title: Visual signs and symptoms in patients with the visual variant of Alzheimer disease.
abstract: BACKGROUND
  Prominent visual symptoms can present in the visual variant of Alzheimer's disease (VVAD). Ophthalmologists have a significant role to play in the early diagnosis of VVAD.
  
  
  METHODS
  We retrospectively reviewed the files of ten consecutive patients diagnosed with VVAD. All patients had a full neuro-ophthalmologic examination, a formal neurological and neuro-psychological testing, and cerebral MRI to confirm diagnosis. In addition, functional neuroimaging was obtained in seven patients.
  
  
  RESULTS
  The common primary symptom at presentation with all patients was difficulty with near vision (reading difficulty n = 8, "visual blur" in near vision n = 2), and difficulty writing (n = 3). Following assessment, impaired reading and writing skills were evident in 9/10 and 8/10 patients respectively. Median distance visual acuity was 20/25 and at near the median visual acuity was J6. Partial homonymous visual field defect was detected in 80 % (8/10) of the patients. Color vision was impaired in all patients when tested with Ishihara pseudoisochromatic plates, but simple color naming was normal in 8/9 tested patients. Simultanagnosia was present in 8/10 patients. Vision dysfunction corresponded with cerebral MRI findings where parieto-occipital cortical atrophy was observed in all patients. PET scan (5 patients) or SPECT (2 patients) revealed parieto-occipital dysfunction (hypometabolism or hypoperfusion) in all 7 tested patients
  
  
  CONCLUSIONS
  Visual difficulties are prominent in VVAD. Dyslexia, incomplete homonymous hemianopia, preserved color identification with abnormal color vision on Ishihara, and simultanagnosia were all symptoms observed frequently in this patient series. Ophthalmologists should be aware of the possibility of neurodegenerative disorders such as VVAD in patients with unexplained visual complaints, in particular reading difficulties.
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Avenue de France 15, CH-1004, Lausanne, Switzerland. pierre-francois.kaeser@fa2.ch.
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Kaeser
authors.affiliation: Department of Neurology, University of Lausanne, CHUV, Lausanne, Switzerland. joseph.ghika@chuv.ch.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ghika
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Avenue de France 15, CH-1004, Lausanne, Switzerland. francois.borruat@fa2.ch.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Borruat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis*; D001284:Atrophy; D003117:Color Vision Defects / Q000175:diagnosis; D042241:Early Diagnosis; D005260:Female; D006423:Hemianopsia / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000473:pathology; D010296:Parietal Lobe / Q000473:pathology; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields