A-116: Pareidolia, Language and Culture in Dementia With Lewy Bodies: A Cantonese-Speaking Case
Abstract
Objective: A biopsychosocial approach was used for the diagnostic formulation of a Cantonese-speaking patient with suspected dementia with Lewy bodies (DLB). This case highlights the complexity of pareidolia, neuropsychiatric, language factors, and caregiver cultural considerations in differentiating mixed neurodegenerative etiologies. Method/Data Selection: A 71-year-old Cantonese-speaking woman with six years of education in Hong Kong presented with progressive cognitive decline and behavioral changes. MoCA scores indicated impairment. Neuroimaging showed white matter ischemic changes. She exhibited disorientation, visual hallucinations, REM sleep disturbances, autonomic changes, and emotional lability with regressive behaviors. Presentation was complicated by macular degeneration and vascular risk factors. Cultural and linguistic considerations, family involvement, and emotional regulation were integrated into testing. Results/Data Synthesis: Testing revealed global cognitive impairment with prominent visuospatial processing, encoding, executive functioning, and processing speed deficits. Elevated pareidolia false-positives were noted. Cantonese speech was mildly dysarthric, with word-finding difficulty and paraphasic errors suggestive of motor slowing. Behavioral observations included disorganization, stimulus-bound behavior, disinhibition and regressive behaviors, such as repeated requests to leave, and increased dependence on husband. Caregiver responses were characterized by frequent reassurance, accommodation of dependency, and normalization of regressive behaviors. Conclusions: Findings were most consistent with major neurocognitive disorder due to multiple etiologies, with features suggestive of DLB and vascular contributions. Qualitative behavioral and language observations may aid DLB identification in older Chinese populations. Elevated pareidolia responses supported Lewy body pathology and differentiation from Alzheimer’s disease, though cultural influences on false-positive rates warrant further study. Caregiver perceptions, shaped by cultural values, may contribute to normalization and reinforcement of regressive behaviors, potentially delaying recognition of neuropsychiatric changes.