG – PET / CT hypometabolism in the left temporal and bifrontal lobes … within two years of symptom onset is atypical for Alzheimer ’ s disease , where a posterior pattern of hypometabolism is more commonly seen ,” they said .
“ This unusual pattern of hypometabolism could support an emerging theory that recollective confabulation is contributed by dual deficits in both memory and metacognition from damage to the temporal and right frontal regions .
“ It may also explain the rarity of recollective confabulation in Alzheimer ’ s disease , that dual deficits and / or a specific network disruption are required for the phenomenon to manifest .”
In the context of the CSF findings , the doctors tried immunotherapy — including IV methylprednisolone , IV immunoglobulin and rituximab — but ceased the therapy when the patient did not improve .
They also prescribed a cholinesterase inhibitor , to no effect .
Two years later — four years after symptom onset — the patient returned for another neuropsychological assessment . His cognitive profile remained consistent with Alzheimer ’ s disease , and the recollective confabulation remained “ pervasive and bothersome ”.
However , he was still able to live safely and independently at home . BMJ Case Rep 2023 ; 16 May .