Ophthalmic impairment or higher-order visual deficit? Posterior cortical atrophy: a case report

A 64-year-old man (GK) was referred to our memory clinic because of progressive memory and concentration problems. His symptoms had started 3 years earlier with gradually increasing visual problems for which no ophthalmologic explanations could be found. Neuropsychological assessment with detailed examination of the visuoperception revealed striking impairments in the higher-order visual functions, leading to a probable diagnosis of posterior cortical atrophy (PCA). The results of magnetic resonance imaging and cerebrospinal fluid examination supported the diagnosis. PCA is considered the posterior variant of Alzheimer's disease that typically presents with problems in visuoperception or, less frequent, apraxia. Despite its clear clinical features, the diagnosis of PCA is often delayed because of the focus on ophthalmologic examination. In this case report, the diagnosis of PCA in a 64-year-old man was not considered until further neuropsychological decay was evident. We argue that screening of higher-order visual functions can significantly contribute to an early diagnosis and treatment of PCA.