Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
State University of Montes Claros (Unimontes), Montes Claros, MG, Brazil.
Exp Gerontol. 2022 Aug;165:111852. doi: 10.1016/j.exger.2022.111852. Epub 2022 May 27.
In this systematic review and meta-analysis, we compared the spatial navigation performance of older adults with mild cognitive impairment (MCI), Alzheimer's Disease (AD), and other dementias, using healthy older adults as controls. In addition, we evaluated the possible influence of the environment type (virtual and real), protocol (object- or environment-based), and the navigation mode (active and passive navigation) on spatial navigation task performance. In total, 1372 articles were identified and 24 studies were included in the meta-analysis. We found a large effect size on the spatial navigation performance of patients with cognitive decline (standardized mean difference (SMD) = 0.87, confidence interval (CI) = 0.62-1.09, p < 0.001), especially amnestic MCI (SMD = 1.10, CI = 0.71-1.49, p < 0.001) and patients with AD (SMD = 1.60, CI = 1.25-1.95, p < 0.001). However, the tasks did not identify mixed and vascular dementia (SMD = 0.92, CI = -0.33-2.18, p = 0.15 and SMD = 0.65, CI = -0.67-1.97, p = 0.33, respectively). Spatial navigation ability assessed using the Floor Maze Test showed the largest effect size in differentiating healthy older adults and patients with cognitive decline (SMD = 1.98,CI = 1.00-2.97, p < 0.001). In addition, tasks that require walking showed the greatest differences between the two groups. These results suggest that spatial navigation impairment is important, but disease-specific behavioral biomarker of the dementia pathology process that can be identified even in the early stages.
在这项系统评价和荟萃分析中，我们将轻度认知障碍（MCI）、阿尔茨海默病（AD）和其他痴呆症患者的空间导航表现与健康老年人进行了比较，并将其作为对照组。此外，我们还评估了环境类型（虚拟和真实）、方案（基于物体或基于环境）和导航模式（主动和被动导航）对空间导航任务表现的可能影响。总共确定了 1372 篇文章，并纳入了 24 项研究进行荟萃分析。我们发现认知衰退患者的空间导航表现存在较大的效应量（标准化均数差（SMD）= 0.87，置信区间（CI）= 0.62-1.09，p<0.001），特别是遗忘型 MCI（SMD=1.10，CI=0.71-1.49，p<0.001）和 AD 患者（SMD=1.60，CI=1.25-1.95，p<0.001）。然而，这些任务并未区分混合性痴呆和血管性痴呆（SMD=0.92，CI=0.33-2.18，p=0.15 和 SMD=0.65，CI=0.67-1.97，p=0.33）。使用地板迷宫测试评估的空间导航能力在区分健康老年人和认知衰退患者方面表现出最大的效应量（SMD=1.98，CI=1.00-2.97，p<0.001）。此外，需要行走的任务在两组之间表现出最大的差异。这些结果表明，空间导航障碍是重要的，但它是痴呆病理过程的特定疾病行为生物标志物，即使在早期阶段也可以识别。
