Cotard's syndrome is a rare disorder in which nihilistic delusions concerning one's own body are the central feature. It is not listed as a specific disorder in the DSM-IV, as it is typically viewed as a part of other underlying disorders. However, it remains important to recognize the syndrome because specific underlying mechanisms are present, and prognostic and therapeutic consequences have to be taken into account. This review presents an up-to-date overview of Cotard's syndrome, which was initially described more than a century ago.
Cotard’s syndrome involves nihilistic delusions about the patient’s own body, such as believing that he or she is a walking corpse. The syndrome is named for Jules Cotard (1840–1889), a French neurologist who first described this condition in 1880. He formulated the syndrome as a new type of depression characterized by symptoms such as anxious melancholia, ideas of damnation or rejection, insensitivity to pain, delusions of nonexistence concerning one’s own body, and delusions of immortality. Along with discussing the typical progression of symptoms and associated features, this chapter situates Cotard’s syndrome within the context of several other disorders and well-known neuropsychological deficits.
In FTD patients, frontal lobe symptoms were severe in the mild, moderate and severe dementia stages although the nature of frontal lobe symptoms depended on disease severity. AD and DLB patients displayed more frontal lobe symptoms in the advanced disease stages as compared to disease onset, suggesting gradual frontal lobe involvement as the disease progresses. The nature of frontal lobe symptoms related to dementia severity differed between AD, DLB and FTD patients, suggesting different patterns of frontal lobe involvement. Last but not the least, these data point to the potential diagnostic value of behavioural observation of frontal lobe symptoms for (differential) dementia diagnosis, especially at the earliest disease stages. These findings await confirmation through a prospective, longitudinal study.
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