Visuospatial impairment and resting-state network correlations in Alzheimer's disease: A systematic review

Alzheimer's disease (AD) exhibits distinct visuospatial impairments across its clinical subtypes, including typical amnestic AD and posterior cortical atrophy (PCA). Resting-state functional MRI (rs-fMRI) reveals disruptions in large-scale brain networks, yet the relationship between connectivity alterations and visuospatial deficits remains unclear.

We investigated visuospatial deficits across AD subtypes and identified affected brain networks to inform clinical interventions.

Six studies were reviewed by comparing visuospatial performance and rs-fMRI-derived functional connectivity in AD and healthy controls (HC). Effect sizes (Bonett's δ) for behavioral tasks and correlation coefficients (r) for imaging-clinical associations were synthesized.

Patients with AD exhibited significant visuospatial deficits, with moderate to large effect sizes in amnestic AD (δ = 1.0-1.5) and severe impairments in PCA (δ ≥ 3.0). Rs-fMRI revealed disrupted connectivity in three key networks: dorsal parietal-occipital networks (strongly linked to visuospatial deficits, especially in PCA), default mode network (DMN) (associated with memory but indirectly contributing to visual integration), and cerebellar-cortical circuits (implicated in early AD). Moderate correlations (r = 0.33-0.44, p < 0.05) were found between connectivity loss (DMN, cerebellar) and poor Rey-Osterrieth Complex Figure (ROCF) performance. However, some studies reported null associations, possibly due to compensatory mechanisms or methodological heterogeneity.

AD subtypes exhibit distinct network dysfunction patterns, with PCA showing severe posterior network disruption and amnestic AD involving broader DMN and cerebellar degeneration. Rs-fMRI provides valuable insights into the neural basis of visuospatial deficits, suggesting potential biomarkers for subtype-specific diagnosis and intervention.