The Heterogeneity of Reading and Spelling Deficits in Posterior Cortical Atrophy

TL;DR

This study explores how reading and spelling problems in PCA are caused by both visual and language-related issues, suggesting the need for comprehensive assessments.

Contribution

The study identifies the dual role of visual and linguistic deficits in reading and spelling impairments in PCA.

Findings

Participants showed visual scanning errors and difficulty with multi-line text.

Spelling errors reflected both visual-perceptual and orthographic-linguistic breakdowns.

Assessments must consider both visual and lexical processes in PCA.

Abstract

Background: Posterior Cortical Atrophy (PCA) is a clinical syndrome marked by progressive visuospatial impairment, usually due to underlying Alzheimer’s disease. While reading and spelling deficits are recognized clinical features of this syndrome, the contributions of visuoperceptual versus linguistic deficits to these impairments are still unclear. Methods: To that end, we examined reading and spelling performance in 23 individuals from the Massachusetts General Hospital PCA cohort. Participants completed tests of reading from the Western Aphasia Battery and spelling to dictation from the Boston Diagnostic Aphasia Examination. A mixed-methods analysis included quantitative scoring and qualitative observations of visual behaviors, error patterns, and compensatory strategies. Results: Participants commonly demonstrated visual scanning errors, difficulty following multi-line text, and spelling errors reflecting both visual–perceptual and orthographic–linguistic breakdowns. Conclusions: Because reading and spelling in PCA are variably impaired cognitive skills driven by visual deficits and lexical vulnerability, assessments and interventions must account for deficits in both cognitive processes. Our findings highlight the vulnerability of reading and spelling in PCA and underscore the need for multimodal assessment strategies that account for the interplay of visual, phonological, and lexical processes. These insights can inform diagnosis and guide the development of accessible interventions tailored to optimize compensatory strategies to support functional language abilities.