Detecting navigational deficits in cognitive aging and Alzheimer disease using virtual reality.
BACKGROUND
Older adults get lost, in many cases because of recognized or incipient Alzheimer disease (AD). In either case, getting lost can be a threat to individual and public safety, as well as to personal autonomy and quality of life. Here we compare our previously described real-world navigation test with a virtual reality (VR) version simulating the same navigational environment.


METHODS
Quantifying real-world navigational performance is difficult and time-consuming. VR testing is a promising alternative, but it has not been compared with closely corresponding real-world testing in aging and AD. We have studied navigation using both real-world and virtual environments in the same subjects: young normal controls (YNCs, n = 35), older normal controls (ONCs, n = 26), patients with mild cognitive impairment (MCI, n = 12), and patients with early AD (EAD, n = 14).


RESULTS
We found close correlations between real-world and virtual navigational deficits that increased across groups from YNC to ONC, to MCI, and to EAD. Analyses of subtest performance showed similar profiles of impairment in real-world and virtual testing in all four subject groups. The ONC, MCI, and EAD subjects all showed greatest difficulty in self-orientation and scene localization tests. MCI and EAD patients also showed impaired verbal recall about both test environments.


CONCLUSIONS
Virtual environment testing provides a valid assessment of navigational skills. Aging and Alzheimer disease (AD) share the same patterns of difficulty in associating visual scenes and locations, which is complicated in AD by the accompanying loss of verbally mediated navigational capacities. We conclude that virtual navigation testing reveals deficits in aging and AD that are associated with potentially grave risks to our patients and the community.
Cushman
Laura A
LA
Department of Neurology, Brain and Cognitive Sciences, Center for Visual Science, The University of Rochester Medical Center, Rochester, NY14642, USA.
Stein
Karen
K
Duffy
Charles J
CJ
D000328:Adult; D000368:Aged; D000375:Aging / Q000523:psychology; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000523:psychology*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000523:psychology*; D006801:Humans; D011939:Mental Recall; D009483:Neuropsychological Tests / Q000592:standards; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013028:Space Perception; D013037:Spatial Behavior; D014584:User-Computer Interface; D014705:Verbal Behavior
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