背景:越来越多的证据表明,空间导航的损害,方向和记忆可能代表了阿尔茨海默病(AD)的最早特征之一,在其他认知领域的先前缺陷。这与与空间处理有关的颞叶和顶叶大脑区域的早期病理性tau和淀粉样蛋白沉积一致。然而,目前尚不清楚哪些指标和空间行为可以区分高风险,临床前或前驱AD个体,和ii)可以用适合未来在临床实践中大规模部署的数字设备捕获。我们通过系统回顾来解决这一知识差距。
方法:按照PRISMA指南搜索两个数据库(PubMed/WebofScience)。不同痴呆类型的医学副标题关键词与前驱结合,临床前和遗传或疾病危险因素术语。我们纳入了直到2022年10月发表的研究,这些研究收集了以自我为中心或以分配为中心的处理的数字或物理客观测量(寻路,定位,参考框架平移,路线学习或路径整合)。我们排除了其他疾病或痴呆症的诊断,无生物标志物的MCI横断面研究,年轻人,案例研究,介入研究或没有适当控制的研究。
结果:从316篇确定的摘要中纳入25篇文章。没有人调查非AD痴呆症。从38个不同的任务中提取了131个指标,其中31位数字(81%)。82个指标显示了痴呆前AD组的分化(63%)。我们将这些统一为21个不同的汇总指标,涵盖了主动或被动跟踪的空间行为的四个领域。在所有域中,记录导航效率下降的指标(即寻找目标所需的距离或时间)和准确性(即与目标的距离或角度)的报告频率最高,但自我中心的前驱分化优于临床前组。用于日常GPS数据的路径集成和被动跟踪的度量很有希望,但相对不足。
结论:对于未来的临床应用,空间测试将需要对已建立的疾病标志物进行标准化和验证。这些审查数据将为选择数字工具提供信息,以评估处于风险中的空间行为,临床前和前驱AD人群作为EDoN计划的一部分。
BACKGROUND: Increasing evidence suggests that impairments of spatial navigation, orientation and memory may represent one of the earliest features Alzheimer\'s disease (AD), preceding deficits in other cognitive domains. This is consistent with early pathological tau and amyloid deposition in temporal and parietal brain regions implicated in spatial processing. However, it remains unclear which metrics and spatial behaviours can i) differentiate high-risk, preclinical or prodromal AD individuals, and ii) may be captured with digital devices suitable for future deployment at scale in clinical practice. We addressed this knowledge gap with a systematic review.
METHODS: Two databases (PubMed/Web of Science) were searched following PRISMA guidelines. Medical subheading keywords for different dementia types were combined with prodromal, preclinical and genetic or disorder risk factor terms. We included studies published until October 2022 that collected digital or physical objective measures of egocentric or allocentric processing (wayfinding, orientation, reference frame translation, route learning or path integration). We excluded diagnoses of other conditions or dementia, cross-sectional MCI studies without biomarkers, young adults, case studies, interventional studies or studies without appropriate controls.
RESULTS: 25 articles were included from 316 identified abstracts. None investigated non-AD dementias. 131 metrics were extracted from 38 different tasks, of which 31 where digital (81%). 82 metrics showed differentiation of predementia AD groups (63%). We harmonised these into 21 distinct summary metrics covering four domains of active or passively tracked spatial behaviours. Across all domains, metrics capturing decreased navigation efficiency (i.e. distance or time required to find goals) and accuracy (i.e. distance or angle from goal) were most frequently reported, but egocentric better differentiated prodromal than preclinical groups. Metrics for path integration and passive tracking of everyday GPS data were promising but relatively under-explored.
CONCLUSIONS: For future clinical use, spatial tests will require standardisation and validation against established markers of disease. These review data will inform the selection of digital tools to assess spatial behaviours in at-risk, preclinical and prodromal AD populations as part of the EDoN Initiative.