Patients with posterior cortical atrophy (PCA) present with difficulties finding objects even when they are in plain sight, problems with driving (eg, veering out of the lane, accidents caused by not seeing objects to the side), difficulty navigating uneven surfaces, loss of dexterity, and difficulties in dressing.
The neurologic examination is a critical part of the evaluation of patients with PCA. The cardinal symptoms of the dorsal variant PCA are Balint syndrome (simultanagnosia, optic ataxia, and oculomotor apraxia) or Gerstmann syndrome (left/right disorientation, finger agnosia, dyscalculia, and dysgraphia). The dorsal variant can also manifest with various degrees of limb, constructional, or dressing apraxia. Other characteristic features of PCA are preserved insight, and relative sparing of other cognitive domains. Some patients may manifest myoclonus, dystonia, or extrapyramidal signs suggestive of other neuropathologic entities, such as corticobasal degeneration or dementia with Lewy bodies.
Ninety-six percent of PCA cases are due to AD.44CTorMRI of the brain in PCA reveals atrophy corresponding to the observed clinical syndrome.
AJ. Polsinelli, LG. Apostolova. Atypical Alzheimer Disease Variants Continuum June 2022