Predicting real world spatial disorientation in Alzheimer’s disease patients using virtual reality navigation tests (original) (raw)
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Cognitive neuroscience
The ability to orient in space constitutes a main sign of cognitive impairment in Alzheimer’s disease (AD). Presently, a peculiar aspect of topographical disorientation in AD linked with spatial reference frame congruence appears to have been only minimally investigated. We aim to study whether there is a decline in performing the allo- to egocentric translation of spatial knowledge during different types of wayfinding in AD patients. We introduced two virtual reality tasks, the VR-Maze and VR-Road Map tasks, in which we compared 26 AD and 26 healthy, elderly subjects. The results emphasize that there is a specific reduction in performing allo- to egocentric spatial tasks in AD, whereas this reduction is not as evident in equivalent allocentric spatial tasks. The data are consistent with the neurological results regarding the early degeneration of the hippocampus and retrosplenial cortex in AD, which underlies the ability to translate between these two reference frames.
Test-retest reliability of spatial navigation in adults at-risk of Alzheimer’s disease
2020
The Virtual Supermarket Task (VST) and Sea Hero Quest detect high-genetic-risk Alzheimer`s disease (AD). We aimed to determine their test-retest reliability in a preclinical AD population. Over two time points, separated by an 18-month period, 59 cognitively healthy individuals underwent a neuropsychological and spatial navigation assessment. At baseline, participants were classified as low-genetic-risk of AD or high-genetic-risk of AD. We calculated two-way mixed effects intraclass correlation coefficients (ICC) for task parameters and used repeated measures ANOVAS to determine whether genetic risk or sex contributed to test-retest variability. The egocentric parameter of the VST measure showed the highest test–retest reliability (ICC = .72), followed by the SHQ distance travelled parameter (ICC = .50). Post hoc longitudinal analysis showed that boundary-based navigation predicts worsening episodic memory concerns in high-risk (F = 5.01, P = 0.03), but in not low-risk, AD candidate...
Cortex, 2015
Alzheimer's disease Frontotemporal dementia a b s t r a c t Spatial disorientation is a prominent feature of early Alzheimer's disease (AD) attributed to degeneration of medial temporal and parietal brain regions, including the retrosplenial cortex (RSC). By contrast, frontotemporal dementia (FTD) syndromes show generally intact spatial orientation at presentation. However, currently no clinical tasks are routinely administered to objectively assess spatial orientation in these neurodegenerative conditions. In this study we investigated spatial orientation in 58 dementia patients and 23 healthy controls using a novel virtual supermarket task as well as voxel-based morphometry (VBM). We compared performance on this task with visual and verbal memory function, which has traditionally been used to discriminate between AD and FTD.
Spatial Navigation in the Elderly with Alzheimer’s Disease: A Cross-Sectional Study
Journal of Alzheimer's Disease, 2018
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.
2014
Wayfinding ability has a high adaptive value, allowing humans to efficiently explore an environment in order to have a goal-oriented activity. This is done thanks to the capacity of individuals to actively acquire knowledge during interaction. Recently, different studies examined the wayfinding performances of older adults in Virtual Reality. While these studies underlined a greater difficulty with the wayfinding task in the elderly subjects, the effects of age on specific aspects of navigational tasks are less well specified. More, a recent study suggested that older people who use spatial navigational strategies (navigation is achieved by orientating oneself in relation to an allocentic landmark map) in their everyday lives may have increased gray matter in the hippocampus and enhance their probability of healthy and successful aging. To evaluate this hypothesis we tested 176 subjects (from 20 to 89 years old) in wayfinding ability by using an interactive computer-based evaluation tool -the VR Maze spatial task -that requires the translation of the allocentric spatial knowledge to the corresponding egocentric one and its organization to perform a goal directed wayfinding. More, the study explored the relationships of these abilites with traditional paper and pencil measures of memory, executive and attentive functions. Data show how some aspects of spatial ability impairment are not clearly detectable using classical tests, whereas they become evident using the VR Maze spatial task. This difference is even more marked in the wayfinding ability evaluation of the elderly population. Finally, the VR Maze spatial task appears to be correlated with classical neuropsychological tests.
Frontiers in Aging Neuroscience, 2015
Several studies have pointed out that egocentric and allocentric spatial impairments are one of the earliest manifestations of Alzheimer's Disease (AD). It is less clear how a break in the continuous interaction between these two representations may be a crucial marker to detect patients who are at risk to develop dementia. The main objective of this study is to compare the performances of participants suffering from amnestic mild cognitive impairment (aMCI group), patients with AD (AD group) and a control group (CG), using a virtual reality (VR)-based procedure for assessing the abilities in encoding, storing and syncing different spatial representations. In the first task, participants were required to indicate on a real map the position of the object they had memorized, while in the second task they were invited to retrieve its position from an empty version of the same virtual room, starting from a different position. The entire procedure was repeated across three different trials, depending on the object location in the encoding phase. Our finding showed that aMCI patients performed significantly more poorly in the third trial of the first task, showing a deficit in the ability to encode and store an allocentric viewpoint independent representation. On the other hand, AD patients performed significantly more poorly when compared to the CG in the second task, indicating a specific impairment in storing an allocentric viewpoint independent representation and then syncing it with the allocentric viewpoint dependent representation. Furthermore, data suggested that these impairments are not a product of generalized cognitive decline or of general decay in spatial abilities, but instead may reflect a selective deficit in the spatial organization Overall, these findings provide an initial insight into the cognitive underpinnings of amnestic impairment in aMCI and AD patient exploiting the potentiality of VR.
Frontiers in Aging Neuroscience, 2015
Several studies have pointed out that egocentric and allocentric spatial impairments are one of the earliest manifestations of Alzheimer's Disease (AD). It is less clear how a break in the continuous interaction between these two representations may be a crucial marker to detect patients who are at risk to develop dementia. The main objective of this study is to compare the performances of participants suffering from amnestic mild cognitive impairment (aMCI group), patients with AD (AD group) and a control group (CG), using a virtual reality (VR)-based procedure for assessing the abilities in encoding, storing and syncing different spatial representations. In the first task, participants were required to indicate on a real map the position of the object they had memorized, while in the second task they were invited to retrieve its position from an empty version of the same virtual room, starting from a different position. The entire procedure was repeated across three different trials, depending on the object location in the encoding phase. Our finding showed that aMCI patients performed significantly more poorly in the third trial of the first task, showing a deficit in the ability to encode and store an allocentric viewpoint independent representation. On the other hand, AD patients performed significantly more poorly when compared to the CG in the second task, indicating a specific impairment in storing an allocentric viewpoint independent representation and then syncing it with the allocentric viewpoint dependent representation. Furthermore, data suggested that these impairments are not a product of generalized cognitive decline or of general decay in spatial abilities, but instead may reflect a selective deficit in the spatial organization Overall, these findings provide an initial insight into the cognitive underpinnings of amnestic impairment in aMCI and AD patient exploiting the potentiality of VR.
Annals of Physical and Rehabilitation Medicine, 2017
Introduction: Spatial navigation, which involves higher cognitive functions, is frequently implemented in daily activities, and is critical to the participation of human beings in mainstream environments. Virtual reality is an expanding tool, which enables on one hand the assessment of the cognitive functions involved in spatial navigation, and on the other the rehabilitation of patients with spatial navigation difficulties. Topographical disorientation is a frequent deficit among patients suffering from neurological diseases. The use of virtual environments enables the information incorporated into the virtual environment to be manipulated empirically. But the impact of manipulations seems differ according to their nature (quantity, occurrence, and characteristics of the stimuli) and the target population. Methods: We performed a systematic review of research on virtual spatial navigation covering the period from 2005 to 2015. We focused first on the contribution of virtual spatial navigation for patients with brain injury or schizophrenia, or in the context of ageing and dementia, and then on the impact of visual or auditory stimuli on virtual spatial navigation. Results: On the basis of 6521 abstracts identified in 2 databases (Pubmed and Scopus) with the keywords « navigation » and « virtual », 1103 abstracts were selected by adding the keywords ''ageing'', ''dementia'', ''brain injury'', ''stroke'', ''schizophrenia'', ''aid'', ''help'', ''stimulus'' and ''cue''; Among these, 63 articles were included in the present qualitative analysis. Conclusion: Unlike pencil-and-paper tests, virtual reality is useful to assess large-scale navigation strategies in patients with brain injury or schizophrenia, or in the context of ageing and dementia. Better knowledge about both the impact of the different aids and the cognitive processes involved is essential for the use of aids in neurorehabilitation.
Spatial disorientation in Alzheimer's disease: The remembrance of things passed
Neurology, 2003
Background: Patients with Alzheimer's disease (AD) and many older adults become lost even in familiar surroundings. This is commonly attributed to memory impairment, but it may reflect impaired spatial cognition. Methods: The authors examined the role of memory, perceptual, and cognitive mechanisms in spatial disorientation by comparing the performance of normal young (YN), middle-aged (MA), older adult (OA), and AD subjects on neuropsychological and spatial orientation tests. Results: The tendency to become lost is shared by almost all patients with AD (93%) and some OA subjects (38%). This impairment is not related to memory impairment. Instead, it reflects an inability to link recognized scenes with locations in the environment. Conclusions: Spatial disorientation reflects the impaired linking of landmarks and routes that should be assessed in conjunction with routine memory testing in elderly patients.
The relationship between object-based spatial ability and virtual navigation performance
Spatial navigation is a multi-faceted behaviour drawing on many different aspects of cognition. Visuospatial abilities, such as spatial working memory and mental rotation, in particular, may be key factors. A range of tests have been developed to assess visuospatial processing and memory, but how such tests relate to navigation ability remains unclear. This understanding is important to advance tests of navigation for disease monitoring in Alzheimer’s Disease, where disorientation is an early symptom. Here, we report the use of an established mobile gaming app, Sea Hero Quest, as a measure of navigation ability. We used three separate tests of navigation embedded in the game: wayfinding, path integration and spatial memory in a radial arm maze. In the same participants, we also collected measures of mental rotation (Mental Rotation Test), visuospatial processing (Design Organization Test) and visuospatial working memory (Digital Corsi). We found few strong correlations across our me...