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Wayfinding in a Nursing Home for Advanced Dementia of the Alzheimer’s Type

The aim of the study was to generate design criteria in order to encourage and facilitate wayfinding for advanced Alzheimer’s patients. Two sources of data were used: interviews with the staff of a typical urban nursing home, and a wayfinding experience with its residents. The results show that even patients with severe cognitive deterioration are able to reach certain destinations. Wayfinding decisions have to be based on environmental information that is readily accessible, so that the patient can proceed from decision point to decision point. Monotony of architectural composition and the lack of reference points render wayfinding difficult. The elevators are seen to be a major anxiety-causing barrier. Visual access to the main destinations increases their use and facilitates wayfinding. Signage has an important function, creating redundancy in wayfinding communication and compensating for the loss of memory and spatial understanding. Floor patterns and dark lines or surfaces can disorient the patients and cause anxiety.

Wayfinding in dementia of the Alzheimer type: planning abilities.

This paper reports on wayfinding in dementia, in particular the ability to develop decision plans for solving wayfinding problems in unfamiliar settings. Fourteen patients diagnosed as having mild to moderate dementia of the Alzheimer type (DAT), and 28 normal elderly were asked to reach a destination in a large hospital setting, and to return to the point of departure. Verbalizations of all subjects were recorded, transcribed, and content-analyzed in order to identify the decisions made during the trip and to establish their functional relationships revealing their planning abilities. Results showed that all DAT patients failed to reach the destination and return to the point of departure without errors. Compared to normal elderly subjects, their overall decision plans were poorly structured, indicating basic problem-solving disorders. However, they were able to solve well-defined problems and develop sub-plans in routine situations when the necessary information was readily available. Nondiscriminatory reading of irrelevant information was also observed and tended to interfere with problem-solving.

Wayfinding in the blind: larger hippocampal volume and supranormal spatial navigation.

In the absence of visual input, the question arises as to how complex spatial abilities develop and how the brain adapts to the absence of this modality. We explored navigational skills in both early and late blind individuals and structural differences in the hippocampus, a brain region well known to be involved in spatial processing. Thirty-eight participants were divided into three groups: early blind individuals (n = 12; loss of vision before 5 years of age; mean age 33.8 years), late blind individuals (n = 7; loss of vision after 14 years of age; mean age 39.9 years) and 19 sighted, blindfolded matched controls. Subjects undertook route learning and pointing tasks in a maze and a spatial layout task. Anatomical data was collected by MRI. Remarkably, we not only show that blind individuals possess superior navigational skills than controls on the route learning task, but we also show for the first time a significant volume increase of the hippocampus in blind individuals [F(1,36) = 6.314; P < or = 0.01; blind: mean = 4237.00 mm(3), SE = 107.53; sighted: mean = 3905.74 mm(3), SE = 76.27], irrespective of whether their blindness was congenital or acquired. Overall, our results shed new light not only on the construction of spatial concepts and the non-necessity of vision for its proper development, but also on the hippocampal plasticity observed in adult blind individuals who have to navigate in this space.

The Spatio-Cognitive Abilities of the Visually Impaired Population:

This article reports on an experiment undertaken to test the spatiocognitive competence of the visually impaired population in regard to wayfinding. The test consisted of eight basic wayfinding tasks, each representing a particular spatio-cognitive operation. The tasks were executed in a labyrinthian layout allowing for control of the difficulty level of the tasks and limiting extraneous perceptual factors, which tended to interfere with the measure of spatio-cognitive abilities. The experimental groups were composed of congenitally totally blind, adventitiously totally blind, and subjects with a weak visual residue; the control was established by a sighted and a sighted blindfolded group. The samples 18 subjects per group were matched in terms of age, education, and sex. The performance results of the visually impaired groups in all eight tasks led to rejection of any spatio-cognitive deficiency theory. The performance of the congenitally totally blind group, in particular, shows that spatio-cognitive competence can be acquired without vision and without previous visual experience. The congenitally totally blind tend to perform better than the adventitiously totally blind and the sighted blindfolded groups, but not as well as the sighted and the group with a visual residue. The visually impaired groups, in general, tend to take more time to complete the tasks than the sighted control group. The results also show that age and education affect performance, but sex does not.

Neuronal substrates of haptic shape encoding and matching: A functional magnetic resonance imaging study

We used functional magnetic resonance imaging to differentiate cerebral areas involved in two different dimensions of haptic shape perception: encoding and matching. For this purpose, healthy right-handed subjects were asked to compare pairs of complex 2D geometrical tactile shapes presented in a sequential two-alternative forced-choice task. Shape encoding involved a large sensorimotor network including the primary (SI) and secondary (SII) somatosensory cortex, the anterior part of the intraparietal sulcus (IPA) and of the supramarginal gyrus (SMG), regions previously associated with somatosensory shape perception. Activations were also observed in posterior parietal regions (aSPL), motor and premotor regions (primary motor cortex (MI), ventral premotor cortex, dorsal premotor cortex, supplementary motor area), as well as prefrontal areas (aPFC, VLPFC), parietal-occipital cortex (POC) and cerebellum. We propose that this distributed network reflects construction and maintenance of sensorimotor traces of exploration hand movements during complex shape encoding, and subsequent transformation of these traces into a more abstract shape representation using kinesthetic imagery. Moreover, haptic shape encoding was found to activate the left lateral occipital complex (LOC), thus corroborating the implication of this extrastriate visual area in multisensory shape representation, besides its contribution to visual imagery. Furthermore, left hemisphere predominance was shown during encoding, whereas right hemisphere predominance was associated with the matching process. Activations of SI, MI, PMd and aSPL, which were predominant in the left hemisphere during the encoding, were shifted to the right hemisphere during the matching. In addition, new activations emerged (right dorsolateral pre-frontal cortex, bilateral inferior parietal lobe, right SII) suggesting their specific involvement during 2D geometrical shape matching.

The criterion-related validity of the IADL Profile with measures of executive functions, indices of trauma severity and sociodemographic characteristics

Primary objective: To examine relationships between classical measures of executive functions (EF) and indices of traumatic brain injury (TBI) severity with the IADL Profile, a new performance-based measure of independence in instrumental activities of daily living (IADL) based on EF. This study hypothesized the presence of correlations between classical tests of EF and the IADL Profile, as the latter aims to establish whether the subjects main difficulties pertain to goal formulation, planning, carrying out the task and/or attaining the initial task goal; all important components of EF. Methods and procedures: One hundred subjects with a moderate/severe TBI aged 16–65 years (convenience sample) were recruited. Subjects were tested with the IADL Profile and three measures of EF within their home environment. Data was analysed using Pearson correlations, t-tests and multiple stepwise regressions. Results: Post-traumatic amnesia and working memory emerged as the major determinants of IADL Profile scores. Together, indices of injury severity, measures of EF, education, age and environmental factors accounted for 12–28% of the variance in IADL Profile scores. Conclusions: This study has shown that the IADL Profiles non-structured approach permits the observation of a broad range of behaviours related to EF deficits and thus provides a closer approximation of the persons independence in IADL. Further study is required to demonstrate the IADL Profiles ability to inform more targeted treatment interventions.

The factorial validity and internal consistency of the Instrumental Activities of Daily Living Profile in individuals with a traumatic brain injury

The objective of the study was to investigate the factorial validity and internal consistency of the Instrumental Activities of Daily Living (IADL) Profile. A group of 96 patients aged 16 to 65 years, with moderate to severe traumatic brain injuries, was recruited from 12 rehabilitation hospitals in Quebec. The IADL Profile was administered by an occupational therapist in each subjects home and community environment. Principal axis factoring and confirmatory factor analysis provide preliminary support for six correlated factors (F): (F1) going to grocery store/shopping for groceries, (F2) having a meal with guests/cleaning up, (F3) putting on outdoor clothing, (F4) obtaining information, (F5) making a budget, (F6) preparing a hot meal for guests. Total explained variance was 73.6%. Cronbachs alpha analysis revealed high to very high internal consistency for all scales ranging from .81 to .98; internal consistency of the total scale was very high (0.95). The findings suggest that the IADL Profile is a promising means of documenting both IADL independence and the repercussions of executive function deficits on everyday tasks in real-world environments.

Executive function deficits in persons with mild cognitive impairment: A study with a Tower of London task

This study assessed executive functions in persons with mild cognitive impairment (MCI) using the Tower of London (TOL). A second objective was to study the impact of three types of problem selected according to the presence or absence of a “trigger.” A trigger (T) is an incitation to the participant, at the first move, to move a ball to its final position according to the model. A positive trigger (T+) is helpful, while a negative trigger (T−) creates an obstruction. Some problems have no trigger (N). This study includes 81 participants with MCI. After follow-up, one year later, two subgroups were distinguished: (a) 51 (63%) participants did not convert or decline (stable MCI); (b) 30 (37%) participants showed significant decline or progressed to dementia (decliner MCI). Persons with MCI were compared to an older adult group matched with respect to sex, age, and education. For the successes, there was a significant group difference between the three types of problem. The post hoc analysis showed that T+ took significantly less time than N or T−. There were significantly more successes for T+ than N, and these two types of problem had more success than T−. For “total number of moves,” there was no significant difference between the groups. In post hoc analysis, T− involved more moves than N or T+. In qualitative analysis, T− MCI decliners produced significantly more rule breakings than the stable MCI and controls. A dysfunction in self-monitoring is a characteristic feature of persons with MCI.

A Multiple Case Study of Wayfinding in Dementia of the Alzheimer Type: Decision Making

Difficulties in finding ones way around familiar and unfamiliar places are among the first clinical signs of dementia of the Alzheimer type (DAT). Few systematic studies have directly examined this ability. This paper reports on wayfinding abilities and decision making of fourteen patients at the early and intermediate stages of the disease. They were asked to reach a destination in a hospital. Each patient was matched with two control subjects. Their verbalizations during the route were recorded, transcribed and content-analyzed to identify decisions according to a pre-established typology. Multiple correspondence analysis was used to reveal patterns of decision making. For the original trip, results showed that DAT patients still had the ability to deal with decisions considered basic and concrete. However, decisions based on higher intellectual abilities were much more difficult.

Inhibition and object relations in borderline personality traits after traumatic brain injury

This study aims to assess the nature and severity of borderline traits after traumatic brain injury (TBI). Thirty subjects with moderate or severe TBI were compared to 30 normal controls on the Revised Diagnostic Interview for Borderlines (DIB-R), a dimensional measure of borderline traits, the Go-no go inhibition task, the Complexity of Representations of People and Affect-Tone Relationships Paradigms, two scales from the Social Cognition and Object Relations Scale (SCORS) evaluating the quality of object relations, an estimation of pre-morbid borderline severity, the Beck Depression Inventory (BDI) and various neuropsychological measures. Results indicate that TBIs present more borderline symptoms and traits than controls. However, the severity of borderline symptomatology remains comparatively low for the vast majority. As expected, the TBI group showed a poorer performance on the Go-no go task, a characteristic neuropsychological inhibition deficit. Yet, both samples present similar profiles on the SCORS. Finally, the DIB-R was correlated with the Affect-Tone scale, the BDI and with the pre-morbid severity estimation. Results suggest that post-TBI borderline traits remain rare and relate more to the affective quality of object relations, negative affects and pre-morbid borderline pathology than inhibition deficits.