What Causes Posterior Cortical Atrophy?

PCA is most commonly linked to Alzheimer’s disease pathology, meaning the same amyloid and tau protein buildup seen in Alzheimer’s is often found in PCA patients. However, instead of affecting memory areas first, these proteins damage the occipital and parietal lobes, which control vision, spatial awareness, and coordination.

Less frequently, PCA may result from other neurodegenerative conditions, such as:

• Dementia with Lewy Bodies (DLB)
• Corticobasal Syndrome (CBS)
• Prion Diseases

PCA typically develops between the ages of 50 and 65, making it an early-onset dementia.

Symptoms of Posterior Cortical Atrophy

Unlike Alzheimer’s disease, where memory loss is a hallmark symptom, PCA initially affects visual and spatial processing.

Visual and Spatial Difficulties

• Inability to recognize faces (prosopagnosia).
• Trouble reading or identifying objects (even with normal eye exams).
• Difficulty judging distances (misreaching for objects, bumping into furniture).
• Problems with depth perception (stairs and escalators become challenging).

Cognitive and Motor Symptoms (Later Stages)

• Difficulty with writing and drawing.
• Trouble with math and calculations (acalculia).
• Problems organizing thoughts and following conversations.
• Clumsiness and coordination issues.

Memory and Behavioral Symptoms (Advanced Stages)

• Memory loss typically appears later in the disease.
• Anxiety and frustration due to vision problems.

Because PCA is often mistaken for vision problems, patients may see multiple ophthalmologists before getting the correct diagnosis.

How is Posterior Cortical Atrophy Diagnosed?

PCA is difficult to diagnose because standard cognitive tests focus on memory loss, which is not the first symptom of PCA. Instead, diagnosis relies on a combination of:

• Neurological Exams – Assessing vision, perception, and problem-solving.
• Neuropsychological Testing – Identifying visual processing deficits.
• Brain Imaging (MRI, PET Scans) – Detecting atrophy in the posterior cortex.
• Eye Exams – Confirming normal eye function despite visual complaints.

A misdiagnosis of glaucoma, macular degeneration, or stroke is common, leading to delays in proper treatment.

Treatment and Management

There is no cure for PCA, but treatments can help manage symptoms and improve quality of life.

Medications:

• Cholinesterase Inhibitors (Donepezil, Rivastigmine) – May slow cognitive decline if PCA is Alzheimer’s-related.
• Memantine – May provide additional cognitive benefits.
• Antidepressants or Anti-Anxiety Medications – Can help with emotional distress.

Therapies and Supportive Care:

• Occupational Therapy – Adapting the environment for vision difficulties.
• Assistive Technology – Screen readers, audio books, and high-contrast settings.
• Speech and Cognitive Therapy – Maintaining communication and cognitive skills.

Lifestyle Adjustments:

• Using larger-print materials and high-contrast colors.
• Simplifying home layouts to reduce obstacles.
• Encouraging caregivers to verbally describe surroundings to help with orientation.

Since PCA affects visual processing rather than the eyes, traditional glasses or eye treatments will not improve symptoms.

Prognosis and Life Expectancy

PCA is progressive, meaning symptoms worsen over time. Over 8 to 12 years, the disease typically follows a pattern similar to Alzheimer’s, with increasing cognitive decline and dependency on caregivers.

In later stages, individuals may develop severe memory loss, communication difficulties, and mobility issues.

Wrapping Up

Posterior Cortical Atrophy is an often-overlooked form of dementia that primarily affects vision and spatial awareness rather than memory in its early stages. Because it is frequently misdiagnosed as an eye disorder, awareness is key to early intervention and support.

While there is no cure, proper management can improve quality of life and help individuals maintain independence for as long as possible.