Posterior Cortical Atrophy: A Case Study of Benson's Syndrome That Initially Presented as Anxiety Disorder

Abstract

The postmortem pathology of posterior cortical atrophy (PCA) and Alzheimer's disease (AD) are often identical. In contrast to AD, PCA is clinically different in that visuoperceptual skills are severely impaired, yet memory is relatively intact. In addition, patients with PCA often report depression with preserved insight. The present case study is a 56-year-old female who initially presented with anxiety and panic-like symptoms. The neuropsychological evaluation and imaging studies were consistent with PCA. This case study is relatively unique in that symptom onset presented as an anxiety disorder, yet formal evaluation revealed severe visuospatial impairment with minimal insight into the severity of cognitive impairment. Anxiety was alleviated following cessation of employment. This case highlights the importance of differential diagnostic consideration of affective and mood disorders and early forms of dementia.

Key words:

• Alzheimer's disease
• anxiety
• Benson's syndrome
• posterior cortical atrophy

ACKNOWLEDGEMENTS

The authors of this manuscript express gratitude to Ralph H. B. Benedict, Ph.D., and Dominic A. Carone, Ph.D., for their comments and input during the formulation of this case study.

Notes

WTAR = Wechsler Test of Adult Reading (Psychological Corporation, 2001); WASI = Wechsler Abbreviated Scale of Intelligence (Psychological Corporation, 1999); D-KEFS = Delis-Kaplan Executive Function System (Delis, Kaplan, & Kramer, 2001); HVLT-R = Hopkins Verbal Learning Test-Revised; WMS-III = Wechsler Memory Scale (Wechsler, 1997b); BVMT-R = Brief Visuospatial Memory Test Revised; WAIS-IV = Wechsler Adult Intelligence Scale-Fourth Edition (Wechsler, 1997a); TMT = Trail-Making Test (Reitan, 1959); VSAT = Visual Search and Attention Test (Trenerry, Crosson, DeBoe, & Leber, 1990); Stroop (Trenerry, Crosson, DeBoe, & Leber, 1989); Symbol-Digit Modalities Test (Smith, 1982).