Spatial reorientation decline in aging: the combination of geometry and landmarks

Virtual Reality and Serious Videogame-Based Instruments for Assessing Spatial Navigation in Alzheimer's Disease: A Systematic Review of Psychometric Properties

Over the past decade, research using virtual reality and serious game-based instruments for assessing spatial navigation and spatial memory in at-risk and AD populations has risen. We systematically reviewed the literature since 2012 to identify and evaluate the methodological quality and risk of bias in the analyses of the psychometric properties of VRSG-based instruments. The search was conducted primarily in July-December 2022 and updated in November 2023 in eight major databases. The quality of instrument development and study design were analyzed in all studies. Measurement properties were defined and analyzed according to COSMIN guidelines. A total of 1078 unique records were screened, and following selection criteria, thirty-seven studies were analyzed. From these studies, 30 instruments were identified. Construct and criterion validity were the most reported measurement properties, while structural validity and internal consistency evidence were the least reported. Nineteen studies were deemed very good in construct validity, whereas 11 studies reporting diagnostic accuracy were deemed very good in quality. Limitations regarding theoretical framework and research design requirements were found in most of the studies. VRSG-based instruments are valuable additions to the current diagnostic toolkit for AD. Further research is required to establish the psychometric performance and clinical utility of VRSG-based instruments, particularly the instrument development, content validity, and diagnostic accuracy for preclinical AD screening scenarios. This review provides a straightforward synthesis of the state of the art of VRSG-based instruments and suggests future directions for research.

Cultural determinants of the gap between self-estimated navigation ability and wayfinding performance: evidence from 46 countries

Cognitive abilities can vary widely. Some people excel in certain skills, others struggle. However, not all those who describe themselves as gifted are. One possible influence on self-estimates is the surrounding culture. Some cultures may amplify self-assurance and others cultivate humility. Past research has shown that people in different countries can be grouped into a set of consistent cultural clusters with similar values and tendencies, such as attitudes to masculinity or individualism. Here we explored whether such cultural dimensions might relate to the extent to which populations in 46 countries overestimate or underestimate their cognitive abilities in the domain of spatial navigation. Using the Sea Hero Quest navigation test and a large sample (N = 383,187) we found cultural clusters of countries tend to be similar in how they self-rate ability relative to their actual performance. Across the world population sampled, higher self-ratings were associated with better performance. However, at the national level, higher self-ratings as a nation were not associated with better performance as a nation. Germanic and Near East countries were found to be most overconfident in their abilities and Nordic countries to be most under-confident in their abilities. Gender stereotypes may play a role in mediating this pattern, with larger national positive attitudes to male stereotyped roles (Hofstede's masculinity dimension) associated with a greater overconfidence in performance at the national level. We also replicate, with higher precision than prior studies, evidence that older men tend to overestimate their navigation skill more than other groups. These findings give insight into how culture and demographics may impact self-estimates of our abilities.

Adults' Visual Cue Preferences and Wayfinding Abilities in Healthcare Centers

OBJECTIVES

Physical and visual elements that help people find their way around an environment are called visual cues (VCs). The current study aims to evaluate adults' wayfinding abilities (navigation, orientation, spatial anxiety, and distance estimation) and VC (navigational color coding) preferences in terms of color and position; additionally, investigates their differences in adults' life span phases (young adults, early middle-aged adults, and late middle-aged adults).

BACKGROUND

Wayfinding in complex environments such as healthcare centers has been challenging for most people. Although VCs are being used increasingly to facilitate wayfinding, considering people's preferences regarding VCs, especially navigational color coding, are neglected.

METHODS

Obtained data from a survey of 375 healthcare center visitors with textual and photo questionnaires were analyzed by descriptive statics and one-way analysis of variance.

RESULTS

Young adults preferred VCs with "mixed colors and positioned in the middle of the floor," early middle-aged adults preferred "warm color VCs in the middle of the wall," and late middle-aged adults preferred "warm color VCs at the bottom of the wall." Additionally, the results demonstrated that with aging, navigation and distance estimation abilities deteriorate, and spatial anxiety increases.

CONCLUSIONS

The outcomes of the present study increase our knowledge regarding the impact of adults' life span phases on their wayfinding abilities and VC preferences and offer suggestions for architects and healthcare center stakeholders to provide environments that improve adults' wayfinding.

A Systematic Review of Navigation Assistance Systems for People With Dementia

Technological developments provide solutions to alleviate the tremendous impact on the health and autonomy due to the impact of dementia on navigation abilities. We systematically reviewed the literature on devices tested to provide assistance to people with dementia during indoor, outdoor and virtual navigation (PROSPERO ID number: 215585). Medline and Scopus databases were searched from inception. Our aim was to summarize the results from the literature to guide future developments. Twenty-three articles were included in our study. Three types of information were extracted from these studies. First, the types of navigation advice the devices provided were assessed through: (i) the sensorial modality of presentation, e.g., visual and tactile stimuli, (ii) the navigation content, e.g., landmarks, and (iii) the timing of presentation, e.g., systematically at intersections. Second, we analyzed the technology that the devices were based on, e.g., smartphone. Third, the experimental methodology used to assess the devices and the navigation outcome was evaluated. We report and discuss the results from the literature based on these three main characteristics. Finally, based on these considerations, recommendations are drawn, challenges are identified and potential solutions are suggested. Augmented reality-based devices, intelligent tutoring systems and social support should particularly further be explored.

Virtual reality in the diagnostic and therapy for mental disorders: A systematic review

BACKGROUND

Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders.

OBJECTIVE

To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders.

DATA SOURCE

Systematic literature searches via PubMed (last literature update: 9^th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders.

ELIGIBILITY CRITERIA

To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology.

STUDY EVALUATION

For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria.

RESULTS

Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder.

CONCLUSION

While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application.

REVIEW REGISTRATION

PROSPERO register CRD42020188436.

FUNDING

The review was funded by budgets from the University of Bonn. No third party funding was involved.

The Legibility Efficacy of Historical Neighborhoods in Creating a Cognitive Map for Citizens

Nowadays, historical neighborhoods in Iran are in a state of decay due to the lack of spatial legibility with respect to their organic spatial layout. Hence, the level of interaction among people and their perception of the environment has gradually diminished. Historical neighborhoods no longer possess their former prosperity and function, and citizens prefer to inhabit neighborhoods with newer configurations to meet their demands. The aim of this study was to investigate the role of the spatial legibility of historical neighborhoods in creating a suitable cognitive map for citizens. Quantitative and qualitative methods were applied using a questionnaire and simulation test instruments. In addition, in order to analyze the spatial configuration of the target areas, the Space Syntax method was implemented using Depthmap 10. The findings indicated that landmarks and navigation signs were identified as the most important factors affecting legibility from the viewpoint of users. Furthermore, the correlation between integration and connectivity illustrated that the studied areas possessed poor spatial legibility due to the organic texture of their spatial configurations. Accordingly, solutions such as enhancing the interaction between highly integrated streets and identified landmarks were emphasized to ameliorate the legibility of these spaces. The present study contributes to sustainable urban design with respect to the rejuvenation of historical districts by proposing a set of pragmatic alterations of urban spatial configurations. This research may be fruitful for urban designers, planners and managers seeking to revitalize historical neighborhoods.

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.

Study of virtual reality for mild cognitive impairment: A bibliometric analysis using CiteSpace

Objectives

Non-invasive and low-cost virtual reality (VR) technology is important for early evaluation and intervention in mild cognitive impairment (MCI). This study aimed to demonstrate the current status of overseas and domestic research as well as the focus and frontier of VR technology among individuals with MCI through a bibliometric analysis.

Methods

Studies from the core collection of Web of Science™ between 1995 and 2020 were used; furthermore, CiteSpace 5.7 R3 was utilized to analyse information on authors/cited authors, keywords, burst words, and cited references.

Results

In total, 230 publications were identified. Most studies were published in the USA (45 publications) and Italy (41 publications), where Guiseppe Riva ranks first (14 publications), and Tarnanas I is the author with the highest centrality (0.44). The hot topics in VR applications in the MCI population are ‘physical activity,’ ‘people,’ ‘single-blind,’ ‘disease,’ ‘walking,’ ‘technology,’ ‘working memory,’ and ‘risk’ in recent years. The keyword ‘mild cognitive impairment’ has attracted extensive attention since 2012, showing the strongest citation outbreak (8.28). The clustering results of the literature show the research types and emerging trends, including ‘exergame,’ ‘serious games,’ ‘spatial navigation,’ ‘activities of daily living,’ ‘exercise,’ ‘enriched environment’ and ‘wayfinding.‘

Conclusions

Cognitive assessment and nonpharmacological intervention research on patients with MCI have become the focus of dementia prevention in recent years. Virtual technology, combined with traditional methods such as exercise therapy, provides new ideas for innovative cognitive evaluation and cognitive intervention.

The contribution of field independence in virtual spatial updating

Field independence (FI) is the extent to which a person perceives part of a field as discrete from the surrounding field rather than embedded in the field. Several studies proposed that it represents a cognitive style that is a relatively stable individuals’ predisposition towards information processing. This study investigated the effects of Field Independence/Field Dependence (FI/FD) cognitive style on topographic memory in a virtual environment. Seventy-nine college students completed the Embedded Figure Test as a measure of FI/FD cognitive style and learned two paths in the VR-Walking Corsi Test apparatus. After the learning phase, participants had to reproduce the paths from a familiar perspective or unfamiliar perspectives. Data showed that FI cognitive style predicted the ability to reproduce a path from unfamiliar perspectives, suggesting a different impact of the angle degree. Results are discussed considering the facilitation of body axes references and the increasing difficulty due to maintaining online perspectives with higher angle degrees that increase the visuo-spatial working memory cognitive load. These results support the idea that FI predicts human navigation.

The impact of age and familiarity with the environment on categorical and coordinate spatial relation representations

Retrieving spatial information is a crucial everyday ability that is affected by age-related changes. Previous research has shown that this change is mediated by familiarity with an environment. The present research uses a series of landmark location tasks to extend and deepen our understanding of the role of aging in spatial mental representations of more or less familiar environments, also disentangling the contribution of coordinate and categorical spatial relations. The study tested the following hypotheses: (1) younger adults only have an advantage over the elderly in less familiar environments; (2) the advantage for categorical over coordinate spatial relations is mainly found for less familiar environments; and finally; (3) interactions between age, familiarity, and spatial relations might reveal that the effects of age and familiarity take different trajectories for coordinate and categorical spatial relations. Results confirmed that: (1) young people outperform the elderly only in less familiar environments; (2) there is a reduction in the difference between coordinate and categorical accuracy with increasing familiarity with the environment; while (3) the interaction between age and level of familiarity did not significantly differentiate coordinate from categorical spatial relations. In conclusion, the present study provides new evidence for the role of familiarity with geographical areas and its impact on the representation of categorical and coordinate relations, with practical implications for the assessment of topographical disorientation in aging.

Differential Brain Activity in Regions Linked to Visuospatial Processing During Landmark-Based Navigation in Young and Healthy Older Adults

Older adults have difficulties in navigating unfamiliar environments and updating their wayfinding behavior when faced with blocked routes. This decline in navigational capabilities has traditionally been ascribed to memory impairments and dysexecutive function, whereas the impact of visual aging has often been overlooked. The ability to perceive visuospatial information such as salient landmarks is essential to navigating efficiently. To date, the functional and neurobiological factors underpinning landmark processing in aging remain insufficiently characterized. To address this issue, functional magnetic resonance imaging (fMRI) was used to investigate the brain activity associated with landmark-based navigation in young and healthy older participants. The performances of 25 young adults (μ = 25.4 years, σ = 2.7; seven females) and 17 older adults (μ = 73.0 years, σ = 3.9; 10 females) were assessed in a virtual-navigation task in which they had to orient using salient landmarks. The underlying whole-brain patterns of activity as well as the functional roles of specific cerebral regions involved in landmark processing, namely the parahippocampal place area (PPA), the occipital place area (OPA), and the retrosplenial cortex (RSC), were analyzed. Older adults' navigational abilities were overall diminished compared to young adults. Also, the two age groups relied on distinct navigational strategies to solve the task. Better performances during landmark-based navigation were associated with increased neural activity in an extended neural network comprising several cortical and cerebellar regions. Direct comparisons between age groups revealed that young participants had greater anterior temporal activity. Also, only young adults showed significant activity in occipital areas corresponding to the cortical projection of the central visual field during landmark-based navigation. The region-of-interest analysis revealed an increased OPA activation in older adult participants during the landmark condition. There were no significant between-group differences in PPA and RSC activations. These preliminary results hint at the possibility that aging diminishes fine-grained information processing in occipital and temporal regions, thus hindering the capacity to use landmarks adequately for navigation. Keeping sight of its exploratory nature, this work helps towards a better comprehension of the neural dynamics subtending landmark-based navigation and it provides new insights on the impact of age-related visuospatial processing differences on navigation capabilities.

The differential effect of normal and pathological aging on egocentric and allocentric spatial memory in navigational and reaching space

BACKGROUND

Topographical disorientation (TD) refers to a particular condition which determines the loss of spatial orientation, both in new and familiar environments. TD and spatial memory impairments occur relatively early as effect of cognitive decline in aging, even in prodromal stages of dementia, namely mild cognitive impairment (MCI).

AIMS

(a) To show that components linked to the recall of familiar spatial knowledge are relatively spared with respect to the learning of unfamiliar ones in normal aging, while they are not in MCI, and (b) to investigate gender differences for their impact on egocentric and allocentric frames of reference.

METHOD

Forty young participants (YC), 40 healthy elderly participants (HE), 40 elderly participants with subjective memory complaints (SMC), and 40 elderly with probable MCI were administered with egocentric and allocentric familiar tasks, based on the map of their hometown, and with egocentric and allocentric unfamiliar tasks, based on new material to be learned. A series of general linear models were used to analyze data.

RESULTS

No group differences were found on egocentric task based on familiar information. MCI performed worse than the other groups on allocentric tasks based on familiar information (YC = HE = SMC > MCI). Significant differences emerged between groups on egocentric and allocentric tasks based on unfamiliar spatial information (YC > HE = SMC > MCI). A gender difference was found, favoring men on allocentric unfamiliar task.

CONCLUSION

Familiarity of spatial memory traces can represent a protective factor for retrospective components of TD in normal aging. Conversely, using newly learned information for assessment may lead to overestimating TD severity.

Age-related differences in the elderly in a spatial recognition task

Spatial memory is a cognitive ability which declines with ageing thus showing changes in some process such as the use of allocentric strategies. These age-related changes in spatial orientation suggest that this skill could be an adequate marker of cognitive decline. Many tasks used in investigation to assess spatial memory demand a participant's active role, which involves that the navigational experience is different for everyone. In this study, the Almeria Spatial Memory Recognition Test (ASMRT), a test based on a recognition paradigm, was used to offer the same experience with the environment. The aim of this research was to determine if the ASMRT is suitable to be applied in the elderly and detect spatial memory differences as one age. The ASMRT and other neuropsychological tests were applied in a sample aged between 50and 79 years. Results revealed a decrease in the ASMRT performance by the older group. No gender differences were found. Performance in attention and visuospatial working memory tests revealed some correlations with the ASMRT performance. In conclusion, this study demonstrates that 70-79-year-old participants clearly show age-related changes in spatial memory. Thanks to its simplicity the ASMRT could be used as a screening test in medical practice.

Memory for familiar locations: The impact of age, education and cognitive efficiency on two neuropsychological allocentric tasks

This research aims to reconsider and support the use of spatial tasks based on familiar geographical information in the neuropsychological assessment of topographical (dis)orientation. Performance on two spatial tasks based on familiar information -l andmark positioning on a map and map of Italy - were compared in two studies assessing allocentric orientation among young and healthy elderly with different levels of education (Study 1) and elderly with and without probable cognitive impairment (Study 2). Results from Study 1 showed that the map of Italy task was affected by education, while the landmark positioning on a map was not. Results of Study 2 showed that both tasks were sensitive to different levels of cognitive functioning in a sample of community-dwelling seniors. Overall, spatial tasks based on mental representation of the hometown environment may be an important supplement in the assessment of allocentric topographical disorientation, discriminating typical from atypical aging.