title: Posterior cortical atrophy: clinical characteristics and differences compared to Alzheimer's disease.
abstract: BACKGROUND
  Predominant and progressive complex visual disorders are often due to posterior cortical atrophy (PCA), a rare early-onset dementing syndrome presenting with visual complaints. In clinicopathological studies, PCA is most commonly considered a form of Alzheimer's disease (AD); no prior study has evaluated clinical differences between PCA and AD.
  
  
  METHODS
  This study identified 15 patients who presented with progressive complex visual disorders and predominant occipitoparietal hypoperfusion on SPECT. These patients were retrospectively compared on clinical variables with 30 patients with clinically probable AD matched for gender, age and duration of illness.
  
  
  RESULTS
  The PCA patients presented with alexia, elements of Balint's syndrome, apperceptive visual agnosia, dressing apraxia and environmental disorientation along with elements of Gerstmann's syndrome. Compared to the AD patients, the 15 PCA patients (mean age of onset 58 years, range 51-64) had significantly better verbal fluency, less memory difficulty, more depression and greater insight into their illness but similar familial and apolipoprotein E risk factors. In the PCA patients, MRI often showed occipitoparietal atrophy without detectable mesiotemporal atrophy.
  
  
  CONCLUSIONS
  PCA is a distinct clinical syndrome and not just AD with prominent visual deficits. Compared to AD controls, PCA patients have better language and memory but more insight and depression and more posterior atrophy on MRI. These results indicate clinical criteria for the diagnosis of PCA and recommend specific interventions such as visual aids and antidepressant medications. Similar risk factors and course suggest that PCA is most commonly an early-onset posteriorly shifted AD variant.
authors.affiliation: Department of Neurology, University of California at Los Angeles, CA, USA. mmendez@ucla.edu
authors.forename: Mario F
authors.initials: MF
authors.lastname: Mendez
authors.forename: Mehdi
authors.initials: M
authors.lastname: Ghajarania
authors.forename: Kent M
authors.initials: KM
authors.lastname: Perryman
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000473:pathology*; D001284:Atrophy / Q000473:pathology; D002540:Cerebral Cortex / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014786:Vision Disorders / Q000209:etiology*