Global Brain Involvement in Posterior Cortical Atrophy: Multimodal MR Imaging Investigation

Posterior cortical atrophy (PCA), considered a visual variant of Alzheimer's disease, has similar pathological characteristics yet shows a selective visual manifestation with relative preservation of other cortical areas, at least at early stages of disease. Using a gamut of imaging methods, we aim to evaluate the global aspect of this relatively local disease and describe the interplay of the involvement of the different brain components. Ten PCA patients and 14 age-matched controls underwent MRI scans. Cortical thickness was examined to identify areas of cortical thinning. Hippocampal volume was assessed using voxel-based morphometry. The integrity of 20 fiber tracts was assessed by Diffusion Tensor Imaging. Regions of difference in global functional connectivity were identified by resting-state fMRI, using multi-variant pattern analysis. Correlations were examined to evaluate the connection between grey matter atrophy, the network changes and the disease load. The patients presented bilateral cortical thinning, primarily in their brains' posterior segments. Impaired segments of white matter integrity were evident only within three fiber tracts in the left hemisphere. Four areas were identified as different in their global connectivity pattern. The visual network-related areas showed reduced connectivity and was correlated to atrophy. Right Broadman area 39 showed in addition increased connectivity to the frontal areas. Global structural and functional imaging pointed to the highly localized nature of PCA. Functional connectivity followed grey matter atrophy in visual regions. White matter involvement seemed less prominent, however damage is directly related to presence of disease and not mediated only by grey matter damage.