Even The Man Who Mistook His Wife for a Hat, from Oliver Sacks’ famous book, has since been speculated to have suffered from posterior cortical atrophy (PCA).
A dementia is not a natural part of ageing.
Dementia is caused by diseases of the brain.
It’s not just about losing your memory.
It’s possible to live well with dementia.
There’s more to a person than the dementia.
Sue Stephen, one of the founding members of the Dementia Alliance International (DAI), spoke about how she came to be diagnosed with PCA.
This is one of the latest additions on their blog, which I strongly recommend. The DAI is an unique group of individuals with a strong sense of solidarity, who live with one of the various types of dementia.
“I had been noticing myself for the last few years that I was having visual issues… very bad glaring.. when I tried to read..”
She put it down to stress, but she still went ‘to get [my] eyes tested.’
And this went on for a few years. Interestingly, she reports this delay in diagnosis as rather typical for many people finding a diagnosis of PCA.
Tests for dementia of the Alzheimer type, typically initially shown up by problems in short term learning and memory, were negative.
When she was eventually given a diagnosis, she was told, “That’s it. There’s nothing I can do. Here’s a prescription for Aricept. See you in six months.”
But she described being shocked, and she had no idea what PCA is/was.
“I lost all certainty in my life. How do I make decisions in my life?”
She then sat on her month doing ‘research’, but reported ‘three wonderful things’ which came out of her research.
She found a list of symptoms which matched what she had been experiencing. “That was really good”. This enabled her to see her GP who then went referred her onto more suitable specific tests, confirming the diagnosis.
That’s one of the slight paradoxes about the way we approach a fellow citizen of ours living with a dementia. Nobody wants to be defined by any medical conditions they live with. They do not wish (rightly) to consider themselves as a collection of diagnoses.
But it is often reported by people living with conditions how it can be both a blessing to know what might happen but also a burden to know something might happen, with this information resulting from a clinical diagnosis.
She then reported discovering the work of Sir Terry Pratchett, who is living well with PCA, still writing books.
A third thing which she reports is finding a group of people on Facebook of people with posterior cortical atrophy. It’s a closed group where people can share in private “scenarios”.
“I could see in the future what symptoms might be. I look at symptoms, and I think if this happened to me, what could I do now to help?”
Stephen reports sharing these stories really helped.
Terry Pratchett went to see other people living with posterior cortical atrophy in 2010, a form of dementia.
Pratchett is an example of an individual who has shown that it is possible to live well with dementia.
Pratchett admitted he was apprehensive about the meeting, as he said it was like ‘seeing into the future’.
One person in the meeting, “Anything coming through the postbox, I can’t read. Susan has to do everything from cutting my nails to putting my shoes on. This disease.. or whatever you call it, changes your perspective.”
“It didn’t happen – it evolved.”
Pratchett though admitted despite his fears he enjoyed the meeting.
“I can see why people enjoy meeting up”
He had dinner with Graham Doggett, who is an 70 year-old author, and academic who has written books about quantum chemistry, and his wife.
“Susan is the gardener. If I help her, I can never find the wretched branches in the air to prune. They disappear.”
“I was doing computing since 1959. That’s gone.”
“I used to play piano up to grade 7. Gone.”
“Reading, writing, gone gone”.
When the term ‘living well with dementia’, one of the main disclaimers on that is that the person living with one of the dementias will have their life before to compare their experience to.
And this is bound to impact upon one’s own personal perception of living with dementia. Unless you bother to find out about the past of a person, in relation to his environment, you will not be able to understand his or her world.
The symptoms of PCA can vary from one person to the next and can change as the condition progresses.
The most common symptoms are consistent with damage to the part of the brain at the back of the head, an area responsible for processing visual information.
Consistent with this process are slowly developing difficulties illustrating its slow and progressive nature due to a disease of the brain.
Now you’re even able to follow it using sophisticated ‘imaging’ of the brain.
These difficulties include visual tasks such as reading a line of text, judging distances, and distinguishing between moving objects and stationary objects.
Other symptoms include an inability to perceive more than one object at a time, disorientation, and difficulty maoneuvering, identifying, and using tools or common objects.
Some people can experience hallucinations.
Yet further symptoms can include difficulty performing mathematical calculations or spelling, and many people with PCA experience anxiety, possibly because they know something is wrong.
In the early stages of PCA, most people do not have markedly reduced memory, but memory can be affected in later stages.
This illustrates how this particular dementia is not just about memory.
Age of onset is typically 50-65, demonstrating why dementia is not simply about ageing.
Both Stephen and Pratchett demonstrate by a country mile while there are more to people than their dementias.
If you’d like to find more about dementia, you can do a short 45 minute session close to where you live in England (and now in other parts of the UK). The initiative is run by the Alzheimer’s Society, but is a Public Health England initiative. To find out more about this initiative called “Dementia Friends”, please go to their website.
There’s more to this initiative than the badge you’ll receive in the process, but this initiative is all about improving understanding in the general population about the dementias. I hope you will wish to learn more.
People with PCA are are at risk of being let down by ‘traditional dementia support groups’.
That is partly because they are younger and face different challenges, and partly because the activities offered in day centres puzzles, large-font books—are visual and thus actively unhelpful for people with PCA.
PCA is not new to the research community.
Already in 1902, the Czech psychiatrist Arnold Pick mentioned a woman’s inability to see and grab a lit candle held in front of her face in his essay “Ueber eine eigenthuemliche sehstoerung senile dementer,” Jahrbuecher f. Psychiatrie u. Neurol., see excerpt.
Several attempts at defining criteria for diagnosis exist.
The neurologist Frank Benson at the University of California, Los Angeles, coined the term while describing the pattern of symptoms in five patients (Benson et al., 1988).
Later, Mario Mendez, also of University of California and San Francisco proposed clinical diagnostic criteria arguing that PCA is its own syndrome, not simply Alzheimer’s disease with visual symptoms (Mendez et al., 2002).
The English dementia strategy is mindful of the needs to develop communities supportive of the needs of people living with PCA, of the need for high quality research research into PCA, and to think how people living with PCA can be best supported professionally and personally.
It’s not only people with posterior cortical atrophy who experience problems with vision, however. This is very important to be aware of.