Behavioral alterations of spatial cognition and role of the Apolipoprotein E-ε4 in patients with MCI due to Alzheimer’s disease: results from the BDSC-MCI project

Background: Beyond memory deterioration, spatial disorientation may occur along the continuum of normal aging—dementia of Alzheimer’s type. The present study aims at detecting behavioral disorders of spatial cognition in prodromal Alzheimer’s disease (AD) and verifying the association between Apolipoprotein E-ε4 (ApoE-ε4) genotype and gait patterns during a real-world naturalistic task. Methods: A sample of 58 elderly participants, of which 20 patients with mild cognitive impairment with CFS biomarker evidence of AD, 23 individuals with subjective cognitive decline (SCD), and 15 healthy controls (HCs), was tested by a modified version of the Detour Navigation Test (DNT-mv). Generalized linear models were run to explore the association between group belonging and wrong turns (WTs)/moments of hesitation (MsH) as behavioral disorientation scores of the DNT-mv as well as the effect of ApoE-ε4 genotype on time and walking speed registered by a smartphone app providing GPS tracking of body movement around urban environments. Results: Patients with MCI due to AD reported more WTs than individuals with SCD and HCs. Further, the ApoE-ε4 genotype determined a lower capacity in spatial information processing, influencing gait during naturalistic spatial navigation tasks. Conclusions: Behavior alterations of spatial cognition can be detected ecologically in prodromal AD. The use of technological solutions supporting gait analysis may help in corroborating the experimental observation.