Shakespeare, TJ; (2014) Neuropsychology, eye tracking and neuroimaging perspectives on Posterior Cortical Atrophy. Doctoral thesis , UCL (University College London).

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Abstract

This thesis describes investigations of the clinico-radiological syndrome Posterior Cortical Atrophy, addressing two broad themes: the consequences of PCA for everyday activities (particularly scene perception) and the heterogeneity of symptoms in PCA. Despite improvements in the recognition and characterisation of PCA, we have little understanding of what the world looks like to someone with PCA. This thesis investigates patients’ perception of real-world stimuli (scenes) using a number of methodologies; characterising their response times when categorising scenes and giving a novel qualitative report of patients’ verbal descriptions (Chapter 2). It is possible that oculomotor behaviour is a contributory factor in these tasks, therefore a study of fixation, saccades and smooth pursuit was carried out. This characterised in detail for the first time the oculomotor abnormalities present in PCA (Chapter 3), facilitating further investigation of patients’ eye movements when viewing scenes (Chapters 4 and 5), revealing a striking impairment in the ability to change fixation patterns in response to task demands. The consequences of PCA for everyday activities are also investigated through a questionnaire given to carers allowing a wide range of symptoms and behaviours to be investigated over different stages of disease severity (Chapter 6). The range of symptoms and severity that this questionnaire measures will eventually allow better characterisation of the heterogeneity within PCA, and the early onset Alzheimer’s Disease spectrum more broadly. One specific manifestation of this heterogeneity is investigated in Chapter 7, demonstrating that a proportion of PCA patients show asymmetric motor symptoms (myoclonus and limb rigidity on the left side) associated with atrophy of motor cortex in the right hemisphere. Together, these studies improve our knowledge of the consequences of PCA for scene perception and more general everyday activities, and address aspects of heterogeneity in the syndrome; with implications for interventions to improve diagnosis and clinical management.

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