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When images come to life: a case series
Frédéric Bertrand1, Mélanie Strauss1,2, Gil Leurquin-Sterk3
1Department of Neurology, Hôpital Universitaire de Bruxelles, Anderlecht, Brussels, Belgium.
BMJ Neurology Open
|March 11, 2026
Summary
Patients with dementia can experience a new delusional misidentification syndrome (DMS) variant, believing people in pictures are alive. This "animated picture syndrome" signals cognitive decline and requires further study.
Area of Science:
- Neurology
- Psychiatry
- Cognitive Science
Background:
- Delusional misidentification syndromes (DMS) are linked to psychiatric and neurological diseases, particularly dementia.
- A novel variant of DMS is reported in dementia patients: the belief that individuals in static images are alive.
Purpose of the Study:
- To describe a previously unreported variant of delusional misidentification syndrome (DMS) in patients with dementia.
- To characterize the clinical presentation, neuroimaging findings, and underlying pathology of this syndrome.
Main Methods:
- Retrospective analysis of four dementia patients exhibiting the described DMS variant.
- Standardized neuropsychological battery to assess cognitive domains.
- Multidisciplinary consensus for diagnosis using MRI, 18F-FDG-PET, DaT-scan, and CSF biomarkers.
Main Results:
- All four patients presented with delusions in the context of dementia, showing emotional-behavioural issues and functional decline.
- Neuroimaging revealed frontoparietotemporal hypometabolism, predominantly in the right hemisphere.
- CSF biomarkers indicated Alzheimer's pathology in all cases; two patients were diagnosed with probable dementia with Lewy bodies.
Conclusions:
- A new DMS variant, 'animated picture syndrome,' is described, characterized by the belief in the vitality of individuals in static images.
- This syndrome emerges in neurodegenerative disease, coinciding with cognitive and functional decline.
- Recognition of this syndrome aids in identifying clinical deterioration and guiding interventions.
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