posterior cortical atrophy

Etiology

• Alzheimer's disease
• Lewy body dementia

Pathology

• degeneration of posterior cortical areas of the brain
• aggregation of Abeta42 & MAP-tau as seen in Alzheimer's disease

Clinical manifestations

• Balint syndrome
  • problems with visuospatial processing
• may be not amnestic manifestations

Radiology

• brain MRI frequently shows parietal-occipital atrophy

Differential diagnosis

• frontotemporal dementia (FTD)
  • behavioral variant FTD exhibit early behavioral changes, including impaired executive functioning
  • other 2 variants of FTD are types of primary progressive aphasia
    • predominantly language problems
  • brain MRI in FTD often shows cortical atrophy of the frontal lobe &/or temporal lobe
• Creutzfeldt-Jakob disease
  • rapidly progressive cognitive impairment (dementia)
  • akinetic mutism, myoclonus, extrapyramidal signs
  • visual dysfunction or cerebellar dysfunction
  • brain MRI may show restricted diffusion of the basal ganglia, thalamus, & cerebral cortex.
• progressive supranuclear palsy
  • difficulty looking up & down
  • slowing of saccades (fast jumps from one eye position to another), particularly vertically
  • brain MRI may show midbrain atrophy
  • parkinsonism, facial dystonia, dysarthria, dysphagia, early falls

Management

• acetylcholinesterase inhibitor
• occupational therapy for visuospatial deficits if needed

Notes

• considered a subtype of Alzheimer's disease (2nd most common presentation)

More general terms

• Alzheimer's disease (AD)