Reduplicative Paramnesia

REDPARAThis syndrome is quite rare and there are no specific epidemiological data. It can be observed in both psychiatric and neurologic settings. In my personal neurologic career, I probably met thirty patients with this condition, most of them after frontal or temporal stroke on the right hemisphere. Few patients had Lewy body disease or other forms of dementia. Other few patients showed the disorder after traumatic brain injury (with hemorrhagic lesions or contusions predominant on the right hemisphere).
Patients with reduplicative paramnesia believe firmly that a familiar place (generally their own house), has been duplicated and exists simultaneously in two or more locations.
Most patients I met believed that the hospital was actually their own house disguised into the hospital. Others were convinced that the hospital was located in another town than the actual (for example Geneva instead than Lausanne). Other patients indicated a sort of chimeric assimilation: finally, a fusion between the hospital and their house took place. These false believes about places cannot be resolved by providing obvious and logical evidence of the contrary. The strength of this delusion (usually explained by the patient with improbable explanations, so called confabulations) is the key clinical element for the diagnosis of reduplicative paramnesia. However, differently than patients with schizophrenia, neurologic patients with reduplicative paramnesia appear collaborative or show little concern for their condition and do not feel themselves completely menaced by the delusion. The exact neural mechanisms of reduplicative paramnesia are not completely understood. The patients with brain lesions generally show memory difficulties together with visuospatial deficits and defective reality checking. Furthermore, this syndrome requires some distorted sensation of familiarity, which finally arises the patients’ doubts on the identity of places. Finally, there is some kind of anosognosia and/or a general reduction of awareness. There are no specific rehabilitation protocols for the treatment of this condition. Some empirical cues are systematically given to the patients to enhance reality orientation. Rarely patients need some pharmacological treatments for the delusion (low doses neuroleptics).
Actually, I follow, as outpatient, an 80 years old woman with a relatively pure form of reduplicative paramnesia 6 months after a medial temporal lobe stroke on the right hemisphere. Actually, she believes that the some furniture of her own house has been removed and is still in the hospital where she had rehabilitation. Her standardized neurobehavioral assessment showed moderate memory visuospatial and executive deficits and the patient verbalizes (despite with mild confusion) her doubts on what is real or not in her thoughts on the location of the furniture. Some suggestions for further assessment and/or treatment?

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6 réponses à Reduplicative Paramnesia

  1. Jue!92b82j dit :

    I have a question: What is the difference as far as the brain goes? Between an average brain and someone who has reduplicative paramnesia?

  2. We see behavior like this quite often in primary rehabilitation after injury to the frontal lobe, like TBI, stroke and ischemia – is there any reason to distinguish this from a typical post-traumatic amnesia (PTA)? In my experience patients who exhibit this behavior gradually become oriented over the course of a year, or at least hide it unless they have permanent cognitive impairment (determined by neuropsychological tests, or even just a simple galvestone orientation and amnesia (GOAT))

  3. Diane dit :

    My father has this condition, and after trying to explain that there is only one room, where he gets very upset and distressed when he says « I cannot understand why you don’t believe me » I now go along with his believing there are multiple rooms with all his clothes and same furniture in each.
    Is it best to play along like this? Or should I keep explaining there is only one room? I’m getting confused!,,

    • F68.10 dit :

      Cannot really help you. But you may be interested in this article.

      « We found that all 17 lesion locations were functionally connected to the left retrosplenial cortex, the region most activated in functional magnetic resonance imaging studies of familiarity. »

      « Competitors in the World Memory Championships are able to perform outstanding feats of memory and show increased fMRI activation in their retrosplenial cortex than normal controls when doing so. This is thought to be due to their use of a spatial learning strategy or mnemonic device known as the method of loci. »

      « ‘the method of loci’, an imaginal technique known to the ancient Greeks and Romans and described by Yates (1966) in her book The Art of Memory as well as by Luria (1969). In this technique the subject memorizes the layout of some building, or the arrangement of shops on a street, or any geographical entity which is composed of a number of discrete loci. When desiring to remember a set of items the subject ‘walks’ through these loci in their imagination and commits an item to each one by forming an image between the item and any feature of that locus. Retrieval of items is achieved by ‘walking’ through the loci, allowing the latter to activate the desired items. The efficacy of this technique has been well established (Ross and Lawrence 1968, Crovitz 1969, 1971, Briggs, Hawkins and Crovitz 1970, Lea 1975), as is the minimal interference seen with its use. »

      Do not think it will help you much. But it may give an entry point to the idea of the context of how spatialization interacts with memory. Just food for thought…

  4. EDBOI dit :

    Have there been any instances where reduplicative paramnesia has been applied to body parts?

    • EDBOI dit :

      To be more specific, has someone ever thought there hand is actually in two or more places at the same time? or that the hand they have is actually not theirs but someone elses? If so, would this still be considered to be reduplicative paramnesia?

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