New screening tool targets hidden signs of cognitive decline

Difficulty finding your way around unfamiliar places or becoming disoriented in once-familiar surroundings could be an early warning sign of dementia, according to new research that is validating a novel navigation-based screening tool.

Researchers from Flinders University and collaborating institutions have developed the Spatial Navigation and Memory Questionnaire (SPAM), a self-report assessment designed to capture changes in both memory and navigation abilities that may signal early cognitive decline.

The findings, published in the Alzheimer's Association journal Alzheimer's & Dementia: Diagnosis, Assessment and Disease Monitoring, are based on a study of 940 older adults.

Lead author Dr Monique Boord said the questionnaire had shown promise as a way of assessing two cognitive domains that are being increasingly linked to early cognitive change.

“We found that the SPAM captured two distinct but related aspects of cognitive function, spatial navigation and memory responses, in healthy older adults. These findings provide support for the SPAM as a measure of these domains and its use in cognitive ageing,” she said.

“Difficulty navigating unfamiliar environments and subtle disorientation are common in Alzheimer's disease, and often precede noticeable memory loss and later significant navigational deficits.”

Growing evidence suggests changes in spatial navigation can emerge before more obvious symptoms associated with Alzheimer’s disease, such as significant memory impairment. The Flinders researchers said that despite this, navigation difficulties are not routinely assessed in many clinical settings.

The questionnaire was developed to address that gap by providing a practical and time-efficient way to assess both memory and navigation abilities, while also comparing a person’s recent experiences with their perceived lifetime functioning. Researchers say that feature may help identify subtle changes that could otherwise be overlooked.

The study found the questionnaire measured two distinct but related domains of cognition, memory and spatial navigation, and that poorer self-reported navigation ability was associated with poorer performance on an objective navigation assessment known as the Virtual Supermarket Test.

Senior co-author Dr Stephanie Wong said navigation difficulties were often noticed by patients and families long before they became part of a formal assessment.

“People in the early stages of dementia often face a hidden challenge. They begin to struggle with directions and get lost, even in familiar places,” she said.

“While patients notice these changes, clinicians haven’t had a step-by-step checklist to ask about them.

“Relying on personal memory is too subjective. By introducing a structured way to track these spatial navigational difficulties, our research team can help clinicians remove the guesswork, spot cognitive decline much sooner, and help families plan their loved ones’ safety.”

The authors say further research is needed before the questionnaire can be used diagnostically. The next phase will involve validating the tool in people with mild cognitive impairment and dementia to determine its clinical usefulness and establish meaningful cut-off scores.

The work forms part of the Spatial Navigation Assessment Validation and Implementation (SNAVI) project in Adelaide, which continues to recruit people with mild cognitive impairment and Alzheimer’s disease for further testing.

For more information about development of the new assessment, please email:
snavi.project@flinders.edu.au or call Dr Alexandra Wade on (08) 7421 9490.