The aim of this study was to compare patterns of cerebral atrophy on MRI, and neurochemistry on magnetic resonance spectroscopy (MRS), in subjects with posterior cortical atrophy (PCA) and typical Alzheimer's disease (AD). Voxel-based morphometry was used to assess grey matter atrophy in 38 subjects with PCA, 38 subjects with typical AD, and 38 controls. Clinical data was assessed in all PCA subjects. Single-voxel 1 H MRS located in the posterior cingulate was analyzed in a subset of subjects with PCA, typical AD, and control subjects. PCA showed a pattern of atrophy affecting occipital, parietal and posterior temporal lobes, compared to controls. The pattern was bilateral, but more severe on the right. Subjects with PCA showed greater atrophy in the right visual association cortex than subjects with typical AD, whereas those with AD showed greater atrophy in the left hippocampus than those with PCA. 1 H MRS suggested loss of neuronal integrity and glial activation in subjects with PCA and AD. The differing patterns of atrophy on MRI suggest that PCA should be considered a distinct entity from typical AD.