Visual Loss and Dementia

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.