TO BE OR NOT TO BE AT, HOME - A NEUROPSYCHOLOGICAL APPROACH TO DELUSION FOR PLACE

A woman, LB, while in recovery from a viral encephalitis, exhibited a delusion for place, which led her to insist that she was at home, in s pite of compelling evidence to the contrary. Later, she developed a Ca pgras syndrome, that is, another misidentification syndrome. The patie nt was given a detailed neuropsychological evaluation to shed some lig ht on the mechanisms underlying her delusional misbelief. Two main def icits were in evidence: (1) a severe visual-spatial impairment, giving the patient a distorted perception of her surroundings; and (2) front al lobe dysfunction, which played a critical role in her impulsive res ponses and lack of self-awareness. The pathogenesis of delusion for pl ace and persons is discussed in light of these observations.