Impaired mechanism of visual focal attention in posterior cortical atrophy

Objective: Simultanagnosia, a deficit in holistic visual perception, is among the most prominent features of posterior cortical atrophy (PCA). Deficits in visuoperceptual and attentional mechanisms could contribute to simultanagnosia. In the present study, we explored the impaired visual perception of global configuration with two main hypotheses: (a) It is due to a deficit in processing low-spatial frequency stimuli, and (b) it arises from deficits in adjusting attentional focus. Method: The visuoperceptual mechanism was explored by asking participants (5 PCA patients and 20 age- and education-matched healthy controls) to report the local and global elements of incongruent hierarchical letters. Stimuli were unbiased (black letters/white background) and parvocellular biased (red letters/green background). A cued T-detection task, where the stimulus onset asynchrony and the cues' features varied, was used to explore focal attention. Results: PCA patients systematically failed in reporting the global but not the local element. The parvocellular-biased condition partially improved the performance in only 1 patient. In the T-detection task, controls responded faster to targets cued by red dots and small cues as compared to no cues. Conversely, the cue's features did not affect patients' performance. Conclusions: Results only partially support the hypothesis according to which simultanagnosia is driven by an impairment in processing low-spatial frequencies. Data indicate a deficit in the flexibility of focal attention that prevents PCA patients from adapting the attentional window to the stimulus features. Simultanagnosia in PCA can be conceptualized as a complex result of a deficit involving visuoperceptual and exogenous attentional mechanisms.