Spatial orientation tasks show moderate to high accuracy for the diagnosis of mild cognitive impairment: a systematic literature review

Abstract

Spatial disorientation has been observed in mild cognitive impairment (MCI) and is associated with a higher risk of progression to Alzheimer's disease (AD). However, there is no gold standard assessment for spatial orientation and paper-and-pencil tests lack ecological validity. Recently, there has been an increasing number of studies demonstrating the role of spatial disorientation as a cognitive marker of pathological decline, shedding new light on its importance for MCI. This systematic review aimed to investigate the accuracy of spatial orientation tasks for the diagnosis of MCI by comparison with cognitively healthy elderly. The search was conducted in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Web of Science, Scopus, Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO). Only original studies reporting spatial orientation assessment in MCI patients compared to a healthy control group were included. Studies were excluded if the MCI classification did not follow well described criteria and/or if accuracy results of spatial orientation assessment were not provided. Seven studies met the eligibility criteria, describing a variety of spatial orientation assessments including questionnaires, paper-and-pencil, office-based route learning, and computer-based and virtual reality tasks. Spatial orientation tasks demonstrated moderate to high accuracy in detecting elderly with MCI compared to cognitively healthy elderly, with areas under the curve (AUC) ranging from 0.77 to 0.99. However, important methodological issues were found in the selected studies which should be considered when interpreting results. Although the inclusion of spatial orientation assessments in MCI evaluations seems to have significant value, further studies are needed to clarify their true capacity to distinguish pathological from non-pathological aging.

Use of the Montreal Cognitive Assessment Thai Version to Discriminate Amnestic Mild Cognitive Impairment from Alzheimer’s Disease and Healthy Controls: Machine Learning Results

“…In our study, disorientation in time, place, and person was another important feature of aMCI. One study found that the mental-orientation task differentiated MCI and HCs with 95% accuracy [76, 77], and another study reported that orientation tasks were among the best individual items for distinguishing aMCI patients from HCs [78, 79]. The importance of orientation as an indicator of aMCI may be explained by hypoperfusion in the bilateral inferior parietal lobules, the bilateral superior parietal lobules, the posterior cingulated cortex, lateral orbitofrontal, bilateral medial orbitofrontal cortices, and precuneus [80].…”

Short-term memory, attention, and temporal orientation as predictors of the cognitive impairment in older adults: A cross-sectional observational study

“…TO presents a greater difference between subjects with MCI or dementia and those without impairment [ 66 ]. Other studies, however, have observed that deterioration of SO in MCI is associated with a higher risk of progression to AD [ 67 ] and spatial disorientation is common in AD [ 68 ].…”

Prediction of Disorientation by Accelerometric and Gait Features in Young and Older Adults Navigating in a Virtually Enriched Environment

“…For example, older people have difficulties walking and navigating in a new environment ( Lithfous et al, 2013 ; Lester et al, 2017 ), resulting in reduced wayfinding abilities. These changes are even more pronounced during the transition from healthy aging to cognitive impairment and dementia ( Gazova et al, 2012 ; Cohen and Verghese, 2019 ; Costa et al, 2020 ). They represent a high burden on older people and lead to fear of getting lost, social withdrawal, and a subsequent decrease in physical mobility ( Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society, 2011 ).…”

“…Previous studies used experiments in virtual reality (VR) environments to assess spatial orientation ( Zakzanis et al, 2009 ; Kizony et al, 2017 ; Tascon et al, 2018 ; Costa et al, 2020 ; Paliokas et al, 2020 ). VR approaches are highly controlled but lack the dual-task characteristic of combining spatial navigation with walking.…”