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The 4 Mountains Test: A Short Test of Spatial Memory with High Sensitivity for the Diagnosis of Pre-dementia Alzheimer's Disease
Published on: October 13, 2016
Spatial Navigation and Its Association With Biomarkers and Future Dementia in Memory Clinic Patients Without Dementia
Gro Gujord Tangen1, Maria H Nilsson2, Erik Stomrud2
1From the The Norwegian National Centre for Ageing and Health (G.G.T.), Vestfold Hospital Trust, Oslo ; Department of Geriatric Medicine (G.G.T.), Oslo University Hospital, Norway; Department of Health Sciences (M.H.N.), Lund Universityl Memory Clinic (M.H.N., E.S., S.P., O.H.), Skåne University Hospital, Malmö; and Clinical Memory Research Unit (M.H.N., E.S., S.P., O.H.), Department of Clinical Sciences Malmö, Lund University, Sweden. gro.tangen@aldringoghelse.no.
Background And Objectives:
Impaired spatial navigation is considered an early sign in many neurodegenerative diseases. We aimed to determine whether spatial navigation was associated with future dementia in patients with subjective cognitive decline (SCD) or mild cognitive impairment (MCI) and to explore associations between spatial navigation and biomarkers of Alzheimer disease (AD) and neurodegeneration.
Methods:
This study included memory clinic patients without dementia in the longitudinal BioFINDER cohort. The Floor Maze Test (FMT) was used to assess spatial navigation at baseline. Conversion to dementia was evaluated at 2-year and 4-year follow-ups. At baseline, amyloid-β 42/40 ratio, phosphorylated-tau (P-tau), and neurofilament light (NfL) were analyzed in CSF. Cortical thickness and volume of regions relevant for navigation and white matter lesion volume were quantified from MRI. The predictive role of the FMT for conversion to all-cause dementia was analyzed using logistic regression analyses in 2 models: (1) controlled for age, sex, and education and (2) adding baseline cognitive status and MMSE. Associations between FMT and biomarkers were adjusted for age, sex, and cognitive status (SCD or MCI).
Results:
One hundred fifty-six patients with SCD and 176 patients with MCI were included. FMT total time was associated with progression to all-cause dementia in model 2 at 2-year (OR 1.10, 95% CI 1.04-1.16) and at 4-year follow-up (OR 1.10, 95% CI 1.04-1.16), i.e., a 10% increase in odds of developing dementia per every 10 seconds increase in FMT. In the adjusted analyses, P-tau and NfL were associated with FMT total time, as well as hippocampal volume, parahippocampal, and inferior parietal cortical thickness. Amyloid-β 42/40 ratio was not associated with FMT total time.
Discussion:
Impaired spatial navigation was associated with conversion to dementia within 2 and 4 years and with key CSF and MRI biomarkers for AD and neurodegeneration in patients with SCD and MCI. This supports its use in early cognitive assessments, but the predictive accuracy should be validated in other cohorts.
Classification Of Evidence:
This is a Class I prospective cohort study demonstrating association of baseline markers of spatial recognition with development of dementia in patients with SCD or MCI at baseline.
