Spatial navigation in normal aging and the prodromal stage of Alzheimer's disease: insights from imaging and behavioral studies

Use of Ordered Beta Regression Unveils Cognitive Flexibility Index and Longitudinal Cognitive Training Signatures in Normal and Alzheimer's Disease Pathological Aging

Generalized linear mixed models (GLMMs) are a cornerstone data analysis strategy in behavioral research because of their robustness in handling non-normally distributed variables. Recently, their integration with ordered beta regression (OBR), a novel statistical tool for managing percentage data, has opened new avenues for analyzing continuous response data. Here, we applied this combined approach to investigate nuanced differences between the 3xTg-AD model of Alzheimer's disease (AD) and their C57BL/6 non-transgenic (NTg) counterparts with normal aging in a 5-day Morris Water Maze (MWM) test protocol. Our longitudinal study included 22 3xTg-AD mice and 15 NTg mice (both male and female) assessed at 12 and 16 months of age. By identifying and analyzing multiple swimming strategies during three different paradigms (cue, place task, and removal), we uncovered genotypic differences in all paradigms. Thus, the NTg group exhibited a higher percentage of direct search behaviors, while an association between circling episodes and 3xTg-AD animals was found. Furthermore, we also propose a novel metric-the "Cognitive Flexibility Index"-which proved sensitive in detecting sex-related differences. Overall, our integrated GLMMs-OBR approach provides a comprehensive insight into mouse behavior in the MWM test, shedding light on the effects of aging and AD pathology.

Reducing younger and older adults' spatial disorientation during indoor-outdoor transitions: Effects of route alignment and visual access on wayfinding

Getting lost could lead to frustration, anxiety, and even fatal accidents. Previous research primarily focused on disorientation in indoor or outdoor environments separately. The indoor-outdoor transition received little attention, yet it is in this complex transition that individuals often lose their way. Therefore, the effects of indoor-outdoor route alignment, visual access, and age on wayfinding performance and spatial cognition were examined. Twenty older adults (aged 18-25) and twenty young adults (aged 65-82) participated in an experiment through desktop Virtual Reality (VR). They traversed indoor-outdoor environments and were informed within a building to quickly navigate an item inside another building. They also drew the route map. Participants repeated tasks in four different environments. Their spatial cognition and wayfinding performance were analyzed. Four main findings were derived. Firstly, the accuracy of global representation of the routes in the indoor-outdoor route alignment environment was higher than that in the non-aligned environment. Secondly, in environments with higher visual access, the accuracy of global representation of the routes for older adults was higher than that with lower visual access. Thirdly, enhancing visual access attenuated the negative impact of the non-aligned route on global representation of the routes. This effect is particularly beneficial for older adults. Fourthly, the younger adults outperformed the older adults in both wayfinding performance and global representation of the routes in indoor-outdoor environments. This difference could potentially be attributed to variations in education level, mental rotation ability, and digital experience. These findings provide valuable implications for urban design and wayfinding strategies.

Interactions between physical exercise, associative memory, and genetic risk for Alzheimer's disease

The ε4 allele of the APOE gene heightens the risk of late onset Alzheimer's disease. ε4 carriers, may exhibit cognitive and neural changes early on. Given the known memory-enhancing effects of physical exercise, particularly through hippocampal plasticity via endocannabinoid signaling, here we aimed to test whether a single session of physical exercise may benefit memory and underlying neurophysiological processes in young ε3 carriers (ε3/ε4 heterozygotes, risk group) compared with a matched control group (homozygotes for ε3). Participants underwent fMRI while learning picture sequences, followed by cycling or rest before a memory test. Blood samples measured endocannabinoid levels. At the behavioral level, the risk group exhibited poorer associative memory performance, regardless of the exercising condition. At the brain level, the risk group showed increased medial temporal lobe activity during memory retrieval irrespective of exercise (suggesting neural compensatory effects even at baseline), whereas, in the control group, such increase was only detectable after physical exercise. Critically, an exercise-related endocannabinoid increase correlated with task-related hippocampal activation in the control group only. In conclusion, healthy young individuals carrying the ε4 allele may present suboptimal associative memory performance (when compared with homozygote ε3 carriers), together with reduced plasticity (and functional over-compensation) within medial temporal structures.

Behavioral Disorders of Spatial Cognition in Patients with Mild Cognitive Impairment due to Alzheimer's Disease: Preliminary Findings from the BDSC-MCI Project

(1) Background: Spatial cognition (SC) is one of the earliest cognitive domains to be impaired in the course of Alzheimer's disease (AD), resulting in spatial disorientation and becoming lost even in familiar surroundings as later dementia symptoms. To date, few studies have identified initial alterations of spatial navigation (SN) in the premorbid AD phase by real-world paradigms, and none have adopted an innovative technological apparatus to better detect gait alterations as well as physiological aspects correlated to spatial disorientation (SD). The present study aimed at exploring initial SN defects in patients with prodromal AD via a naturalistic task by using a sensory garment. (2) Methods: 20 community-dwelling patients with Mild Cognitive Impairment (MCI) due to AD and 20 age/education controls were assessed on their sequential egocentric and allocentric navigation abilities by using a modified version of the Detour Navigation Test (DNT-mv). (3) Results: When compared to controls, patients with MCI due to AD exhibited higher wrong turns (WT) and moments of hesitation (MsH) in the DNT-mv, reflecting difficulties both in sequential egocentric and allocentric navigation, depending on hippocampal deterioration. Moreover, they reported more complaints about their SN competencies and lower long-term visuospatial memory abilities than controls. Remarkably, WTs and MsH manifested in the allocentric naturalistic task of the DNT-mv were associated with autonomic nervous system alteration pertaining to cardiac functioning in the whole sample. (4) Conclusions: Naturalistic navigation tests of hippocampal function using a continuous non-invasive monitoring device can provide early markers of spatial disorientation in patients with MCI due to AD. Future studies should develop cognitive remediation techniques able to enhance SC residual abilities in patients at high risk of conversion into dementia and ecological paradigms to be replicated on a large scale.

Early and specific detection of Alzheimer's disease: more than a (virtual) reality?

This scientific commentary refers to 'Path integration deficits are associated with phosphorylated tau accumulation in the entorhinal cortex', by Koike et al. (https://doi.org/10.1093/braincomms/fcad359).

Exploring the Remediation of Behavioral Disturbances of Spatial Cognition in Community-Dwelling Senior Citizens with Mild Cognitive Impairment via Innovative Technological Apparatus (BDSC-MCI Project): Protocol for a Prospective, Multi-Center Observational Study

Spatial navigation (SN) has been reported to be one of the first cognitive domains to be affected in Alzheimer's disease (AD), which occurs as a result of progressive neuropathology involving specific brain areas. Moreover, the epsilon 4 isoform of apolipoprotein-E (APOE-ε4) has been associated with both sporadic and familial late-onset AD, and patients with mild cognitive impairment (MCI) due to AD are more likely to progressively deteriorate. Spatial navigation performance will be examined on a sample of 76 community-dwelling senior citizens (25 healthy controls; 25 individuals with subjective cognitive decline (SCD); and 26 patients with MCI due to AD) via a virtual computer-based task (i.e., the AppleGame) and a naturalistic task (i.e., the Detour Navigation Test-modified version) for which a wearable device with sensors will be used for recording gait data and revealing physiological parameters that may be associated with spatial disorientation. We expect that patients with MCI due to AD and APOE-ε4 carriers will show altered SN performances compared to individuals with SCD and healthy controls in the experimental tasks, and that VR testing may predict ecological performance. Impaired SN performances in people at increased risk of developing AD may inform future cognitive rehabilitation protocols for counteracting spatial disorientation that may occur during elders' traveling to unfamiliar locations. The research protocol has been approved by the Ethics Committee of the Istituto Auxologico Italiano. Findings will be published in peer-reviewed medical journals and discussed in national and international congresses.

Geospatial environmental complexity, spatial brain volume, and spatial behavior across the Alzheimer's disease spectrum

INTRODUCTION

Understanding impact of environmental properties on Alzheimer's disease (AD) is paramount. Spatial complexity of one's routinely navigated environment is an important but understudied factor.

METHODS

A total of 660 older adults from National Alzheimer's Coordinating Center (NACC) dataset were geolocated and environmental complexity index derived from geospatial network landmarks and points-of-interest. Latent models tested mediation of spatial navigation-relevant brain volumes and diagnosis (cognitively-healthy, mild cognitive impairment [MCI], AD) on effect of environmental complexity on spatial behavior.

RESULTS

Greater environmental complexity was selectively associated with larger allocentric (but not egocentric) navigation-related brain volumes, lesser diagnosis of MCI and AD, and better spatial behavioral performance, through indirect hierarchical mediation.

DISCUSSION

Findings support hypothesis that spatially complex environments positively impact navigation neural circuitry and spatial behavior function. Given the vulnerability of these very circuits to AD pathology, residing in spatially complex environments may be one factor to help stave off the brain atrophy that accompanies spatial navigation deficits across the AD spectrum.

Transcranial direct current stimulation of the right temporoparietal junction facilitates hippocampal spatial learning in Alzheimer's disease and mild cognitive impairment

OBJECTIVE

Spatial memory deficits are an early symptom in Alzheimer's disease (AD), reflecting the neurodegenerative processes in the neuronal navigation network such as in hippocampal and parietal cortical areas. As no effective treatment options are available, neuromodulatory interventions are increasingly evaluated. Against this backdrop, we investigated the neuromodulatory effect of anodal transcranial direct current stimulation (tDCS) on hippocampal place learning in patients with AD or mild cognitive impairment (MCI).

METHODS

In this randomized, double-blind, sham-controlled study with a cross-over design anodal tDCS of the right temporoparietal junction (2 mA for 20 min) was applied to 20 patients diagnosed with AD or MCI and in 22 healthy controls while they performed a virtual navigation paradigm testing hippocampal place learning.

RESULTS

We show an improved recall performance of hippocampal place learning after anodal tDCS in the patient group compared to sham stimulation but not in the control group.

CONCLUSIONS

These results suggest that tDCS can facilitate spatial memory consolidation via stimulating the parietal-hippocampal navigation network in AD and MCI patients.

SIGNIFICANCE

Our findings suggest that tDCS of the temporoparietal junction may restore spatial navigation and memory deficits in patients with AD and MCI.

Components of navigation ability and their predictors in a community-dwelling sample of older adults

Introduction: Navigation, as a complex skill important for independent living, requires a variety of cognitive processes. Current scales tapping components are lengthy and can be burdensome for older adults. Methods: Community-dwelling older adults (n = 380, age 60-90 years) completed an online survey tapping wayfinding, being lost navigating, and needing help navigating. Participants then completed objective measures of navigation ability and self-reported memory ability. Cronbach's α was calculated for navigation subscales consisting of subsets of the Wayfinding Questionnaire and Santa Barbara Sense of Direction Questionnaire, and an exploratory factor analysis (EFA) was conducted. Regression analyses were used to test whether objective navigation, memory, and demographic information navigation predicted navigation subscale performance. Results: Each of the individual subscales demonstrated high reliability. EFA generated five unique factors: routing, mental mapping, navigation in near vicinities, feeling lost in far vicinities, and needing help in far vicinities. Across regression analyses, memory, gender, and performance on the Spatial Orientation Test were significant predictors. Discussion: Navigation is a multi-faceted construct that can be reliably measured using concise surveys. Further research is necessary to understand the intricacies of aging and navigation.

Systematic characterization of a non-transgenic Aβ1-42 amyloidosis model: synaptic plasticity and memory deficits in female and male mice

BACKGROUND

The amyloid-β (Aβ) cascade is one of the most studied theories linked to AD. In multiple models, Aβ accumulation and dyshomeostasis have shown a key role in AD onset, leading to excitatory/inhibitory imbalance, the impairments of synaptic plasticity and oscillatory activity, and memory deficits. Despite the higher prevalence of Alzheimer's disease (AD) in women compared to men, the possible sex difference is scarcely explored and the information from amyloidosis transgenic mice models is contradictory. Thus, given the lack of data regarding the early stages of amyloidosis in female mice, the aim of this study was to systematically characterize the effect of an intracerebroventricular (icv.) injection of Aβ1-42 on hippocampal-dependent memory, and on associated activity-dependent synaptic plasticity in the hippocampal CA1-CA3 synapse, in both male and female mice.

METHODS

To do so, we evaluated long term potentiation (LTP) with ex vivo electrophysiological recordings as well as encoding and retrieval of spatial (working, short- and long-term) and exploratory habituation memories using Barnes maze and object location, or open field habituation tasks, respectively.

RESULTS

Aβ1-42 administration impaired all forms of memory evaluated in this work, regardless of sex. This effect was displayed in a long-lasting manner (up to 17 days post-injection). LTP was inhibited at a postsynaptic level, both in males and females, and a long-term depression (LTD) was induced for the same prolonged period, which could underlie memory deficits.

CONCLUSIONS

In conclusion, our results provide further evidence on the shifting of LTP/LTD threshold due to a single icv. Aβ1-42 injection, which underly cognitive deficits in the early stages of AD. These long-lasting cognitive and functional alterations in males and females validate this model for the study of early amyloidosis in both sexes, thus offering a solid alternative to the inconsistence of amyloidosis transgenic mice models.

Spatial navigation is associated with subcortical alterations and progression risk in subjective cognitive decline

BACKGROUND

Subjective cognitive decline (SCD) may serve as a symptomatic indicator for preclinical Alzheimer's disease; however, SCD is a heterogeneous entity regarding clinical progression. We aimed to investigate whether spatial navigation could reveal subcortical structural alterations and the risk of progression to objective cognitive impairment in SCD individuals.

METHODS

One hundred and eighty participants were enrolled: those with SCD (n = 80), normal controls (NCs, n = 77), and mild cognitive impairment (MCI, n = 23). SCD participants were further divided into the SCD-good (G-SCD, n = 40) group and the SCD-bad (B-SCD, n = 40) group according to their spatial navigation performance. Volumes of subcortical structures were calculated and compared among the four groups, including basal forebrain, thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and accumbens. Topological properties of the subcortical structural covariance network were also calculated. With an interval of 1.5 years ± 12 months of follow-up, the progression rate to MCI was compared between the G-SCD and B-SCD groups.

RESULTS

Volumes of the basal forebrain, the right hippocampus, and their respective subfields differed significantly among the four groups (p < 0.05, false discovery rate corrected). The B-SCD group showed lower volumes in the basal forebrain than the G-SCD group, especially in the Ch4p and Ch4a-i subfields. Furthermore, the structural covariance network of the basal forebrain and right hippocampal subfields showed that the B-SCD group had a larger Lambda than the G-SCD group, which suggested weakened network integration in the B-SCD group. At follow-up, the B-SCD group had a significantly higher conversion rate to MCI than the G-SCD group.

CONCLUSION

Compared to SCD participants with good spatial navigation performance, SCD participants with bad performance showed lower volumes in the basal forebrain, a reorganized structural covariance network of subcortical nuclei, and an increased risk of progression to MCI. Our findings indicated that spatial navigation may have great potential to identify SCD subjects at higher risk of clinical progression, which may contribute to making more precise clinical decisions for SCD individuals who seek medical help.

Neural activity during monkey vehicular wayfinding

Navigation gets us from place to place, creating a path to arrive at a goal. We trained a monkey to steer a motorized cart in a large room, beginning at its trial-by-trial start location and ending at a trial-by-trial cued goal location. While the monkey steered its autonomously chosen path to its goal, we recorded neural activity simultaneously in both the hippocampus (HPC) and medial superior temporal (MST) cortex. Local field potentials (LFPs) in these sites show similar patterns of activity with the 15-30 Hz band highlighting specific room locations. In contrast, 30-100 Hz LFPs support a unified map of the behaviorally relevant start and goal locations. The single neuron responses (SNRs) do not substantially contribute to room or start-goal maps. Rather, the SNRs form a continuum from neurons that are most active when the monkey is moving on a path toward the goal, versus other neurons that are most active when the monkey deviates from paths toward the goal. Granger analyses suggest that HPC firing precedes MST firing during cueing at the trial start location, mainly mediated by off-path neurons. In contrast, MST precedes HPC firing during steering, mainly mediated by on-path neurons. Interactions between MST and HPC are mediated by the parallel activation of on-path and off-path neurons, selectively activated across stages of this wayfinding task.

Reconfiguration of brain network dynamics underlying spatial deficits in subjective cognitive decline

Brain dynamics and the associations with spatial navigation in individuals with subjective cognitive decline (SCD) remain unknown. In this study, a hidden Markov model (HMM) was inferred from resting-state functional magnetic resonance imaging data in a cohort of 80 SCD and 77 normal control (NC) participants. By HMM, 12 states with distinct brain activity were identified. The SCD group showed increased fractional occupancy in the states with less activated ventral default mode, posterior salience, and visuospatial networks, while decreased fractional occupancy in the state with general network activation. The SCD group also showed decreased probabilities of transition into and out of the state with general network activation, suggesting an inability to dynamically upregulate and downregulate brain network activity. Significant correlations between brain dynamics and spatial navigation were observed. The combined features of spatial navigation and brain dynamics showed an area under the curve of 0.854 in distinguishing between SCD and NC. The findings may provide exploratory evidence of the reconfiguration of brain network dynamics underlying spatial deficits in SCD.

Towards early detection of neurodegenerative diseases: A gut feeling

The gastrointestinal tract communicates with the nervous system through a bidirectional network of signaling pathways called the gut-brain axis, which consists of multiple connections, including the enteric nervous system, the vagus nerve, the immune system, endocrine signals, the microbiota, and its metabolites. Alteration of communications in the gut-brain axis is emerging as an overlooked cause of neuroinflammation. Neuroinflammation is a common feature of the pathogenic mechanisms involved in various neurodegenerative diseases (NDs) that are incurable and debilitating conditions resulting in progressive degeneration and death of neurons, such as in Alzheimer and Parkinson diseases. NDs are a leading cause of global death and disability, and the incidences are expected to increase in the following decades if prevention strategies and successful treatment remain elusive. To date, the etiology of NDs is unclear due to the complexity of the mechanisms of diseases involving genetic and environmental factors, including diet and microbiota. Emerging evidence suggests that changes in diet, alteration of the microbiota, and deregulation of metabolism in the intestinal epithelium influence the inflammatory status of the neurons linked to disease insurgence and progression. This review will describe the leading players of the so-called diet-microbiota-gut-brain (DMGB) axis in the context of NDs. We will report recent findings from studies in model organisms such as rodents and fruit flies that support the role of diets, commensals, and intestinal epithelial functions as an overlooked primary regulator of brain health. We will finish discussing the pivotal role of metabolisms of cellular organelles such as mitochondria and peroxisomes in maintaining the DMGB axis and how alteration of the latter can be used as early disease makers and novel therapeutic targets.

A New Smart 2-Min Mobile Alerting Method for Mild Cognitive Impairment Due to Alzheimer's Disease in the Community

The early identification of mild cognitive impairment (MCI) due to Alzheimer's disease (AD), in an early stage of AD can expand the AD warning window. We propose a new capability index evaluating the spatial execution process (SEP), which can dynamically evaluate the execution process in the space navigation task. The hypothesis is proposed that there are neurobehavioral differences between normal cognitive (NC) elderly and AD patients with MCI reflected in digital biomarkers captured during SEP. According to this, we designed a new smart 2-min mobile alerting method for MCI due to AD, for community screening. Two digital biomarkers, total mission execution distance (METRtotal) and execution distance above the transverse obstacle (EDabove), were selected by step-up regression analysis. For the participants with more than 9 years of education, the alerting efficiency of the combination of the two digital biomarkers for MCI due to AD could reach 0.83. This method has the advantages of fast speed, high alerting efficiency, low cost and high intelligence and thus has a high application value for community screening in developing countries. It also provides a new intelligent alerting approach based on the human-computer interaction (HCI) paradigm for MCI due to AD in community screening.

Applicability of an immersive virtual reality system to assess egocentric orientation of older adults

BACKGROUND

Spatial orientation is a cognitive domain frequently compromised in patients with Alzheimer disease (AD) and may be one of its first clinical manifestations. Some studies have shown that allocentric integration with egocentric spatial information seems to be impaired in this pathology. There is no consensus on how best to assess spatial orientation and traditional tests lack ecological validity, but, recently, virtual reality (VR) has provided new opportunities for this assessment.

OBJECTIVES

To analyze the applicability and stability of an immersive virtual task developed to assess spatial orientation, the Spatial Orientation in Immersive Virtual Environment Maze Test (SOIVET-Maze) in older adults with and without mild cognitive impairment.

METHODS

Forty-three older adults were included in the study, 24 without cognitive impairment and 19 with mild cognitive impairment. Applicability was assessed by the Witmer and Singer Sense of Presence Questionnaire and a questionnaire for adverse events of cybersickness. To assess stability, participants were assessed twice with an interval of 7 to 14 days, and the intraclass correlation coefficient was calculated between visits. The t test or the Mann-Whitney test was used to compare applicability and stability between groups.

RESULTS

There was no significant difference between the groups regarding applicability. A strong correlation between the first and second day of testing was found in the mild cognitive impairment group.

CONCLUSION

The SOIVET-Maze task showed excellent applicability and good stability, favoring its clinical application for the evaluation of spatial orientation in older adults.

Navigational Experience and the Preservation of Spatial Abilities into Old Age Among a Tropical Forager-Farmer Population

Navigational performance responds to navigational challenges, and both decline with age in Western populations as older people become less mobile. But mobility does not decline everywhere; Tsimané forager-farmers in Bolivia remain highly mobile throughout adulthood, traveling frequently by foot and dugout canoe for subsistence and social visitation. We, therefore, measured both natural mobility and navigational performance in 305 Tsimané adults, to assess differences with age and to test whether greater mobility was related to better navigational performance across the lifespan. Daily mobility was measured by GPS tracking, regional mobility through interview, navigational performance through pointing accuracy and perspective taking in environmental space, and mental rotation by a computerized task. Although mental rotation and spatial perspective taking declined with age, mobility and pointing accuracy remained high from mid-life through old age. Greater regional mobility was associated with greater accuracy at pointing and perspective taking, suggesting that spatial experience at environmental scales may help maintain navigational performance in later adulthood.

Randomized Controlled Trial of Social Ballroom Dancing and Treadmill Walking: Preliminary Findings on Executive Function and Neuroplasticity From Dementia-at-Risk Older Adults

This randomized controlled trial (NCT03475316) examined the relative efficacy of 6 months of social ballroom dancing and treadmill walking on a composite executive function score, generated from digit symbol substitution test, flanker interference, and walking while talking tasks. Brain activation during functional magnetic resonance imaging (fMRI) versions of these executive function tasks were secondary outcomes. Twenty-five dementia-at-risk older adults (memory impairment screen score of ≥3 to ≤6 and/or an Alzheimer's disease-8 Dementia Screening Interview of ≥1) were randomized in June 2019 to March 2020-16 completed the intervention before study termination due to the COVID-19 (eight in each group). Composite executive function scores improved post-intervention in both groups, but there was no evidence for between-group differences. Social dancing, however, generated greater improvements on digit symbol substitution test than treadmill walking. No intervention-related differences were observed in brain activation-although less hippocampal atrophy (tertiary) was observed following social dancing than treadmill walking. These preliminary findings are promising but need to be confirmed in future large-scale and sufficiently powered randomized controlled trials.

A fuzzy-oscillatory model of medial prefrontal cortex control function in spatial memory retrieval in human navigation function

Navigation can be broadly defined as the process of moving from an origin to a destination through path-planning. Previous research has shown that navigation is mainly related to the function of the medial temporal lobe (MTL), including the hippocampus (HPC), and medial prefrontal cortex (mPFC), which controls retrieval of the spatial memories from this region. In this study, we suggested a cognitive and computational model of human navigation with a focus on mutual interactions between the hippocampus (HPC) and the mPFC using the concept of synchrony. The Van-der-pol oscillator was used to model the synchronous process of receiving and processing “what stream” information. A fuzzy lookup table system was applied for modeling the controlling function of the mPFC in retrieving spatial information from the HPC. The effect of attention level was also included and simulated. The performance of the model was evaluated using information reported in previous experimental research. Due to the inherent stability of the proposed fuzzy-oscillatory model, it is less sensitive to the exact values of the initial conditions, and therefore, it is shown that it is consistent with the actual human performance in real environments. Analyzing the proposed cognitive and fuzzy-oscillatory computational model demonstrates that the model is able to reproduce certain cognitive and functional disturbances in navigation in related diseases such as Alzheimer’s disease (AD). We have shown that an increase in the bifurcation parameter of the Van-der-pol equation represents an increase in the low-frequency spectral power density and a decrease in the high-frequency spectral power as occurs in AD due to an increase in the amyloid plaques in the brain. These changes in the frequency characteristics of neuronal activity, in turn, lead to impaired recall and retrieval of landmarks information and learned routes upon encountering them. As a result, and because of the wrong frequency code being transmitted, the relevant set of rules in the mPFC is not activated, or another unrelated set will be activated, which leads to forgetfulness and erroneous decisions in routing and eventually losing the route in Alzheimer’s patients.

Could an Immersive Virtual Reality Training Improve Navigation Skills in Children with Cerebral Palsy? A Pilot Controlled Study

Children with cerebral palsy (CP) suffer deficits in their motor, sensory, and cognitive abilities, as well as in their visuospatial competences. In the last years, several authors have tried to correlate the visuospatial abilities with the navigational ones. Given their importance in everyday functions, navigation skills have been deeply studied using increasingly cutting-edge techniques such as virtual reality (VR). However, to our knowledge, there are no studies focused on training using immersive VR (IVR) in children with movement disorders. For this reason, we proposed an IVR training to 35 young participants with CP and conceived to improve their navigation skills in a “simil-real” environment while playing on a dynamic platform. A subgroup performed a part of the training which was specifically dedicated to the use of the allocentric strategy (i.e., looking for landmarks) to navigate the virtual environment. We then compared the children’s navigation and spatial skills pre- and post-intervention. All the children improved their visual–spatial abilities; particularly, if the IVR activities specifically trained their ability to look for landmarks and use them to navigate. The results of this work highlight the potential of an IVR training program to increase the navigation abilities of patients with CPs.

Intuitive assessment of spatial navigation beyond episodic memory: Feasibility and proof of concept in middle-aged and elderly individuals

Deficits in spatial navigation in three-dimensional space are prevalent in various neurological disorders and are a sensitive cognitive marker for prodromal Alzheimer’s disease, but are also associated with non-pathological aging. However, standard neuropsychological tests used in clinical settings lack ecological validity to adequately assess spatial navigation. Experimental paradigms, on the other hand, are often too difficult for seniors or patients with cognitive or motor impairments since most require operating a human interface device (HID) or use complex episodic memory tasks. Here, we introduce an intuitive navigation assessment, which is conceptualized using cognitive models of spatial navigation and designed to account for the limited technical experience and diverging impairments of elderly participants and neurological patients. The brief computer paradigm uses videos of hallways filmed with eye tracking glasses, without employing an episodic memory task or requiring participants to operate a HID. Proof of concept data from 34 healthy, middle-aged and elderly participants (56–78 years) provide evidence for the assessment’s feasibility and construct validity as a navigation paradigm. Test performance showed normal distribution and was sensitive to age and education, which needs to be considered when investigating the assessment’s psychometric properties in larger samples and clinical populations. Correlations of the navigation assessment with other neuropsychological tests confirmed its dependence on visuospatial skills rather than visual episodic memory, with age driving the association with working memory. The novel paradigm is suitable for a differentiated investigation of spatial navigation in elderly individuals and promising for experimental research in clinical settings.

Assessing mild cognitive impairment using object-location memory in immersive virtual environments

Pathological changes in the medial temporal lobe (MTL) are found in the early stages of Alzheimer's disease (AD) and aging. The earliest pathological accumulation of tau colocalizes with the areas of the MTL involved in object processing as part of a wider anterolateral network. Here, we sought to assess the diagnostic potential of memory for object locations in iVR environments in individuals at high risk of AD dementia (amnestic mild cognitive impairment [aMCI] n = 23) as compared to age-related cognitive decline. Consistent with our primary hypothesis that early AD would be associated with impaired object location, aMCI patients exhibited impaired spatial feature binding. Compared to both older (n = 24) and younger (n = 53) controls, aMCI patients, recalled object locations with significantly less accuracy (p < .001), with a trend toward an impaired identification of the object's correct context (p = .05). Importantly, these findings were not explained by deficits in object recognition (p = .6). These deficits differentiated aMCI from controls with greater accuracy (AUC = 0.89) than the standard neuropsychological tests. Within the aMCI group, 16 had CSF biomarkers indicative of their likely AD status (MCI+ n = 9 vs. MCI- n = 7). MCI+ showed lower accuracy in the object-context association than MCI- (p = .03) suggesting a selective deficit in object-context binding postulated to be associated with anterior-temporal areas. MRI volumetric analysis across healthy older participants and aMCI revealed that test performance positively correlates with lateral entorhinal cortex volumes (p < .05) and hippocampus volumes (p < .01), consistent with their hypothesized role in binding contextual and spatial information with object identity. Our results indicate that tests relying on the anterolateral object processing stream, and in particular requiring successful binding of an object with spatial information, may aid detection of pre-dementia AD due to the underlying early spread of tau pathology.

Glucose metabolism patterns: A potential index to characterize brain ageing and predict high conversion risk into cognitive impairment

Exploring individual hallmarks of brain ageing is important. Here, we propose the age-related glucose metabolism pattern (ARGMP) as a potential index to characterize brain ageing in cognitively normal (CN) elderly people. We collected 18F-fluorodeoxyglucose (18F-FDG) PET brain images from two independent cohorts: the Alzheimer's Disease Neuroimaging Initiative (ADNI, N = 127) and the Xuanwu Hospital of Capital Medical University, Beijing, China (N = 84). During follow-up (mean 80.60 months), 23 participants in the ADNI cohort converted to cognitive impairment. ARGMPs were identified using the scaled subprofile model/principal component analysis method, and cross-validations were conducted in both independent cohorts. A survival analysis was further conducted to calculate the predictive effect of conversion risk by using ARGMPs. The results showed that ARGMPs were characterized by hypometabolism with increasing age primarily in the bilateral medial superior frontal gyrus, anterior cingulate and paracingulate gyri, caudate nucleus, and left supplementary motor area and hypermetabolism in part of the left inferior cerebellum. The expression network scores of ARGMPs were significantly associated with chronological age (R = 0.808, p < 0.001), which was validated in both the ADNI and Xuanwu cohorts. Individuals with higher network scores exhibited a better predictive effect (HR: 0.30, 95% CI: 0.1340 ~ 0.6904, p = 0.0068). These findings indicate that ARGMPs derived from CN participants may represent a novel index for characterizing brain ageing and predicting high conversion risk into cognitive impairment.

Age and sex impact on visuospatial working memory (VSWM), mental rotation, and cognitive strategies during navigation

This study assessed the impact of sex and typical aging on visuospatial working memory (VSWM), mental rotations, and navigational strategies using behavioral information. Fifty healthy participants regrouped in older (OA) and young adults (YA) performed the Walking Corsi test (WalCT) and the Redrawn Mental Rotation Test (MRT) to explore mental rotation abilities. We recorded kinematic data such as locomotion trajectories, and spatial orientations during navigation. We created a new method of data analysis for the WalCT performances and compared it with the classical approach. This original method allowed us to identify cognitive strategies based on errors analysis. Our data suggested that VSWM and mental rotation capacities in locomotion were modulated by age (YA scored higher than OA), and sex (Young Adult Males (YA-M) having higher performance than Young Adult Females (YA-F). We observed a preferential use of cognitive strategies related to sex; YA-F relied more on egocentric strategies whereas YA-M relied more on allocentric strategies. The preferential use of cognitive strategies in the YA group was not observed in the OA group producing more random errors per sequence. The results suggest the effects that age and sex have on VSWM, cognitive strategies, and mental rotation during navigation and highlight the importance of navigational strategies training.

Walking on a minefield: planning, remembering, and avoiding obstacles: preliminary findings

Travel planning (TP) is a kind of planning devoted to spatial orientation that is distinguishable from general planning (GP). It is crucial to reach a destination, since it allows to select the best route according to the environmental features (e.g., the one with little traffic or the safest). TP is also needed to avoid obstacles along the way and to put in place effective strategies to support navigation. TP involves several cognitive processes, such as visuo-spatial and topographic memory as well as other executive functions (i.e., general planning, cognitive flexibility, problem solving, and divergent thinking) and it is affected by internal factors (such as gender, cognitive strategies, age). Here, we focused on the effects of visuo-spatial (VSWM) and topographic (TWM) working memory on TP, using the Minefield Task (MFT), a new tool aimed at testing TP. We tested VSWM, TWM, GP, and TP in 44 college students. First, we checked for gender differences in all the tasks proposed and then assessed the relation among VSWM, TWM, GP, and TP. Results showed that even though gender difference could be found on TWM, GP, and TP, significative correlations emerged among TP, VSWM, and GP as well as a tendency to significance for VSWM and GP in the regression analyses. Though more evidence is needed, these results suggest that when a brand-new route is computed, GP and VSWM can be the most relevant processes, whereas topographic memory was less involved, probably because the MFT does not require to recall a route from memory. The implications of these results in clinical settings are discussed.

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

Objective

To determine whether gait and accelerometric features can predict disorientation events in young and older adults.

Methods

Cognitively healthy younger (18–40 years, n = 25) and older (60–85 years, n = 28) participants navigated on a treadmill through a virtual representation of the city of Rostock featured within the Gait Real-Time Analysis Interactive Lab (GRAIL) system. We conducted Bayesian Poisson regression to determine the association of navigation performance with domain-specific cognitive functions. We determined associations of gait and accelerometric features with disorientation events in real-time data using Bayesian generalized mixed effect models. The accuracy of gait and accelerometric features to predict disorientation events was determined using cross-validated support vector machines (SVM) and Hidden Markov models (HMM).

Results

Bayesian analysis revealed strong evidence for the effect of gait and accelerometric features on disorientation. The evidence supported a relationship between executive functions but not visuospatial abilities and perspective taking with navigation performance. Despite these effects, the cross-validated percentage of correctly assigned instances of disorientation was only 72% in the SVM and 63% in the HMM analysis using gait and accelerometric features as predictors.

Conclusion

Disorientation is reflected in spatiotemporal gait features and the accelerometric signal as a potentially more easily accessible surrogate for gait features. At the same time, such measurements probably need to be enriched with other parameters to be sufficiently accurate for individual prediction of disorientation events.

Two Immersive Virtual Reality Tasks for the Assessment of Spatial Orientation in Older Adults with and Without Cognitive Impairment: Concurrent Validity, Group Comparison, and Accuracy Results

OBJECTIVE

Spatial disorientation is common in Alzheimer's disease (AD), Mild Cognitive Impairment (MCI), and preclinical individuals with AD biomarkers. However, traditional neuropsychological tests lack ecological validity for the assessment of spatial orientation and to date, there is still no gold standard. The current study aimed to determine the validity and accuracy of two virtual reality tasks for the assessment of spatial orientation.

METHODS

We adapted two spatial orientation tasks to immersive virtual environments: a "survey to route" task in which participants had to transfer information from a map to their body position within a maze [Spatial Orientation in Immersive Virtual Environment Test (SOIVET) Maze], and an allocentric-type, route learning task, with well-established topographic landmarks (SOIVET Route). A total of 19 MCI patients and 29 cognitively healthy older adults aged 61-92 participated in this study. Regular neuropsychological assessments were used for correlation analysis and participant performances were compared between groups. Receiver Operating Characteristic (ROC) curve analysis was performed for accuracy.

RESULTS

The SOIVET Maze correlated with measures of visuoperception, mental rotation, and planning, and was not related to age, educational level, or technology use profile. The SOIVET Route immediate correlated with measures of mental rotation, memory, and visuoconstruction, and was influenced only by education. Both tasks significantly differentiated MCI and control groups, and demonstrated moderate accuracy for the MCI diagnosis.

CONCLUSION

Traditional neuropsychological assessment presents limitations and immersive environments allow for the reproduction of complex cognitive processes. The two immersive virtual reality tasks are valid tools for the assessment of spatial orientation and should be considered for cognitive assessments of older adults.

Applicability of an immersive virtual reality system for assessing route learning in older adults

Spatial orientation is defined as the ability to find one’s way around an environment, follow familiar routes, recognize places, and learn new routes. Spatial disorientation is one of the early symptoms of Alzheimer’s disease (AD), and traditional cognitive evaluation lacks ecological validity. Therefore, new assessment methods are needed for the early identification of this cognitive impairment.

Paeoniflorin ameliorates cognitive impairment in Parkinson's disease via JNK/p53 signaling

Paeoniflorin (PF) has numerous benefits, including anti-inflammatory and anti-apoptosis effects. However, it is not clear if it has neuroprotective effects against cognitive impairment (CI) in Parkinson's disease (PD). Through network pharmacology, we identified probable targets as well as signal pathways through which PF might affect CI in PD. Then, we experimentally validated our findings. The core genes of the protein-protein interactions (PPI) network include MAPK8 (JNK), TP53, CASP3 (caspase-3), postsynaptic density protein-95 (PSD-95) and synaptophysin (SYN). Pathway enrichment analysis revealed that genes involved in apoptosis and mitogen-activated protein kinase (MAPK) signaling were significantly enriched. Because JNK is a key mediator of p53-induced apoptosis, we wondered if JNK/p53 pathway influences the effects of PF against apoptosis in mouse model of PD. Molecular docking analysis showed that PF had good affinity for JNK/p53. The results of the experiments indicated that PF ameliorated behavioral impairments and upregulated the expression of the dopamine (DA) neurons, suppressed cell apoptosis in substantia nigra pars compacta (SNpc) of PD. Additionally, PF improved 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced neuronal injury by inhibiting apoptosis in hippocampal neurons of the CA1 and CA3, and upregulating PSD-95 as well as SYN protein levels. Similar protective effects were observed upon JNK/p53 pathway inhibition using SP600125. Overall, PF improved CI in PD by inhibiting JNK/p53 pathway.

“CityQuest,” A Custom-Designed Serious Game, Enhances Spatial Memory Performance in Older Adults

Spatial cognition is known to decline with aging. However, little is known about whether training can reduce or eliminate age-related deficits in spatial memory. We investigated whether a custom-designed video game involving spatial navigation, obstacle avoidance, and balance control would improve spatial memory in older adults. Specifically, 56 healthy adults aged 65 to 84 years received 10 sessions of multicomponent video game training, based on a virtual cityscape, over 5 weeks. Participants were allocated to one of three training conditions: the main intervention, the “CityQuest” group (n = 19), and two control groups, spatial navigation without obstacle avoidance (“Spatial Navigation-only” group, n = 21) and obstacle avoidance without spatial navigation (“Obstacles-only” group, n = 15). Performance on object recognition, egocentric and allocentric spatial memory (incorporating direction judgment tasks and landmark location tasks, respectively), navigation strategy preference, and executive functioning was assessed in pre- and post-intervention sessions. The results showed an overall benefit on performance in a number of spatial memory measures and executive function for participants who received spatial navigation training, particularly the CityQuest group, who also showed significant improvement on the landmark location task. However, there was no evidence of a shift from egocentric to allocentric strategy preference. We conclude that spatial memory in healthy older participants is amenable to improvement with training over a short term. Moreover, technology based on age-appropriate, multicomponent video games may play a key role in cognitive training in older adults.

Effect of curcumin nanoparticles on streptozotocin-induced male Wistar rat model of Alzheimer's disease

Alzheimer's disease (AD) is a progressive neurodegenerative disease that afflicts millions of people all over the world. Intracerebroventricular (ICV) injection of a sub-diabetogenic dose of streptozotocin (STZ) was established as an experimental animal model of AD. The present study was conducted to evaluate the efficacy of curcumin nanoparticles (CNs) against the behavioral, neurochemical and histopathological alterations induced by ICV-STZ. The animals were divided into: control animals, the animal model of AD that received a single bilateral ICV microinjection of STZ, and the animals protected by a daily oral administration of CNs for 6 days before the ICV-STZ injection. The animals of all groups were subjected to surgical operation on the 7th day of administration. Then the administration of distilled water or CNs was continued for 8 days. The ICV-STZ microinjection produced cognitive impairment as evident from the behavioral Morris water maze (MWM) test and induced oxidative stress in the cortex and hippocampus as indicated by the significant increases in lipid peroxidation and nitric oxide (NO) levels and the significant decrease in reduced glutathione (GSH) levels. It also produced a significant increase in acetylcholinesterase (AChE) and tumor necrosis-alpha (TNF-ɑ) and a significant decrease in Na+,K + -ATPase. In addition, a significant increase in amino acid neurotransmitters occurred in the hippocampus, whereas a significant decrease was obtained in the cortex of STZ-induced AD rats. CNs ameliorated the behavioral, immunohistochemical and most of the neurochemical alterations induced by STZ in the hippocampus and cortex. It may be concluded that CNs might be considered as a promising therapeutic agent for the treatment of AD.

APOEɛ4 Allele Moderates the Association Between Basal Forebrain Nuclei Volumes and Allocentric Navigation in Older Adults Without Dementia

BACKGROUND

Cholinergic deficit and medial temporal lobe (MTL) atrophy are hallmarks of Alzheimer's disease (AD) leading to early allocentric spatial navigation (aSN) impairment. APOEɛ4 allele (E4) is a major genetic risk factor for late-onset AD and contributes to cholinergic dysfunction. Basal forebrain (BF) nuclei, the major source of acetylcholine, project into multiple brain regions and, along with MTL and prefrontal cortex (PFC), are involved in aSN processing.

OBJECTIVE

We aimed to determine different contributions of individual BF nuclei atrophy to aSN in E4 positive and E4 negative older adults without dementia and assess whether they operate on aSN through MTL and PFC or independently from these structures.

METHODS

120 participants (60 E4 positive, 60 E4 negative) from the Czech Brain Aging Study underwent structural MRI and aSN testing in real-space arena setting. Hippocampal and BF nuclei volumes and entorhinal cortex and PFC thickness were obtained. Associations between brain regions involved in aSN were assessed using MANOVA and complex model of mutual relationships was built using structural equation modelling (SEM).

RESULTS

Path analysis based on SEM modeling revealed that BF Ch1-2, Ch4p, and Ch4ai nuclei volumes were indirectly associated with aSN performance through MTL (pch1 - 2 = 0.039; pch4p = 0.042) and PFC (pch4ai = 0.044). In the E4 negative group, aSN was indirectly associated with Ch1-2 nuclei volumes (p = 0.015), while in the E4 positive group, there was indirect effect of Ch4p nucleus (p = 0.035).

CONCLUSION

Our findings suggest that in older adults without dementia, BF nuclei affect aSN processing indirectly, through MTL and PFC, and that APOE E4 moderates these associations.

Bezafibrate Exerts Neuroprotective Effects in a Rat Model of Sporadic Alzheimer’s Disease

Bezafibrate, a pan-peroxisome proliferator-activated receptor (PPAR) agonist, reportedly attenuated tau pathology in a transgenic mouse model of primary tauopathy. Since tau pathology is a neuropathological hallmark of Alzheimer’s disease (AD), bezafibrate may be a potential drug for the treatment of AD. However, no study has investigated its effects in AD models. Thus, we aimed to evaluate whether bezafibrate has neuroprotective effects in a sporadic AD model induced by streptozotocin (STZ) intracerebroventricular (ICV) injection. Rats were administered STZ-ICV (3 mg/kg) followed by bezafibrate (50 mg/kg/day, intraperitoneal) for 4 weeks. Behavior tests and positron emission tomography (PET) were performed to evaluate longitudinal changes in cognitive function, tau pathology, and cerebral glucose metabolism. Immunofluorescence staining was performed to assess neuronal survival and microglial accumulation. STZ-ICV administration induced significant cognitive impairment and substantial neuronal loss, tau pathology, glucose hypometabolism, and microgliosis in the cortex and hippocampus, while bezafibrate effectively attenuated these abnormalities. This study demonstrated that bezafibrate has long-lasting neuroprotective effects in a sporadic AD model. Our data indicate that the neuroprotective effects of bezafibrate might be associated with its ability to ameliorate tau pathology, brain glucose hypometabolism, and neuroinflammation. These findings suggest that bezafibrate is a potential multi-target drug candidate for the treatment of AD.

Future trends in brain aging research: Visuo-cognitive functions at stake during mobility and spatial navigation

Aging leads to a complex pattern of structural and functional changes, gradually affecting sensorimotor, perceptual, and cognitive processes. These multiscale changes can hinder older adults' interaction with their environment, progressively reducing their autonomy in performing tasks relevant to everyday life. Autonomy loss can further be aggravated by the onset and progression of neurodegenerative disorders (e.g., age-related macular degeneration at the sensory input level; and Alzheimer's disease at the cognitive level). In this context, spatial cognition offers a representative case of high-level brain function that involves multimodal sensory processing, postural control, locomotion, spatial orientation, and wayfinding capabilities. Hence, studying spatial behavior and its neural bases can help identify early markers of pathogenic age-related processes. Until now, the neural correlates of spatial cognition have mostly been studied in static conditions thereby disregarding perceptual (other than visual) and motor aspects of natural navigation. In this review, we first demonstrate how visuo-motor integration and the allocation of cognitive resources during locomotion lie at the heart of real-world spatial navigation. Second, we present how technological advances such as immersive virtual reality and mobile neuroimaging solutions can enable researchers to explore the interplay between perception and action. Finally, we argue that the future of brain aging research in spatial navigation demands a widespread shift toward the use of naturalistic, ecologically valid experimental paradigms to address the challenges of mobility and autonomy decline across the lifespan.

Impaired Color Discrimination in Alzheimer Disease Dementia

OBJECTIVE

Patients with Alzheimer disease dementia (ADD) often show impaired orientation and navigation. Signage offers an opportunity to compensate for these deficits, communicate information efficiently and facilitate wayfinding. Certain properties of signs such as colors and contrasts may beneficially affect the uptake and processing of information particularly in ADD patients.

METHODS

Thirty-six healthy older adults and 30 ADD patients performed a computerized color perception task that required discriminating different color combinations. The effects of different contrast features on performance accuracy and speed in the 2 experimental groups were examined by nonparametric mixed analysis of variances.

RESULTS

Analyses revealed a significant effect of contrast polarity on reaction times, significant effects of group on reaction times and errors as well as a marginally significant interaction of group×color on errors. All participants benefitted from positive contrast polarity (ie, dark target on lighter background) as indicated by increased performance speed. Furthermore, ADD patients reacted slower and less accurate than healthy controls, but showed higher accuracy at black-white and red-yellow than at blue-green color combinations.

CONCLUSIONS

Our findings suggest the implementation of signs with positive contrast polarity to ensure faster reactions. In addition, certain color combinations may enhance accuracy, particularly in patients with ADD.

Impaired Experience-Dependent Refinement of Place Cells in a Rat Model of Alzheimer's Disease

BACKGROUND

Hippocampal place cells play an integral role in generating spatial maps. Impaired spatial memory is a characteristic pathology of Alzheimer's disease (AD), yet it remains unclear how AD influences the properties of hippocampal place cells.

OBJECTIVE

To record electrophysiological activity in hippocampal CA1 neurons in freely-moving 18-month-old male TgF344-AD and age-matched wild-type (WT) littermates to examine place cell properties.

METHODS

We implanted 32-channel electrode arrays into the CA1 subfield of 18-month-old male WT and TgF344-AD (n = 6/group) rats. Ten days after implantation, single unit activity in an open field arena was recorded across days. The spatial information content, in-field firing rate, and stability of each place cell was compared across groups. Pathology was assessed by immunohistochemical staining, and a deep neural network approach was used to count cell profiles.

RESULTS

Aged TgF344-AD rats exhibited hippocampal amyloid-β deposition, and a significant increase in Iba1 immunoreactivity and microglia cell counts. Place cells from WT and TgF344-AD rat showed equivalent spatial information, in-field firing rates, and place field stability when initially exposed to the arena. However, by day 3, the place cells in aged WT rats showed characteristic spatial tuning as evidenced by higher spatial information content, stability, and in-field firing rates, an effect not seen in TgF344-AD rats.

CONCLUSION

These findings support the notion that altered electrophysiological properties of place cells may contribute to the learning and memory deficits observed in AD.

Macro-event recognition in healthy ageing, Alzheimer's disease, and mild cognitive impairment

Event perception and cognition is integral to our everyday experience and functional ability. A commonly reported complaint in Alzheimer's disease (AD) is the inability to follow narratives - be it textual, conversational, video, or pictures. This phenomenon has received little systematic research so far. In the current study, we developed a novel paradigm to examine macro-event recognition in individuals with AD in the early stage and its preceding stage of mild cognitive impairment (MCI) in comparison with cognitively healthy older adults, using pictures depicting events. In Experiment 1, we examined participants' ability to integrate pictorially depicted sub-events into macro-events. The pictures were presented in a scrambled order, and participants were expected to arrange them in the temporally and causally appropriate sequence, as dictated by the macro-event schema. Additionally, we investigated the effect of cueing the appropriate event schema by providing a word cue (verb). In Experiment 2, macro-event recognition was examined again using a cognitively less taxing paradigm, where pictures depicting sub-events were presented in correct order, but staggered, and recognition speed was measured. We observed significant deficits in the AD and MCI groups' performance compared with the cognitively healthy older adults, across both experiments, suggesting event perception and cognition is impaired early in the course of AD. There was no effect of cueing on the performance of any of the groups. The theoretical and clinical implications of these findings are discussed.

Characteristics of Neural Network Changes in Normal Aging and Early Dementia

To understand the mechanisms underlying preserved and impaired cognitive function in healthy aging and dementia, respectively, the spatial relationships of brain networks and mechanisms of their resilience should be understood. The hub regions of the brain, such as the multisensory integration and default mode networks, are critical for within- and between-network communication, remain well-preserved during aging, and play an essential role in compensatory processes. On the other hand, these brain hubs are the preferred sites for lesions in neurodegenerative dementias, such as Alzheimer's disease. Disrupted primary information processing networks, such as the auditory, visual, and sensorimotor networks, may lead to overactivity of the multisensory integration networks and accumulation of pathological proteins that cause dementia. At the cellular level, the brain hub regions contain many synapses and require a large amount of energy. These regions are rich in ATP-related gene expression and had high glucose metabolism as demonstrated on positron emission tomography (PET). Importantly, the number and function of mitochondria, which are the center of ATP production, decline by about 8% every 10 years. Dementia patients often have dysfunction of the ubiquitin-proteasome and autophagy-lysosome systems, which require large amounts of ATP. If there is low energy supply but the demand is high, the risk of disease can be high. Imbalance between energy supply and demand may cause accumulation of pathological proteins and play an important role in the development of dementia. This energy imbalance may explain why brain hub regions are vulnerable to damage in different dementias. Here, we review (1) the characteristics of gray matter network, white matter network, and resting state functional network changes related to resilience in healthy aging, (2) the mode of resting state functional network disruption in neurodegenerative dementia, and (3) the cellular mechanisms associated with the disruption.

From aMCI to AD: The Role of Visuo-Spatial Memory Span and Executive Functions in Egocentric and Allocentric Spatial Impairments

A difficulty in encoding spatial information in an egocentric (i.e., body-to-object) and especially allocentric (i.e., object-to-object) manner, and impairments in executive function (EF) are typical in amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD). Since executive functions are involved in spatial encodings, it is important to understand the extent of their reciprocal or selective impairment. To this end, AD patients, aMCI and healthy elderly people had to provide egocentric (What object was closest to you?) and allocentric (What object was closest to object X?) judgments about memorized objects. Participants’ frontal functions, attentional resources and visual-spatial memory were assessed with the Frontal Assessment Battery (FAB), the Trail Making Test (TMT) and the Corsi Block Tapping Test (forward/backward). Results showed that ADs performed worse than all others in all tasks but did not differ from aMCIs in allocentric judgments and Corsi forward. Regression analyses showed, although to different degrees in the three groups, a link between attentional resources, visuo-spatial memory and egocentric performance, and between frontal resources and allocentric performance. Therefore, visuo-spatial memory, especially when it involves allocentric frames and requires demanding active processing, should be carefully assessed to reveal early signs of conversion from aMCI to AD.

Hippocampal Connectivity with Retrosplenial Cortex is Linked to Neocortical Tau Accumulation and Memory Function

The mechanisms underlying accumulation of Alzheimer's disease (AD)-related tau pathology outside of the medial temporal lobe (MTL) in older adults are unknown but crucial to understanding cognitive decline. A growing body of evidence from human and animal studies strongly implicates neural connectivity in the propagation of tau in humans, but the pathways of neocortical tau spread and its consequences for cognitive function are not well understood. Using resting state functional magnetic resonance imaging (fMRI) and tau PET imaging from a sample of 97 male and female cognitively normal older adults, we examined MTL structures involved in medial parietal tau accumulation and associations with memory function. Functional connectivity between hippocampus (HC) and retrosplenial cortex (RsC), a key region of the medial parietal lobe, was associated with tau in medial parietal lobe. By contrast, connectivity between entorhinal cortex (EC) and RsC did not correlate with medial parietal lobe tau. Further, greater hippocampal-retrosplenial (HC-RsC) connectivity was associated with a stronger correlation between MTL and medial parietal lobe tau. Finally, an interaction between connectivity strength and medial parietal tau was associated with episodic memory performance, particularly in the visuospatial domain. This pattern of tau accumulation thus appears to reflect pathways of neural connectivity, and propagation of tau from EC to medial parietal lobe via the HC may represent a critical process in the evolution of cognitive dysfunction in aging and AD.SIGNIFICANCE STATEMENT The accumulation of tau pathology in the neocortex is a fundamental process underlying Alzheimer's disease (AD). Here, we use functional connectivity in cognitively normal older adults to track the accumulation of tau in the medial parietal lobe, a key region for memory processing that is affected early in the progression of AD. We show that the strength of connectivity between the hippocampus (HC) and retrosplenial cortex (RsC) is related to medial parietal tau burden, and that these tau and connectivity measures interact to associate with episodic memory performance. These findings establish the HC as the origin of medial parietal tau and implicate tau pathology in this region as a crucial marker of the beginnings of AD.

Short Digital Spatial Memory Test Detects Impairment in Alzheimer's Disease and Mild Cognitive Impairment

BACKGROUND

Impairment in navigation abilities and object location memory are often seen in early-stage Alzheimer's Disease (AD), yet these constructs are not included in standard neuropsychological assessment. We investigated the differential ability of a short digital spatial memory test in mild AD dementia and mild cognitive impairment (MCI).

METHODS

21 patients with AD dementia (66.9 ± 6.9; 47% female), 22 patients with MCI (69.6 ± 8.3; 46% female) and 21 patients with subjective cognitive decline (SCD) (62.2 ± 8.9; 48% female) from the Amsterdam Dementia Cohort performed the Object Location Memory Test (OLMT), consisting of a visual perception and memory trial, and the Virtual Tübingen (VT) test, consisting of a scene recognition, route continuation, route ordering and distance comparison task. The correlations with other cognitive domains were examined.

RESULTS

Patients with mild AD dementia (Z: -2.51 ± 1.15) and MCI (Z: -1.81 ± 0.92) performed worse than participants with SCD (Z: 0.0 ± 1.0) on the OLMT. Scene recognition and route continuation were equally impaired in patients with AD dementia (Z: -1.14 ± 0.73; Z: -1.44 ± 1.13) and MCI (Z: -1.37 ± 1.25; Z: -1.21 ± 1.07). Route ordering was only impaired in patients with MCI (Z: -0.82 ± 0.78). Weak to moderate correlations were found between route continuation and memory (r(64) = 0.40, p < 0.01), and between route ordering and attention (r(64) = 0.33, p < 0.01), but not for the OLMT.

CONCLUSION

A short digital spatial memory test battery was able to detect object location memory and navigation impairment in patients with mild AD dementia and MCI, highlighting the value of incorporating such a test battery in standard neuropsychological assessment.

Supporting route learning in older adults: the role of imagery strategy

OBJECTIVES

Route learning is an everyday spatial ability important to individuals' independent living, and is known to decline with age. This study aimed to investigate the benefit of using an imagery strategy to support route learning in young and older adults.

METHODS

Forty young adults and 40 older adults learned a path from a video. Twenty of each age group were taught to use an imagery strategy (strategy groups [SGs]), while the others received no specific instructions (control groups [CGs]). Then participants were asked to recall the order and location of landmarks they had seen along the path (landmark ordering and locating tasks).

RESULTS

Young adults recalled the order and location of landmarks better than older adults, and the SGs outperformed the CGs regardless of age. The Age group x Learning group interaction was only significant for the landmark locating task, with the young CG performing better than the older CG, while the older SG proved as good at recalling landmark locations as the young SG. Further, it was only among the older adults that the SG outperformed the CG.

CONCLUSION

These findings newly suggest that using imagery helps to sustain older adults' route learning ability, especially in spatial recall tasks demanding the active manipulation of spatial information learnt, such as locating landmarks previously encountered while navigating a path. These results are discussed within the aging and spatial cognition frameworks.

Microcircuits for spatial coding in the medial entorhinal cortex

The hippocampal formation is critically involved in learning and memory and contains a large proportion of neurons encoding aspects of the organism’s spatial surroundings. In the medial entorhinal cortex (MEC), this includes grid cells with their distinctive hexagonal firing fields as well as a host of other functionally defined cell types including head direction cells, speed cells, border cells, and object-vector cells. Such spatial coding emerges from the processing of external inputs by local microcircuits. However, it remains unclear exactly how local microcircuits and their dynamics within the MEC contribute to spatial discharge patterns. In this review we focus on recent investigations of intrinsic MEC connectivity, which have started to describe and quantify both excitatory and inhibitory wiring in the superficial layers of the MEC. Although the picture is far from complete, it appears that these layers contain robust recurrent connectivity that could sustain the attractor dynamics posited to underlie grid pattern formation. These findings pave the way to a deeper understanding of the mechanisms underlying spatial navigation and memory.

The Measurement of Everyday Cognition (ECog): Revisions and Updates

INTRODUCTION

The Everyday Cognition scale (ECog), a measure of everyday functioning developed in 2008, is sensitive to early detection and progression of neurodegenerative disease. The goal was to update ECog item content to ensure relevancy to contemporary older adults from diverse backgrounds.

METHODS

Participants included 44 culturally diverse older adults (18 with normal cognition, 11 with mild cognitive impairment) and their study partners. Item understandability and relevance was evaluated using iterative interviewing methods that were analyzed using standard qualitative methods. On the basis of this information, items were modified, deleted, or developed as needed.

RESULTS

Of the 39 original items, 19 were revised, 3 new items were added (primarily to cover contemporary activities such as the use of technology), and 1 was deleted. The revised version (ECog-II) includes 41 items.

DISCUSSION

To ensure strong psychometric properties, and to facilitate harmonization of previously collected data, we preserved well over half of the items. Future work will validate the revised ECog by measuring associations with neuropsychological performance, external measures of disease, and other functional measures. Overall, the revised ECog will continue to be a useful tool for measuring cognitively relevant everyday abilities in clinical settings and intervention clinical trials.

Disrupted Network Topology Contributed to Spatial Navigation Impairment in Patients With Mild Cognitive Impairment

Impairment in spatial navigation (SN) and structural network topology is not limited to patients with Alzheimer’s disease (AD) dementia and can be detected earlier in patients with mild cognitive impairment (MCI). We recruited 32 MCI patients (65.91 ± 11.33 years old) and 28 normal cognition patients (NC; 69.68 ± 10.79 years old), all of whom underwent a computer-based battery of SN tests evaluating egocentric, allocentric, and mixed SN strategies and diffusion-weighted and T₁-weighted Magnetic Resonance Imaging (MRI). To evaluate the topological features of the structural connectivity network, we calculated its measures such as the global efficiency, local efficiency, clustering coefficient, and shortest path length with GRETNA. We determined the correlation between SN accuracy and network topological properties. Compared to NC, MCI subjects demonstrated a lower egocentric navigation accuracy. Compared with NC, MCI subjects showed significantly decreased clustering coefficients in the left middle frontal gyrus, right rectus, right superior parietal gyrus, and right inferior parietal gyrus and decreased shortest path length in the left paracentral lobule. We observed significant positive correlations of the shortest path length in the left paracentral lobule with both the mixed allocentric–egocentric and the allocentric accuracy measured by the average total errors. A decreased clustering coefficient in the right inferior parietal gyrus was associated with a larger allocentric navigation error. White matter hyperintensities (WMH) did not affect the correlation between network properties and SN accuracy. This study demonstrated that structural connectivity network abnormalities, especially in the frontal and parietal gyri, are associated with a lower SN accuracy, independently of WMH, providing a new insight into the brain mechanisms associated with SN impairment in MCI.