A man in his 80s gradually started feeling that he was witnessing the same events again and again. This disturbing symptom, somewhat reminiscent of the 1993 movie "Groundhog Day," likely emerged as a rare complication of Alzheimer's disease, according to a new report of the case.
According to the report, published May 16 in the journal BMJ Case Reports, the man once complained to his e-book manufacturer because he thought it kept showing the same material, and he also contacted a technician about his television repeatedly showing the same news.
When describing his predicament in his own words, he said, "Wherever I go, the same people are on the side of the road, the same cars behind me with the same people in them … the same person gets out of the cars wearing the same clothes, carrying the same bags, saying the same things … nothing is new."
This condition, called deja vecu with recollective confabulation (DVRC), is sometimes seen in neurodegenerative diseases such as Alzheimer's, according to the report. Neurodegenerative diseases are those in which cells of the central nervous system stop working and ultimately die. These conditions worsen over time, and no cures yet exist.
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Deja vecu differs from the more familiar deja vu, the transient and strange feeling that you have experienced the present before. While deja vu describes a fleeting sensation, deja vecu is the persistent perception that new encounters are repetitions of previous experiences.
Those with deja vecu often lack insight into their condition and develop disabling, delusion-like false beliefs and behaviors to justify their abnormal perception, the case report authors wrote. Collectively, this false perception combined with the production of false evidence to support it is known as recollective confabulation.
DVRC has been described in a handful of other patients with neurodegeneration, including some with Alzheimer's. The exact cause of DVRC remains elusive, but some have suggested that dysfunction of the hippocampus, a part of the brain that helps convert short-term memories into long-term memories, may give rise to a "false sense of recollection," the authors noted.
Deja vecu without recollective confabulation has also been seen in some neurological diseases, including temporal lobe epilepsy and traumatic brain injury, and in psychiatric disorders, such as schizophrenia. In one reported case, it was linked to a person taking 5-hydroxytryptophan, a compound that gets converted into the chemical messenger serotonin in the body.
A neuropsychological assessment of the man in the recent case revealed memory loss, impulsive behavior and cognitive decline, and he often conflated two separate stories as being just one. Brain scans highlighted unusually low activity in the left temporal lobe, a region of the brain's wrinkled outer layer located behind the left ear, and the frontal lobes, with abnormalities being more pronounced on the right than on the left.
Doctors also examined the man's cerebrospinal fluid (CSF), the fluid that surrounds and cushions the brain and spinal cord. They found that in the CSF, the level of the protein amyloid beta-42 was reduced, while the tau protein level was borderline elevated. These are signs of Alzheimer's disease.
The man was treated with a trial of immunotherapy, likely because his doctors had also found antibodies in his CSF, but this treatment was discontinued following a lack of clinical improvement. Four years after the onset of his symptoms, the man scored worse on cognitive tests than he had during his initial assessment.
"His recollective confabulation symptoms remain pervasive and bothersome," the case report authors wrote. Still, "he continued to live at home and remained independent with self-care."
The largest case series to document DVRC included reports of 13 patients, nine of whom had probable Alzheimer's. Three of the patients had mild cognitive impairment, and one had frontotemporal dementia, the case report authors wrote. They noted that their case report is unique in that it's the first report of DVRC that analyzed brain activity with scans, evaluated the patient's CSF and included repeated neuropsychological testing.
