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Capgras syndrome, a delusional misidentification syndrome characterized by the belief that a close relative or friend has been replaced by an identical imposter, is a rare phenomenon often associated with psychotic disorders. Here, we present a case of a male in his early 80s with Lewy body dementia (LBD) who developed Capgras syndrome. Despite initial challenges in management, including thought blocking and word-finding difficulty, the patient experienced complete resolution of symptoms following treatment with rivastigmine, a cholinesterase inhibitor, commonly used in major neurocognitive disorders. This case highlights the potential efficacy of cholinesterase inhibitors in alleviating psychotic symptoms associated with Capgras syndrome, particularly in individuals with LBD.