Development of a questionnaire on everyday navigational ability to assess topographical disorientation in Alzheimer's disease.

We developed a Questionnaire on Everyday Navigational Ability (QuENA) to detect topographical disorientation (TD) in patients with Alzheimer's disease (PwAD). In the QuENA, 3 items were designed to assess landmark agnosia, 2 for egocentric disorientation, 3 for heading disorientation, and 2 for inattention. The PwAD and their caregivers rated QuENA according to which TD symptoms would occur. Regarding the construct validity, confirmatory factor analysis showed that the caregiver version of the QuENA fits the proposed TD model well but the patient version does not. Regarding the internal consistency, the Cronbach's α for the caregiver version was 0.91 and that for the patient version was 0.87. A discrepancy existed between the appraisal of navigational abilities by PwAD and by caregivers, and it was correlated with the number of getting lost (GL) events. The caregiver version of QuENA is a feasible, reliable, and valid instrument to assess TD and it also discriminates well between the PwAD with GL and those without.

Dissociation between recognition of familiar scenes and of faces in patients with very mild Alzheimer disease: an event-related potential study.

OBJECTIVE: We used event-related potentials (ERPs) to examine the recognition of familiar faces and scenes in patients with very mild Alzheimer disease (VMAD). METHODS: Two types of stimuli, FACEs and SCENEs, and two versions of each type, FAMILIAR and NOVEL, were presented. Three ERPs were compared between VMAD and normal control (NC): (1) P100 to examine basic visual processing, (2) N170 structural encoding, and (3) N250r familiarity. RESULTS: A prominent N170 was elicited by FACEs in P8 and the largest N170 by SCENEs in P3 and P4. Participants had more errors when judging pictures of SCENEs as familiar or not than that of FACEs. In P3 and P4, NC produced larger N170 than VMAD. From N250r in F3, the familiarity effect was absent in VMAD when familiar scenes were provided. This deficit was not seen in processing familiar faces. CONCLUSIONS: This study shows that different neural regions are responsible for the early visual processing in the structural encoding of scenes and faces. The pattern of P100 and that of N170 suggest that VMAD patients maintain basic visual processing and structural encoding abilities. A conflict between behavioral and physiological responses may play a role in VMAD patients' risk of getting lost in familiar environments. SIGNIFICANCE: Scene recognition is impaired earlier than face recognition in the course of Alzheimer disease.