Visual mechanisms of spatial disorientation in Alzheimer's disease

Impaired optic flow perception may contribute to the visuospatial disorientation of Alzheimer's disease (AD). We find that 36% of AD patients have elevated perceptual thresholds for left/right outward radial optic flow discrimination. This impairment is related to independent visual motion processing deficits affecting the perception of left/right motion-defined boundaries and in/out radial motion. Elevated optic flow thresholds in AD are correlated with greater difficulty in the Road Map test of visuospatial function (r = -0.5) and in on-the-road driving tests (r = -0.83). When local motion cues are removed from optic flow, subjects must rely on the global pattern of motion. This reveals global pattern perceptual deficits that affect most AD patients (85%) and some normal elderly subjects (21%). This deficit might combine with impaired local motion processing to undermine the alternative perceptual strategies for visuospatial orientation. The greater prevalence of global pattern deficits suggests that it might precede local motion processing impairments, possibly relating to the sequence of early hippocampal and later posterior cortical damage that is typical of AD.

Visual loss and getting lost in Alzheimer's disease

BACKGROUND

AD causes patients to get lost in familiar surroundings, in part because of visuospatial disorientation from parieto-occipital involvement. Parieto-occipital cortex analyzes the radial patterns of visual motion that create optic flow and guide movements through the environment by showing one's direction of self-movement.

OBJECTIVE

To determine whether AD patients are impaired in perceiving the visual patterns of optic flow, suggesting a perceptual mechanism of visuospatial disorientation.

METHODS

We studied the ability of young normal subjects, elderly normal subjects, and AD patients to see and interpret visual patterns, including the radial motion of optic flow. Each person sat in front of a panoramic computer display and gave push-button responses to indicate their perception of the projected visual stimuli. Spatial navigation was tested by asking questions about a recently traversed path.

RESULTS

Half of the AD subjects showed impaired optic flow perception that was associated with poor performance on the spatial navigation test, even though their perception of simple moving patterns was relatively preserved. Some AD subjects also showed a separate impairment in interpreting optic flow, so that they could not use those stimuli to judge their direction of self-movement.

CONCLUSIONS

AD greatly impairs the ability to see the radial patterns of optic flow. This may interfere with the use of visual information to guide self-movement and maintain spatial orientation.