Investigating the Impact of Presentation Format on Reading Ability in Posterior Cortical Atrophy: A Case Study.

Background and Clinical Significance: Patients with a neurodegenerative condition known as posterior cortical atrophy (PCA) can present with attention impairments across a variety of cognitive contexts, but the consequences of these are little explored in example of single word reading. Case Presentation: We present a detailed single-case study of KL, a local resident of South Wales, a patient diagnosed with posterior cortical atrophy (PCA) in 2018, whose reading and letter-naming abilities are selectively disrupted under non-canonical visual presentations. In particular, KL shows significantly impaired accuracy performance when reading words presented in tilted (rotated 90°) format. By contrast, his reading under conventional horizontal (canonical) presentation is nearly flawless. Whilst other presentation formats including, mixed-case text (e.g., TaBLe) and vertical (marquee) format led to only mild performance decrements-even though mixed-case formats are generally thought to increase attentional 'crowding' effects. Discussion: These findings indicate that impairments of word reading can emerge in PCA when visual-attentional demands are sufficiently high, and access to 'top down' orthographic information is severely attenuated. Next, we explored a cardinal feature of attentional dyslexia, namely the word-letter reading dissociation in which word reading is superior to letter-in-string naming. In KL, a similar dissociative pattern could be provoked by non-canonical formats. That is, conditions that similarly disrupted his word reading led to a pronounced disparity between word and letter-in-string naming performance. Moreover, different orientation formats revealed the availability (or otherwise) of distinct compensatory strategies. KL successfully relied on an oral (letter by letter) spelling strategy when reading vertically presented words or naming letters-in-strings, whereas he had no ability to engage compensatory mental rotation processes for tilted text. Thus, the observed impact of non-canonical presentations was moderated by the success or failure of alternative compensatory strategies. Conclusions: Importantly, our results suggest that an attentional 'dyslexia-like' profile can be unmasked in PCA under sufficiently taxing visual-attentional conditions. This approach may prove useful in clinical assessment, highlighting subtle reading impairments that conventional testing might overlook.