When Dementia Kills Before One Passes Away: Case Report of Cotard's Syndrome

Cotard's Syndrome (CS), among the noncognitive changes in the forms of dementia, is a seldom-found manifestation (1). This syndrome is characterized by the delusion of having lost organs (the individual experiences huge changes in the body and believes that he/she no longer has one or more organs) and by nihilistic delusion (the individual believes he/she or everyone in the world has died or been destroyed) (2). In 1880, Jules Cotard (1840-1889) described a clinical condition that he believed corresponded to a new subtype of depression, which he called anxious melancholia. He proposed that a state of acute depression and morbid anxiety could foster the development of structured delusions of hypochondria. Two years later he referred to the same clinical condition using the term délires des négations for the first time (3). The eponym CS was only introduced in 1893 by Emil Regis, who stated that Cotard had not described a new clinical entity but rather a syndrome - a cluster of symptoms that could also be found in other mental illnesses apart from depression and in which anxiety was the central characteristic (4). The most prominent symptoms found in an analysis of one hundred cases were: depressed mood (89%), nihilistic delusion (69%), anxiety (65%), delusion of guilt (63%), delusion of immortality (55%) and hypochondriacal delusions (58%) (12). Currently, CS is not classified as an isolated disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association or in the International Statistical Classification of Diseases and Related Health Problems (ICD-10). There is a growing consensus to consider it a secondary syndrome of an underlying disorder, of which the most associated disorders are: unipolar depression, bipolar depression and primary psychotic disorders. Other conditions have also been described, such as dementia, severe intellectual disability, cerebrovascular accident, brain tumor, and Parkinson's disease, among others (5).