![]() We thus conducted an outdoor navigation study on a sample of community-dwelling patients with AD and age-matched healthy controls, using GPS tracking over a 2-week period. Specifically, we are interested in mobility risk factors, which if identified can potentially be used to establish which individuals may be at a high risk for getting lost in the community. Exploring this relationship can potentially offer insight into variables that are associated with spatial disorientation. However, none of these studies have related the measured navigation patterns of these individuals to the occurrence of spatial disorientation or environmental risk factors. ![]() To date, very few studies have investigated the outdoor navigation patterns of patients with AD in the community, exploring these patterns in a general sense and, more specifically, relating them to factors such as caregiver burden and the individual’s own well-being. However, these factors were identified using retrospective police case reports of missing people with dementia, and owing to the unavailability of trajectory data for the missing individuals, the true extent to which these factors contribute to spatial disorientation is unclear. In addition to the spatial navigation impairments, previous studies from our group have suggested that certain environmental factors, such as increased outdoor landmark density and complex road network structure, may act as risk factors for spatial disorientation by potentially triggering patients to make navigation errors. Such navigation impairments can play a fundamental role in causing patients to make navigation errors when out in the community that they are ultimately unable to recover from, and hence leading to them getting lost. For example, neuropathology induced alterations to the medial temporal and parietal lobe structures result in impairments to egocentric (body-based) and allocentric (map-based) navigation strategies, respectively, as well as the interaction between the two. Indeed, this is due to the pattern in which the AD neuropathology spreads, appearing early in regions of the brain that underlie spatial navigation. From a neural standpoint, it has been suggested that spatial disorientation is seen more in AD as opposed to in other dementias. ĭespite getting lost episodes leading to significant negative consequences for the patients, their carers, and beyond, very little is still known about exactly why these episodes, and spatial disorientation in general, occur in patients with AD. ![]() Extending beyond the patients themselves, other consequences of these episodes include increasing carer burden and distress as well as the involvement of law enforcement groups (ie, the police) and community search resources. Getting lost episodes can cause various negative consequences for the patients, such as increasing their chances of a care home admission by 7 times, decreasing their sense of autonomy, and increasing their risk of sustaining injuries and even potential death. Īlthough unpredictable in its onset, common real-world situations where patients with AD are likely to experience a getting lost episode include (1) when they perform routine activities in the community (ie, daily neighborhood walks and going to the corner shop), (2) when they are purposefully left unsupervised by their carer (ie, waiting for carer outside the shop), and (3) during night time while the carer is asleep. Indeed, up to 40,000 people with dementia in the United Kingdom get lost in the community for the first time every year, and these incidence rates are likely to increase with the projected global rise in the patient population of dementia. Being a prevalent problem worldwide, up to 70% of patients with dementia experience at least 1 getting lost episode over their disease course, while others experience multiple episodes. This symptom manifests behaviorally as patients making navigation errors when in the community, which in turn can lead to a risk of them getting lost in both unfamiliar and familiar environments. ![]() It is defined as moments where patients are unsure about their whereabouts and are unable to navigate to an intended location. Spatial disorientation is one of the earliest and most distressing symptoms seen in patients with Alzheimer disease (AD).
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