Visual Dysfunction in Posterior Cortical Atrophy: A Masquerade

Posterior cortical atrophy, considered an atypical dementia, is a syndrome characterised by dysfunction of posterior cortical regions with prominent visuospatial and visuoperceptual impairment at presentation. We report the case of posterior cortical atrophy, which was diagnosed six years after the onset of visual symptoms. The patient is a 67-year-old married gentleman, with six years history of visual impairment, characterised by difficulty in locating and manipulating door handles, overreaching objects and difficulty in depth perception. He had a history of repeated visits to ophthalmologists and underwent multiple unsuccessful changes in eyeglasses and a cataract surgery to correct acuity. The patient also developed recent memory deficits about two years back, insidious in onset and gradually progressed and symptoms of visual and auditory hallucinations about six months back. Cognitive and functional assessments, and imaging findings were consistent with a diagnosis of posterior cortical atrophy, possible Alzheimer’s disease. The patient was started on cognitive enhancers and low dose antipsychotics. He was engaged in meaningful and cognitively stimulating activities. Environmental manipulations and home safety recommendations for visual impairment were conveyed to the family. In the early stages of posterior cortical atrophy, visual symptoms predominate, while episodic memory, executive functioning, language, and insight are substantially retained. Better identification, prognosis, and treatment of posterior cortical atrophy will result from increased knowledge and understanding of the condition among neurologists, psychiatrists, general doctors, ophthalmologists, and optometrists.