Benson’s Disease or Posterior Cortical Atrophy, Revisited

Article type: Research Article

Authors: Yerstein, Oleg^a | Parand, Leila^{b; c} | Liang, Li-Jung^d | Isaac, Adrienne^e | Mendez, Mario F.^{b; c; f; *}

Affiliations: [a] Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA, USA | [b] Department of Neurology, Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA | [c] Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA | [d] Department of Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA | [e] Department of Linguistics, Georgetown University, Washington, DC, USA | [f] Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA

Correspondence: [*] Correspondence to: Mario F. Mendez, MD, PhD, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare Center, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA. Tel.: +1 310 478 3711/ Ext. 42696; Fax: +1 310 268 4181; E-mail: mmendez@UCLA.edu.

Abstract: Background:D. Frank Benson and colleagues first described the clinical and neuropathological features of posterior cortical atrophy (PCA) from patients in the UCLA Neurobehavior Program. Objective:We reviewed the Program’s subsequent clinical experience with PCA, and its potential for clarifying this relatively rare syndrome in comparison to the accumulated literature on PCA. Methods:Using the original criteria derived from this clinic, 65 patients with neuroimaging-supported PCA were diagnosed between 1995 and 2020. Results:On presentation, most had visual localization complaints and related visuospatial symptoms, but nearly half had memory complaints followed by symptoms of depression. Neurobehavioral testing showed predominant difficulty with visuospatial constructions, Gerstmann’s syndrome, and Balint’s syndrome, but also impaired memory and naming. On retrospective application of the current Consensus Criteria for PCA, 59 (91%) met PCA criteria with a modification allowing for “significantly greater visuospatial over memory and naming deficits.” There were 37 deaths (56.9%) with the median overall survival of 10.3 years (95% CI: 9.6–13.6 years), consistent with a slow neurodegenerative disorder in most patients. Conclusion:Together, these findings recommend modifying the PCA criteria for “relatively spared” memory, language, and behavior to include secondary memory and naming difficulty and depression, with increased emphasis on the presence of Gerstmann’s and Balint’s syndromes.

Keywords: Alzheimer’s disease, balint’s syndrome, gerstmann’s syndrome, posterior cortical atrophy

DOI: 10.3233/JAD-210368

Journal: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 493-502, 2021