The Impact of Spatial Orientation Changes on Driving Behavior in Healthy Aging.

OBJECTIVES: Global cognitive changes in older age affect driving behavior and road safety, but how spatial orientation differences affect driving behaviors is unknown on a population level, despite clear implications for driving policy and evaluation during aging. The present study aimed to establish how spatial navigation changes affect driving behavior and road safety within a large cohort of older adults. METHODS: Eight hundred and four participants (mean age: 71.05) were recruited for a prospective cohort study. Participants self-reported driving behavior followed by spatial orientation (allocentric and egocentric) testing and a broader online cognitive battery (visuomotor speed, processing speed, executive functioning, spatial working memory, episodic memory, visuospatial functioning). RESULTS: Spatial orientation performance significantly predicted driving difficulty and frequency. Experiencing more driving difficulty was associated with worse allocentric spatial orientation, processing speed, and source memory performance. Similarly, avoiding challenging driving situations was associated with worse spatial orientation and episodic memory. Allocentric spatial orientation was the only cognitive domain consistently affecting driving behavior in under 70 and over 70 age groups, a common age threshold for driving evaluation in older age. DISCUSSION: We established for the first time that worse spatial orientation performance predicted increased driving difficulty and avoidance of challenging situations within an older adult cohort. Deficits in spatial orientation emerge as a robust indicator of driving performance in older age, which should be considered in future aging driving assessments, as it has clear relevance for road safety within the aging population.

Spatial orientation - a stable marker for vascular cognitive impairment?

Vascular cognitive impairment (VCI) is the second most prevalent form of dementia, but little is known about the early cognitive and neuroimaging markers. Spatial navigation deficits are an emerging marker for Alzheimer's disease (AD), yet less is known about spatial orientation deficits sensitive to VCI. This case report follows up on the first VCI patient identified to have an egocentric orientation deficit. The study aimed to examine the patient's spatial deficits three years on and gain insights from the addition of the patient's MRI brain scan. A battery of spatial navigation tasks were administered following neuropsychological assessment. Results continue to show spatial orientation deficits. Critically, these changes appear stable and are sensitive to novel spatial tests. Whereas conventional screening tools demonstrate patient recovery. MRI DTI analysis indicates a non-significant trend towards loss of structural integrity to the posterior tracts of the longitudinal superior fasciculus (SLF), while the medial temporal lobe, typically implicated in spatial navigation, is unaffected. This finding potentially reflects reduced network connectivity in posterior to anterior white matter tracts co-existing with spatial orientation deficits. Findings have clinical utility and show spatial orientation as a potential sensitive cognitive marker for VCI.

Reduced cognitive ability in people with rheumatoid arthritis compared with age-matched healthy controls.

OBJECTIVE: The aim was to compare the cognitive ability of people with RA with healthy controls (HCs). METHODS: People with RA were recruited from the Norfolk Arthritis Register (NOAR), a population-based cohort study of people with inflammatory arthritis. Data on aged-matched HCs (people with no cognitive impairment) came from the comparison arm of The Dementia Research and Care Clinic Study (TRACC). People with RA and HCs performed a range of cognitive ability tasks to assess attention, memory, verbal fluency, language, visuospatial skills, emotional recognition, executive function and theory of mind. A score of <88 on the Addenbrooke's Cognitive Examination III was considered cognitive impairment. Scores were compared using linear regression adjusting for age, sex, smoking status, education, BMI, anxiety and depression. RESULTS: Thirty-eight people with RA [mean (S.D.) age: 69.1 (8.0) years; 25 (65.8%) women] were matched with 28 HCs [mean (S.D.) age: 68.2 (6.4) years; 15 (53.6%) women]. Twenty-three (60.5%) people with RA were considered to have mild cognitive impairment [mean (S.D.) Addenbrooke's Cognitive Examination III: RA = 85.2 (7.4), HC = 96.0 (2.5)]. People with RA had impairments in memory, verbal fluency, visuospatial functioning, executive function and emotional recognition in faces compared with HCs, after adjustment for confounders. CONCLUSION: People with RA had cognitive impairments in a range of domains. People with RA might benefit from cognitive impairment screening to allow for early administration of appropriate interventions.

Path Integration Changes as a Cognitive Marker for Vascular Cognitive Impairment?-A Pilot Study.

Path integration spatial navigation processes are emerging as promising cognitive markers for prodromal and clinical Alzheimer's disease (AD). However, such path integration changes have been less explored in Vascular Cognitive Impairment (VCI), despite neurovascular change being a major contributing factor to dementia and potentially AD. In particular, the sensitivity and specificity of path integration impairments in VCI compared to AD is unclear. In the current pilot study, we explore path integration performance in early-stage AD and VCI patient groups and hypothesize that: (i) medial parietal mediated egocentric processes will be more affected in VCI; and (ii) medial temporal mediated allocentric processes will be more affected in AD. This cross-sectional study included early-stage VCI patients (n = 9), AD patients (n = 10) and healthy age-matched controls (n = 20). All participants underwent extensive neuropsychological testing, as well as spatial navigation testing. The spatial navigation tests included the virtual reality "Supermarket" task assessing egocentric (body-based) and allocentric (map-based) navigation as well as the "Clock Orientation" test assessing egocentric and path integration processes. Results showed that egocentric integration processes are only impaired in VCI, potentially distinguishing it from AD. However, in contrast to our prediction, allocentric integration was not more impaired in AD compared to VCI. These preliminary findings suggest limited specificity of allocentric integration deficits between VCI and AD. By contrast, egocentric path integration deficits emerge as more specific to VCI, potentially allowing for more specific diagnostic and treatment outcome measures for vascular impairment in dementia.

Single-response appetitive Pavlovian to instrumental transfer is suppressed by aversive counter-conditioning.

Environmental stimuli, when paired with reward, can influence behaviour in maladaptive ways, for example, by encouraging overeating or addiction. Such behaviour can be sensitive to reward value manipulations, under circumscribed conditions, but whether reward-seeking is also sensitive to stimulus value manipulations remains unclear. Thus, the current experiment investigated whether reducing the hedonic value of a reward-paired stimulus would reduce reward-seeking behaviour. In total, 36 participants successfully completed a single-response Pavlovian-instrumental transfer (PIT) task with a counter-conditioning procedure. The Pavlovian phase associated three conditioned stimuli (CSs) with money at 100%, 50%, or 0% contingency. Counter-conditioning then followed for the experimental group, who saw the 100% CS paired with unpleasant pictures, while the control group saw only neutral images. Instrumental training required participants to learn a button-pressing response to win money. The transfer phase contrasted instrumental responding during baseline and CS presentation. Both experimental and control groups liked the 100% CS more than the other CSs after Pavlovian training, but counter-conditioning reduced this 100% CS liking. In transfer, the experimental group showed an abolition of appetitive PIT, while the control group showed maintenance of appetitive PIT. However, this group difference was only evident in response vigour, not response initiation. In summary, CS hedonic value influences cue-potentiated instrumental responding. More specifically, hedonic value of a reward-paired cue influences the vigour of instrumental responses, but not the decision to initiate a response. These data may have relevance to smoking cessation policies, where the introduction of health warnings may be viewed as a real-world example of counter conditioning.

Diagnostic relevance of spatial orientation for vascular dementia: A case study.

Spatial orientation is emerging as an early and reliable cognitive biomarker of Alzheimer's disease (AD) pathophysiology. However, no evidence exists as to whether spatial orientation is also affected in vascular dementia (VaD). OBJECTIVE: To examine allocentric (map-based) and egocentric (viewpoint-based) spatial orientation in an early stage VaD case. METHODS: A spatial test battery was administered following clinical and neuropsychological cognitive evaluation. RESULTS: Despite the patient's complaints, little evidence of episodic memory deficits were detected when cueing was provided to overcome executive dysfunction. Similarly, medial temporal lobe-mediated allocentric orientation was intact. By contrast, medial parietal-mediated egocentric orientation was impaired, despite normal performance on standard visuospatial tasks. CONCLUSION: To our knowledge, this is the first in-depth investigation of spatial orientation deficits in VaD. Isolated egocentric deficits were observed. This differs from AD orientation deficits which encompass both allocentric and egocentric orientation deficits. A combination of egocentric orientation and executive function tests could serve as a promising cognitive marker for VaD pathophysiology.

A orientação espacial está emergindo como um biomarcador cognitivo precoce e confiável da fisiopatologia da doença de Alzheimer (DA). No entanto, não existe evidência de que a orientação espacial também seja afetada na demência vascular (DVa). OBJETIVO: Examinar a orientação espacial alocêntrica (baseada em mapas) e egocêntrica (baseada no ponto de vista) em um caso de DVa em fase incial. MÉTODOS: Uma bateria de testes espaciais foi administrada após avaliação clínica e neuropsicológica cognitiva. RESULTADOS: Apesar das queixas do paciente, poucas evidências de déficits de memória episódica foram detectadas quando foram fornecidas pistas para superar a disfunção executiva. Da mesma forma, a orientação alocêntrica mediada pelo lobo temporal medial estava intacta. Em contrapartida, a orientação egocêntrica mediada pela região parietal medial estava comprometida, apesar do desempenho normal em tarefas visuoespaciais padrão. CONCLUSÃO: Pelo nosso conhecimento, esta é a primeira investigação aprofundada dos déficits de orientação espacial na DVa. Foram observados déficits egocêntricos isolados. Isso difere dos déficits de orientação da DA que abrangem déficits de orientação alocêntricos e egocêntricos. Uma combinação de orientação egocêntrica e testes de função executiva poderia servir como um marcador cognitivo promissor para a fisiopatologia de DVa.

Diagnostic relevance of spatial orientation for vascular dementia: A case study / Relevância da orientação espacial para o diagnóstico de demência vascular: um estudo de caso

ABSTRACT Spatial orientation is emerging as an early and reliable cognitive biomarker of Alzheimer's disease (AD) pathophysiology. However, no evidence exists as to whether spatial orientation is also affected in vascular dementia (VaD). Objective: To examine allocentric (map-based) and egocentric (viewpoint-based) spatial orientation in an early stage VaD case. Methods: A spatial test battery was administered following clinical and neuropsychological cognitive evaluation. Results: Despite the patient's complaints, little evidence of episodic memory deficits were detected when cueing was provided to overcome executive dysfunction. Similarly, medial temporal lobe-mediated allocentric orientation was intact. By contrast, medial parietal-mediated egocentric orientation was impaired, despite normal performance on standard visuospatial tasks. Conclusion: To our knowledge, this is the first in-depth investigation of spatial orientation deficits in VaD. Isolated egocentric deficits were observed. This differs from AD orientation deficits which encompass both allocentric and egocentric orientation deficits. A combination of egocentric orientation and executive function tests could serve as a promising cognitive marker for VaD pathophysiology.

RESUMO A orientação espacial está emergindo como um biomarcador cognitivo precoce e confiável da fisiopatologia da doença de Alzheimer (DA). No entanto, não existe evidência de que a orientação espacial também seja afetada na demência vascular (DVa). Objetivo: Examinar a orientação espacial alocêntrica (baseada em mapas) e egocêntrica (baseada no ponto de vista) em um caso de DVa em fase incial. Métodos: Uma bateria de testes espaciais foi administrada após avaliação clínica e neuropsicológica cognitiva. Resultados: Apesar das queixas do paciente, poucas evidências de déficits de memória episódica foram detectadas quando foram fornecidas pistas para superar a disfunção executiva. Da mesma forma, a orientação alocêntrica mediada pelo lobo temporal medial estava intacta. Em contrapartida, a orientação egocêntrica mediada pela região parietal medial estava comprometida, apesar do desempenho normal em tarefas visuoespaciais padrão. Conclusão: Pelo nosso conhecimento, esta é a primeira investigação aprofundada dos déficits de orientação espacial na DVa. Foram observados déficits egocêntricos isolados. Isso difere dos déficits de orientação da DA que abrangem déficits de orientação alocêntricos e egocêntricos. Uma combinação de orientação egocêntrica e testes de função executiva poderia servir como um marcador cognitivo promissor para a fisiopatologia de DVa.