TY - JOUR
T1 - Computerized visual field defects in posterior cortical atrophy
AU - Pelak, Victoria S.
AU - Smyth, Shawn F.
AU - Boyer, Philip J.
AU - Filley, Christopher M.
N1 - Funding Information:
Dr. Pelak receives publishing royalties from UpToDate, Inc.; serves as a consultant for Anthem Blue Cross and Blue Shield; receives research support from the NIH and the Alzheimer's Association; and has given expert testimony in medico-legal cases. Dr. Smyth reports no disclosures. Dr. Boyer serves on the editorial board of the Journal of Pathology Informatics and has given expert testimony in medico-legal cases. Dr. Filley receives publishing royalties for Neurobehavioral Anatomy, 2nd ed. (University Press of Colorado, 2001) and The Behavioral Neurology of White Matter (Oxford University Press, 2001); receives research support from University of Colorado Alzheimer's Disease and Cognition Center (ADCC), Alzheimer's Association, and the NIH/NIAMSD; and has given expert testimony in medico-legal cases.
PY - 2011/12/13
Y1 - 2011/12/13
N2 - Background and objective: Posterior cortical atrophy (PCA) is a progressive neurodegenerative syndrome that presents with cortical visual dysfunction and relatively preserved memory. Although higher cortical visual syndromes are well known in PCA, visual field defects detected by computerized visual field (CVF) perimetry have not been systematically described. The objective of this study was to describe CVF defects measured by threshold perimetry in PCA. Methods: This was a retrospective case series of patients meeting proposed PCA diagnostic criteria seen in the Neuro-ophthalmology and Neurobehavior Clinics at the University of Colorado during 2002 to 2006. History, examination, neuroimaging, autopsy, and CVF studies were analyzed. Results: Nine of 11 patients who met the criteria for PCA and had CVF testing were included. Seven of the 9 patients had homonymous hemianopia or quadrantanopia, and 2 had bilateral constriction. All patients progressed to dementia. Criteria were met for probable Alzheimer disease (AD) in 7, definite AD in 1, and definite dementia with Lewy bodies associated with AD pathology in 1. Seven of 9 patients had early and prominent complaints of difficulty driving. Conclusions: CVF defects were characterized by homonymous visual field defects or bilateral constriction. Eight of 9 patients progressed to probable or definite AD, but the CVF defects were distinctly different from those in typical AD. This observation probably reflects a posterior shift of cortical pathology to the primary and early secondary visual cortices in PCA. CVF testing should be considered in older patients with unexplained visual complaints, particularly when associated with difficulty driving, which may indicate the possibility of PCA and prompt early neurobehavioral evaluation.
AB - Background and objective: Posterior cortical atrophy (PCA) is a progressive neurodegenerative syndrome that presents with cortical visual dysfunction and relatively preserved memory. Although higher cortical visual syndromes are well known in PCA, visual field defects detected by computerized visual field (CVF) perimetry have not been systematically described. The objective of this study was to describe CVF defects measured by threshold perimetry in PCA. Methods: This was a retrospective case series of patients meeting proposed PCA diagnostic criteria seen in the Neuro-ophthalmology and Neurobehavior Clinics at the University of Colorado during 2002 to 2006. History, examination, neuroimaging, autopsy, and CVF studies were analyzed. Results: Nine of 11 patients who met the criteria for PCA and had CVF testing were included. Seven of the 9 patients had homonymous hemianopia or quadrantanopia, and 2 had bilateral constriction. All patients progressed to dementia. Criteria were met for probable Alzheimer disease (AD) in 7, definite AD in 1, and definite dementia with Lewy bodies associated with AD pathology in 1. Seven of 9 patients had early and prominent complaints of difficulty driving. Conclusions: CVF defects were characterized by homonymous visual field defects or bilateral constriction. Eight of 9 patients progressed to probable or definite AD, but the CVF defects were distinctly different from those in typical AD. This observation probably reflects a posterior shift of cortical pathology to the primary and early secondary visual cortices in PCA. CVF testing should be considered in older patients with unexplained visual complaints, particularly when associated with difficulty driving, which may indicate the possibility of PCA and prompt early neurobehavioral evaluation.
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U2 - 10.1212/WNL.0b013e31823e9f2a
DO - 10.1212/WNL.0b013e31823e9f2a
M3 - Article
C2 - 22131540
AN - SCOPUS:84856188642
SN - 0028-3878
VL - 77
SP - 2119
EP - 2122
JO - Neurology
JF - Neurology
IS - 24
ER -