Spatial disorientation in Alzheimer's disease: The remembrance of things passed

Background: Patients with Alzheimer's disease (AD) and many older adults become lost even in familiar surroundings. This is commonly attributed to memory impairment, but it may reflect impaired spatial cognition. Methods: The authors examined the role of memory, perceptual, and cognitive mechanisms in spatial disorientation by comparing the performance of normal young (YN), middle-aged (MA), older adult (OA), and AD subjects on neuropsychological and spatial orientation tests. Results: The tendency to become lost is shared by almost all patients with AD (93%) and some OA subjects (38%). This impairment is not related to memory impairment. Instead, it reflects an inability to link recognized scenes with locations in the environment. Conclusions: Spatial disorientation reflects the impaired linking of landmarks and routes that should be assessed in conjunction with routine memory testing in elderly patients.