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Schöberl F, Pradhan C, Irving S, Buerger K, Xiong G, Kugler G, Kohlbecher S, Engmann J, Werner P, Brendel M, Schneider E, Perneczky R, Jahn K, la Fougère C, Bartenstein P, Brandt T, Dieterich M, Zwergal A. Real-space navigation testing differentiates between amyloid-positive and -negative aMCI. Neurology 2020; 94:e861-e873. [PMID: 31896617 DOI: 10.1212/wnl.0000000000008758] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/05/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To distinguish between patients with amyloid-positive (A+) and -negative (A-) amnestic mild cognitive impairment (aMCI) by simultaneously investigating navigation performance, visual exploration behavior, and brain activations during a real-space navigation paradigm. METHODS Twenty-one patients with aMCI were grouped into A+ (n = 11) and A- cases by amyloid-PET imaging and amyloid CSF levels and compared to 15 healthy controls. Neuropsychological deficits were quantified by use of the Consortium to Establish a Registry for Alzheimer's Disease-plus cognitive battery. All participants performed a navigation task in which they had to find items in a realistic spatial environment and had to apply egocentric and allocentric route planning strategies. 18F-fluorodeoxyglucose was injected at the start to detect navigation-induced brain activations. Subjects wore a gaze-controlled, head-fixed camera that recorded their visual exploration behavior. RESULTS A+ patients performed worse during egocentric and allocentric navigation compared to A- patients and controls (p < 0.001). Both aMCI subgroups used fewer shortcuts, moved more slowly, and stayed longer at crossings. Word-list learning, figural learning, and Trail-Making tests did not differ in the A+ and A- subgroups. A+ patients showed a reduced activation of the right hippocampus, retrosplenial, and parietal cortex during navigation compared to A- patients (p < 0.005). CONCLUSIONS A+ patients with aMCI perform worse than A- patients with aMCI in egocentric and allocentric route planning because of a more widespread impairment of their cerebral navigation network. Navigation testing in real space is a promising approach to identify patients with aMCI with underlying Alzheimer pathology.
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Affiliation(s)
- Florian Schöberl
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Cauchy Pradhan
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Stephanie Irving
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Katharina Buerger
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Guoming Xiong
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Günter Kugler
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Stefan Kohlbecher
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Julia Engmann
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Philipp Werner
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Matthias Brendel
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Erich Schneider
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Robert Perneczky
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Klaus Jahn
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Christian la Fougère
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Peter Bartenstein
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Thomas Brandt
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Marianne Dieterich
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany
| | - Andreas Zwergal
- From the Department of Neurology (F.S., J.E., P.W., A.Z., M.D.), University Hospital, German Center for Vertigo and Balance Disorders (F.S., C.P., S.I., G.X., G.K., S.K., E.S., K.J., C.l.F., P.B., T.B., M.D., A.Z.), DSGZ, Institute for Stroke and Dementia Research (K.B.), ISD, University Hospital, Department of Nuclear Medicine (G.X., M.B., P.B.), Department of Psychiatry (R.P.), and Clinical Neurosciences (T.B.), Ludwig Maximilian University of Munich; German Center for Neurodegenerative Diseases (K.B., R.P., M.D.), DZNE, Munich; Institute for Medical Technology (E.S.), Brandenburg University of Technology Cottbus-Senftenberg; Munich Cluster of Systems Neurology (R.P., P.B., M.D.), SyNergy, Germany; Ageing Epidemiology Research Unit (R.P.), School of Public Health, Imperial College, London, UK; Neurological Hospital (K.J.), Schön Klinik Bad Aibling; and Department of Nuclear Medicine (C.l.F.), Eberhard Karl University of Tübingen, Germany.
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