Diagnosis of Posterior Cortical Atrophy

The Neurobehavior and Memory Clinic at Northwestern Medicine is affiliated with our center and offers clinical consultations to patients, families and providers, including diagnostic evaluations, second opinions and supportive services. 

After cognitive testing with a doctor or neuropsychologist has determined there is a problem, an MRI is often the next step in diagnosis of Posterior Cortical Atrophy (PCA). An MRI rules out strokes, tumors, and other structural problems while looking for characteristic “atrophy” or shrinking in the back parts of the brain. This atrophy suggests a neurodegenerative process may be ongoing. Typically blood work is done to rule out thyroid problems, infections, or vitamin deficiencies that rarely contribute to cognitive changes.   

A neurologist uses the patient’s history, neurologic exam, and MRI to determine whether or not a neurodegenerative disease is causing the symptoms at which point the diagnosis of Posterior Cortical Atrophy (PCA) syndrome can be made. However, a syndrome can be caused by many diseases.

Understanding the Underlying Disease  

• If Alzheimer’s disease is causing the syndrome by testing for biomarkers, most commonly with a lumbar puncture to sample the fluid around the spine. If cerebrospinal fluid is negative other considerations are made.  
• If the patient displays signs of Parkinson’s disease or other symptoms like REM behavior disorder, a presumed diagnosis of Lewy Body Disease is made.  
• If the patient has motor problems on one side of the body a presumed diagnosis of Corticobasal Degeneration may be made.  
•  Cruetzfeldt-Jakob Disease is suspected in rapidly progressive patients, often with characteristic findings on physical exam and MRI, and is confirmed with spinal fluid testing.