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Visual Loss and Dementia

  • Ariel Chen
  • Andrew G. LeeEmail author
Chapter

Abstract

Visual loss can be the presenting and only symptom of a patient with dementia. Posterior cortical atrophy (PCA) is the term used to describe a neurodegenerative syndrome that presents with predominantly visual processing symptoms that may progress to cognitive decline. PCA includes etiologies such as Lewy body dementia, corticobasal degeneration, prion disease, and Alzheimer’s disease. These patients are often difficult for ophthalmologists to identify since the structural eye examination and visual acuity are often unrevealing. Additionally, patient presentations are variable including alexia, agraphia, hemianopsia, visual agnosia, and dyschromatopsia. Another clue for visual presentations of dementia is if the patient is brought in by a spouse, suggesting poor patient insight. Evaluations for these patients include perimetry and neuroimaging. Structural imaging may often be normal, while functional imaging can show decreased activity. For geriatric patients who present with nonspecific visual complaints, posterior cortical atrophy and neurocognitive disorders should be considered for earlier diagnosis and treatment. Patients with visuospatial manifestations of dementia should be cared for by a comprehensive and multidisciplinary team of providers.

Keywords

Posterior cortical atrophy Visual variant of Alzheimer’s disease Complex visual disorders Practice-based learning and improvement Interpersonal and communication skills Professionalism Systems-based practice Perimetry Dementia Visual agnosia 

References

  1. 1.
    Duffy CJ. Visual loss in Alzheimer’s disease: out of sight, out of mind. Neurology. 1999;52:10–1.CrossRefGoogle Scholar
  2. 2.
    Giannakopoulos P, Gold G, Duc M, et al. Neuroanatomic correlates of visual agnosia in Alzheimer’s disease: a clinicopathologic study. Neurology. 1999;52:71–7.CrossRefGoogle Scholar
  3. 3.
    Kiyosawa M, Bosley TM, Chawluk J, et al. Alzheimer’s disease with prominent visual symptoms. Clinical and metabolic evaluation. Ophthalmology. 1989;96:1077–86.CrossRefGoogle Scholar
  4. 4.
    Levine DN, Lee JM, Fisher CM. The visual variant of Alzheimer’s disease: a clinicopathologic case study. Neurology. 1993;43:305–13.CrossRefGoogle Scholar
  5. 5.
    Sadun AA, Bassi CJ. Optic nerve damage in Alzheimer’s disease. Ophthalmology. 1990;97:9–17.CrossRefGoogle Scholar
  6. 6.
    Sadun AA, Borchert M, DeVita E, et al. Assessment of visual impairment in patients with Alzheimer’s disease. Am J Ophthalmol. 1987;104:113–20.CrossRefGoogle Scholar
  7. 7.
    Trick GL, Trick LR, Morris P, Wolf M. Visual field loss in senile dementia of the Alzheimer’s type. Neurology. 1995;45:68–74.CrossRefGoogle Scholar
  8. 8.
    Warren S, Hier DB, Pavel D. Visual form of Alzheimer’s disease and its response to anticholinesterase therapy. J Neuroimaging. 1998;8:249–52.CrossRefGoogle Scholar
  9. 9.
    Zakzanis VK, Boulos MI. Posterior cortical atrophy. Neurologist. 2001;7:341–9.CrossRefGoogle Scholar
  10. 10.
    Benson DF, Davis RJ, Snyder BD. Posterior cortical atrophy. Arch Neurol. 1998;45:789–93.CrossRefGoogle Scholar
  11. 11.
    Victoroff J, Ross GW, Benson DF, et al. Posterior cortical atrophy. Neuropathologic correlations. Arch Neurol. 1994;51:269–74.CrossRefGoogle Scholar
  12. 12.
    Hof PR, Vogt BA, Bouras C, Morrison JH. Atypical form of Alzheimer’s disease with prominent posterior cortical atrophy: a review of lesion distribution and circuit disconnection in cortical visual pathways. Vis Res. 1997;37:3609–25.CrossRefGoogle Scholar
  13. 13.
    Brazis PW, Lee AG, Graff-Radford N, et al. Homonymous visual field defects in patients without corresponding structural lesions on neuroimaging. J Neuroophthalmol. 2000;20:92–6.CrossRefGoogle Scholar
  14. 14.
    Rizzo M, Vecera SP. Psychoanatomical substrates of Balint’s syndrome. J Neurol Neurosurg Psychiatry. 2002;72:162–78.CrossRefGoogle Scholar
  15. 15.
    Rizzo M, Anderson SW, Dawson J, Nawrot M. Vision and cognition in Alzheimer’s disease. Neuropsychologia. 2000;38:1157–69.CrossRefGoogle Scholar
  16. 16.
    Rizzo M, Anderson SW, Dawson J, et al. Visual attention impairments in Alzheimer’s disease. Neurology. 2000;54:1954–9.CrossRefGoogle Scholar
  17. 17.
    Rizzo M, Nawrot M. Perception of movement and shape in Alzheimer’s disease. Brain. 1998;121:2259–70.CrossRefGoogle Scholar
  18. 18.
    Uhlmann RF, Larson EB, Koepsell TD, et al. Visual impairment and cognitive dysfunction in Alzheimer’s disease. J Gen Intern Med. 1992;7(1):122.CrossRefGoogle Scholar
  19. 19.
    George J, Bleasdale S, Singleton SJ. Causes and prognosis of delirium in elderly patients admitted to a district general hospital. Ageing. 1997;26(6):423–7.Google Scholar
  20. 20.
    Steinman SB, Steinman BA, Trick GL, Lehmkuhle S. A sensory explanation for visual attention deficits in the elderly. Optom Vis Sci. 1994 Dec;71(12):743.CrossRefGoogle Scholar
  21. 21.
    Lee AG, Martin CO. Neuro-ophthalmic findings in the visual variant of Alzheimer’s disease. Ophthalmology. 2004;111:376–80.CrossRefGoogle Scholar
  22. 22.
    Bokde ALW, Pietrini P, Ibanez V, et al. The effect of brain atrophy on cerebral hypometabolism in the visual variant of Alzheimer disease. Arch Neurol. 2001;58:480–6.CrossRefGoogle Scholar
  23. 23.
    Crutch JS, Lehmann M, Schott JM, et al. Posterior cortical atrophy. Lancet Neurol. 2012;11:170–8.CrossRefGoogle Scholar
  24. 24.
    Borruat FX. Posterior cortical atrophy: review of the recent literature. Curr Neurol Neurosci Rep. 2013;13(12):406.CrossRefGoogle Scholar
  25. 25.
    Tang-Wai DF, Graff-Radford NR, Boeve BF, et al. Clinical, genetic, and neuropathologic characteristics of posterior cortical atrophy. Neurology. 2004;63:1168–74.CrossRefGoogle Scholar
  26. 26.
    Renner JA, Burns JM, Hou CE, et al. Progressive posterior cortical dysfunction. A clinicopathologic series. Neurology. 2004;63:1175–80.CrossRefGoogle Scholar
  27. 27.
    Snowden JS, Stopford CL, Julien CL, et al. Cognitive phenotypes in Alzheimer’s disease and genetic risk. Cortex. 2007;43:833–45.CrossRefGoogle Scholar
  28. 28.
    Tang-Wai D, Mapstone M. What are we seeing? Is posterior cortical atrophy just Alzheimer disease? Neurology. 2006;66:300–1.CrossRefGoogle Scholar
  29. 29.
    Mendez MF, Ghajarania M, Perryman KM. Posterior cortical atrophy: clinical characteristics and differences compared to Alzheimer’s disease. Dement Geriatr Cogn Disord. 2002;14:33–40.CrossRefGoogle Scholar
  30. 30.
    Kaeser PF, Ghika J, Borruat FX. Visual signs and symptoms in patients with the visual variant of Alzheimer disease. BMC Ophthalmol. 2015;15(1):1.CrossRefGoogle Scholar
  31. 31.
    Tang-Wai DF, Josephs KA, Boeve BF, Dickson DW, Parisi JE, Petersen RC. Pathologically confirmed corticobasal degeneration presenting with visuospatial dysfunction. Neurology. 2003;61:1134–5.CrossRefGoogle Scholar
  32. 32.
    Formaglio M, Krolak-Salmon P, Tilikete C, et al. Homonymous hemianopia and posterior cortical atrophy. Rev Neurol. 2009;165:256–62.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Baylor College of Medicine, Department of OphthalmologyHoustonUSA
  2. 2.Blanton Eye Institute, Houston Methodist HospitalHoustonUSA
  3. 3.Weill Cornell MedicineNew York CityUSA
  4. 4.UTMBGalvestonUSA
  5. 5.UT MD Anderson Cancer CenterHoustonUSA
  6. 6.Texas A&M College of MedicineCollege StationUSA
  7. 7.Baylor College of MedicineHoustonUSA
  8. 8.University of Iowa Hospitals and ClinicsIowa CityUSA
  9. 9.University of BuffaloBuffaloUSA

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