Spatial Navigation in the Elderly with Alzheimer’s Disease: A Cross-Sectional Study

Abstract

Background: Spatial navigation is a fundamental cognitive ability that allows an individual to maintain independence by facilitating the safe movement from one place to another. It emerges as one of the first deficits in patients with Alzheimer's disease (AD). Objective: To compare spatial navigation performance in the healthy elderly and AD patients through use of the Floor Maze Test (FMT)-an easy-to-apply two-dimensional (2D) maze-and determine which cognitive and functional capacities were associated with performance in this task. Methods: The FMT was administered to 24 AD patients and 36 healthy controls. Spatial navigation was evaluated through the FMT. Functional capacity was evaluated through the Senior Fitness Test battery of tests. Cognitive functions were evaluated through the Mini-Mental State Examination (MMSE), verbal fluency, digit span test, and the Rey Auditory Verbal Learning Test (RAVLT). Results: The group with AD was significantly slower and presented more errors at all stages of the FMT. Planning Time (PT) performance was associated with cardiorespiratory resistance (Step test) and delayed memory according to the RAVLT (R 2 = 0.395, p < 0.001). Performance in the Immediate Maze Time (IMT) and Delayed Maze Time (DMT) was associated with global cognitive status (MMSE) (R 2 = 0.509) and delayed memory (R 2 = 0.540). Conclusion:Patients with AD present significant spatial navigation deficits. Their performance on the FMT is influenced by cardiorespiratory capacity, memory, and global cognitive function. As exercise helps to improve executive function and functional capacity, future intervention studies should be carried out to analyze the possible effects of physical exercise on spatial navigation.

Floor Maze Test as a predictor of cognitive decline in older adults living in nursing homes

“…The older people living in LTCF seem to experience more impairment of executive function than older adults living at community, while there is no difference in the decrease in memory ability between the groups. Our results corroborate previous studies, showing that impairment in IMT and DMT FMT performance is associated withAD 11 and risk of dementia 15 . Moreover, longer times in FMT have been associated with cognitive impairment, with particular effects on executive functions, attention, learning and memory 10 .…”

“…Spatial navigation ability is one of several interrelated cognitive domains that require contributions from cognitive processes such as visual perception, learning, memory, and executive functions 10,11 . Spatial navigation can be subdivided into egocentric and allocentric domains.…”

“…The Floor Maze Test (FMT) is a new tool used to measures the capacity for path integration, planning and execution of tasks 14 . Better performance in the FMT has been associated with lower risk of cognitive decline and may be useful for assessing cognitive abilities, considering the low cost, ease of application and ecological characteristics [10][11][12] . Recently, Verghese et al verified, that every 10 seconds in the FMT score is related to 25% increase in the risk of dementia 15 .…”

Spatial Disorientation in Alzheimer's Disease: The Missing Path From Virtual Reality to Real World

“…Beyond missing incidents, some studies have investigated the navigation of AD patients in controlled and naturalistic RW environments. In controlled environments (i.e., hospital settings, floor mazes), studies show that AD patients exhibit impairments in egocentric navigation, which was associated with decreased volumes of the right posterior hippocampus/parietal cortex, landmark recognition/recall, and allocentric processes (Cherrier et al, 2001;DeIpolyi et al, 2007;Benke et al, 2014;Tangen et al, 2015;Zanco et al, 2018). Meanwhile, in naturalistic environments (i.e., familiar neighborhoods) studies report that in familiar settings, AD patients increasingly use visible landmarks as navigation aids and are more likely to exhibit spatial disorientation/get lost when compared to controls (Sheehan et al, 2006;Olsson et al, 2019).…”

NavWell: A simplified virtual-reality platform for spatial navigation and memory experiments

“…In addition to these findings, impairment in spatial memory and navigation is a feature of many disorders and normal ageing decline (Head & Isom, 2010). For example, people living with schizophrenia (Kargar, Askari, Khoshaman, & Mohammadi, 2019), stroke (Takahashi, Kawamura, Shiota, Kasahata, & Hirayama, 1997), acquired brain injury (Kolarik et al, 2016), and Alzheimer's disease (Zanco et al, 2018) all show spatial deficits. Furthermore, as spatial disorientation is a key deficit with mild cognitive impairment and a strong predictor of AD, there is increasing interest in the possibility of using navigation as an early marker for this disease (Coughlan, Laczó, Hort, & Hornberger, 2018).…”