Posterior Cortical Atrophy and Acalculia

Clinical Manifestations

• The American Academy of Neurology notes that acalculia is a characteristic manifestation of posterior cortical atrophy, occurring as part of the spectrum of cognitive dysfunctions that localize to the posterior cortical regions, often accompanied by visuospatial difficulties and other cognitive impairments 1
• Acalculia in posterior cortical atrophy occurs in conjunction with other posterior cognitive dysfunctions, including visuospatial difficulties that affect visual and spatial perception, frequently accompanied by apraxia, alexia, and agraphia 1

Underlying Pathology

• The Alzheimer's Association recommends that the presence of acalculia in the context of progressive visuospatial dysfunction should prompt investigation into underlying pathology, which is generally Alzheimer's disease, although it can rarely be frontotemporal-corticobasal degeneration or Alzheimer's disease with Lewy bodies 1
• Biomarkers such as amyloid PET or cerebrospinal fluid analysis can confirm underlying Alzheimer's disease pathology 1