Exploring the Remediation of Behavioral Disturbances of Spatial Cognition in Community-Dwelling Senior Citizens with Mild Cognitive Impairment via Innovative Technological Apparatus (BDSC-MCI Project): Protocol for a Prospective, Multi-Center Observational Study

Abstract

Spatial navigation (SN) has been reported to be one of the first cognitive domains to be affected in Alzheimer’s disease (AD), which occurs as a result of progressive neuropathology involving specific brain areas. Moreover, the epsilon 4 isoform of apolipoprotein-E (APOE-ε4) has been associated with both sporadic and familial late-onset AD, and patients with mild cognitive impairment (MCI) due to AD are more likely to progressively deteriorate. Spatial navigation performance will be examined on a sample of 76 community-dwelling senior citizens (25 healthy controls; 25 individuals with subjective cognitive decline (SCD); and 26 patients with MCI due to AD) via a virtual computer-based task (i.e., the AppleGame) and a naturalistic task (i.e., the Detour Navigation Test—modified version) for which a wearable device with sensors will be used for recording gait data and revealing physiological parameters that may be associated with spatial disorientation. We expect that patients with MCI due to AD and APOE-ε4 carriers will show altered SN performances compared to individuals with SCD and healthy controls in the experimental tasks, and that VR testing may predict ecological performance. Impaired SN performances in people at increased risk of developing AD may inform future cognitive rehabilitation protocols for counteracting spatial disorientation that may occur during elders’ traveling to unfamiliar locations. The research protocol has been approved by the Ethics Committee of the Istituto Auxologico Italiano. Findings will be published in peer-reviewed medical journals and discussed in national and international congresses.

Behavioral Disorders of Spatial Cognition in Patients with Mild Cognitive Impairment Due to Alzheimer’s Disease (The BDSC-MCI Project): Ecological Validity of the Corsi Learning Suvra-Span Test

“…Moreover, the veridicality approach has been subject to criticism because a direct comparison between traditional neurocognitive tests and functional performance evaluated through behavioral observation is not often evident [53]. By using the Italian norms from Aiello and colleagues [42], we converted the MMSE scores into MoCA scores for those participants who were not assessed by the latter instrument, since our study was a multi-center investigation recruiting participants from three sites [38]. The three groups were not perfectly balanced either, even if they were well matched in terms of age, education, and gender.…”

“…Participants engaged in a modified version of the Detour Navigation Test [28], which we designed to explore spatial alterations in patients with prodromal AD navigating unfamiliar urban environments (for a detailed description, please see [38]). The test was conducted in an ecological setting, i.e., the urban park of the Pontificio Istituto Missioni Estere-PIME (81, Monterosa Street, Milan, Italy) (Figure 2).…”

“…For this second experimental part, feedback was not allowed. Wrong turns, measured in numbers (n.) and moments of hesitation (in seconds), were recorded during the Route A return and the Route B return and added up, and we assessed deviations from the predefined path and uncertainties, respectively (for a complete description and calculation of these two disorientation scores, please see [38]). The observational protocol for reporting behavioral data and the experimental procedure for the collection and registration of wrong turns and moments of hesitation are reported in Supplementary Materials.…”

Editorial: Digital health and virtual health care for adults and older adults: innovative technological solutions for diagnosis, management, and rehabilitation

“…A very recent application of technological solutions for the digital care of older adults, such as smart sensory garments, can be used to monitor neurophysiological activation related to spatial cognition (SC) in patients suffering from Mild Cognitive Impairment due to Alzheimer's disease (MCI due to AD) ( 4 ). Through an ecological paradigm capable of evaluating SC behavioral disorders in the elderly along the continuum of normal aging to Alzheimer's type dementia, we have shed light on the activation of the autonomic nervous system related to the topographical disorientation that characterized patients with prodromal AD while walking unfamiliar routes ( 5 ). Specifically, participants wore a smart sensory garment (i.e., the Comftech Howdy Senior ® , Monza, Italia) able to provide an instant report, displayed on the connected smartphone App, on cardiac parameters (among which the RMSSD, as the root mean square of successive differences between normal heartbeats), respiratory parameters (among which the SDBR, as the standard deviation of cumulative breathing rate), and accelerometer parameters during a naturalistic walking task of spatial navigation (i.e., the Detour Navigation Test-modified version) performed in an urban public garden ( 5 ).…”

“…Through an ecological paradigm capable of evaluating SC behavioral disorders in the elderly along the continuum of normal aging to Alzheimer's type dementia, we have shed light on the activation of the autonomic nervous system related to the topographical disorientation that characterized patients with prodromal AD while walking unfamiliar routes ( 5 ). Specifically, participants wore a smart sensory garment (i.e., the Comftech Howdy Senior ® , Monza, Italia) able to provide an instant report, displayed on the connected smartphone App, on cardiac parameters (among which the RMSSD, as the root mean square of successive differences between normal heartbeats), respiratory parameters (among which the SDBR, as the standard deviation of cumulative breathing rate), and accelerometer parameters during a naturalistic walking task of spatial navigation (i.e., the Detour Navigation Test-modified version) performed in an urban public garden ( 5 ). We tested 64 participants ( mean age = 72.23 ± 6.42; education = 11.84 ± 3.89; M = 34; F = 30), among them 22 patients with MCI due to AD, 22 individuals with subjective cognitive decline (SCD), and 20 healthy controls (HCs).…”