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Case Reports
. 2018 Jan-Mar;12(1):85-91.
doi: 10.1590/1980-57642018dn12-010013.

Diagnostic relevance of spatial orientation for vascular dementia: A case study

Gillian Coughlan  1 , Emma Flanagan  1 , Stephen Jeffs  1 , Maxime Bertoux  1 , Hugo Spiers  2 , Eneida Mioshi  3 , Michael Hornberger  1   4
Affiliations
Case Reports

Diagnostic relevance of spatial orientation for vascular dementia: A case study

Gillian Coughlan et al. Dement Neuropsychol. 2018 Jan-Mar.

Abstract
in English, Portuguese

Spatial orientation is emerging as an early and reliable cognitive biomarker of Alzheimer's disease (AD) pathophysiology. However, no evidence exists as to whether spatial orientation is also affected in vascular dementia (VaD).

Objective: To examine allocentric (map-based) and egocentric (viewpoint-based) spatial orientation in an early stage VaD case.

Methods: A spatial test battery was administered following clinical and neuropsychological cognitive evaluation.

Results: Despite the patient's complaints, little evidence of episodic memory deficits were detected when cueing was provided to overcome executive dysfunction. Similarly, medial temporal lobe-mediated allocentric orientation was intact. By contrast, medial parietal-mediated egocentric orientation was impaired, despite normal performance on standard visuospatial tasks.

Conclusion: To our knowledge, this is the first in-depth investigation of spatial orientation deficits in VaD. Isolated egocentric deficits were observed. This differs from AD orientation deficits which encompass both allocentric and egocentric orientation deficits. A combination of egocentric orientation and executive function tests could serve as a promising cognitive marker for VaD pathophysiology.

A orientação espacial está emergindo como um biomarcador cognitivo precoce e confiável da fisiopatologia da doença de Alzheimer (DA). No entanto, não existe evidência de que a orientação espacial também seja afetada na demência vascular (DVa).

Objetivo: Examinar a orientação espacial alocêntrica (baseada em mapas) e egocêntrica (baseada no ponto de vista) em um caso de DVa em fase incial.

Métodos: Uma bateria de testes espaciais foi administrada após avaliação clínica e neuropsicológica cognitiva.

Resultados: Apesar das queixas do paciente, poucas evidências de déficits de memória episódica foram detectadas quando foram fornecidas pistas para superar a disfunção executiva. Da mesma forma, a orientação alocêntrica mediada pelo lobo temporal medial estava intacta. Em contrapartida, a orientação egocêntrica mediada pela região parietal medial estava comprometida, apesar do desempenho normal em tarefas visuoespaciais padrão.

Conclusão: Pelo nosso conhecimento, esta é a primeira investigação aprofundada dos déficits de orientação espacial na DVa. Foram observados déficits egocêntricos isolados. Isso difere dos déficits de orientação da DA que abrangem déficits de orientação alocêntricos e egocêntricos. Uma combinação de orientação egocêntrica e testes de função executiva poderia servir como um marcador cognitivo promissor para a fisiopatologia de DVa.

Keywords: VaD; allocentric; egocentric; executive function; neurodegeneration; spatial orientation; vascular dementia.

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Conflict of interest statement

Disclosure: The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Screenshots from the Supermarket task, showing i) start viewpoint; ii) movement during an example video clip; iii) end location of an example video clip; iv) ‘onscreen instructions prompting the participant to indicate the direction of their starting point’; v) the supermarket map participants use to indicate their finishing location and their heading direction when the video clip ends
Figure 2
Figure 2. Screenshots from wall, stool and memory subtasks of the Statue test. Participants view images and are asked i) identify the statue closest to the wall (permanent landmark), ii) identify the statue closest to the stool (transient landmark), iii) identify which statue moved its location. Note, red circled figures are only shown for illustration purposes to identify the correct choice for each example, which was not shown to the participants.
See this image and copyright information in PMC

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