Özet:

Purpose: Posterior cortical atrophy (PCA) is a rare dementia syndrome characterized by volume loss and visual-spatial impairment in the parieto-occipital areas. It has a heterogeneous clinical presentation as it may be associated with Balint Syndrome and Gerstmann Syndrome. This research aimed to examine the language and cognitive involvement and to describe the narrative features in a patient with PCA. It has been reported that in the initial period of PCA, physiospastic involvement such as apraxia of dressing is more prominent and language functions are relatively preserved. The clinical picture may be exacerbated by the presence of Gerstmann (agraphia, acalculia, right-left disorientation, finger agnosia) and Balint syndrome (simultanagnosia, optic ataxia, ocular apraxia) components. Method: A 54-year-old, native Turkish speaker and high school graduate, cranial imaging showed volume loss in the right parietooccipital sulcus neighborhood. Aphasia language assessment test (ADD), arithmetic calculation (4 basic operations), home picture copying, line division test, picture description, WMS I personal and actual knowledge test, WMS II orientation, WMS III mental control, WMS IV logical memory - immediate recall, WMS IV logical memory - long-term recall, WMS VI visual memory - immediate recall, WMS VI visual memory - long-term free recall, WMS R number range, abstract thinking test, constructive praxis, clock drawing test, verbal fluency test, controlled word association test, category association test were applied. Results: The ADD score was calculated as 84 points using the subtests of speech fluency (11 points), auditory comprehension (48 points), repetition (9 points), naming (5 points), grammar (7 points), speech act (4 points), reading (0 points) and writing (0 points). In addition to the symptoms of Gerstmann and Balint syndromes, limb apraxia, constrictive apraxia, dysdiadokinesis, dysphagia and dysarthria were observed. Immediate and delayed recall, attention, inhibition, set shifting, cognitive flexibility and abstraction performance were very low. Their verbal production often included perseverations and paraphasias, and marked anomia was observed. No complex sentence production was observed in narrative samples. Total word production was limited in speech samples. Conclusion: PCA was associated with severe visual spatial disturbances and severe language impairment. Although it is known that PCA often does not present with the language impairments seen in primary progressive aphasia and Alzheimer's dementia, it should be considered that language and communication functions may be affected at various levels regardless of the stage of the disease and should be evaluated by speech-language pathologists.

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