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Behavioural Neurology
Volume 24 (2011), Issue 3, Pages 229-236

The Evolution of Alexia in Two Cases of Posterior Cortical Atrophy

Eleonora Catricalà,1,2 Pasquale A. Della Rosa,2 Paola Ortelli,3 Valeria Ginex,3 Alessandra Marcone,3 Daniela Perani,2,4 and Stefano F. Cappa2,3

1Department of Psychology, Milano-Bicocca University, Milan, Italy
2Vita-Salute University and San Raffaele Scientific Institute, Milan, Italy
3Department of Clinical Neurosciences, San Raffaele Turro Hospital, Milan, Italy
4Nuclear Medicine Unit and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy

Received 25 August 2011; Accepted 25 August 2011

Copyright © 2011 Hindawi Publishing Corporation and the authors. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Posterior cortical atrophy (PCA) is an uncommon presentation of Alzheimer's disease (AD), characterised by prevalent anatomo-functional involvement of posterior cortical areas. Accordingly, the main clinical features at onset are disorders of high-order visual processing, such as alexia and impairments of visuo-spatial and visuo-constructional abilities. The clinical features in the early stages of disease are variable, and they have been suggested to stem from prevalent ventral or dorsal brain pathology, and/or asymmetric hemispheric involvement. With disease progression, these differences tend to blur with the increasing severity of neuropsychological dysfunction. We report two PCA patients showing different patterns of reading impairment (respectively, letter-by-letter reading and neglect dyslexia). A follow-up study suggested that the qualitative features of alexia remain distinctive with disease evolution. In addition, single photon emission tomography (SPECT) studies revealed different patterns of hypoperfusion, consistent with the alexia types. A careful reading assessment can provide important insights to the pattern of progression of the disease in patients with PCA up to the late stages of the pathology.