Memory loss is one of the best-known signs of dementia, but changes in thinking can appear in other ways.
One early warning may be something much more practical: finding it harder to work out where you are or how to get somewhere.
Researchers from Flinders University and collaborating institutions are studying whether problems with spatial navigation could help identify cognitive decline earlier.
They have tested a new questionnaire designed to measure how well older adults believe they can navigate places and remember information.
Spatial navigation is the brain’s ability to understand where we are and move from one place to another. It allows someone to remember the route to a shop, recognize landmarks, follow directions and find the way home.
Most people occasionally take a wrong turn or forget where they parked. The concern is when navigation becomes noticeably harder than it used to be, especially when a person becomes confused in places that should be familiar.
Research has suggested that these changes can occur early in Alzheimer’s disease. In some people, difficulty finding the way through unfamiliar surroundings or episodes of mild disorientation may appear before obvious memory problems become severe.
Despite this, navigation is not routinely examined during many standard cognitive assessments. Tests often concentrate on memory, language, attention and problem-solving, leaving everyday navigation difficulties less systematically measured.
To address this gap, researchers developed the Spatial Navigation and Memory Questionnaire, shortened to SPAM. The questionnaire provides a structured way for people to report changes in both their navigation abilities and their memory.
Dr. Monique Boord and Dr. Stephanie Wong, cognitive neuroscience researchers at Flinders University, led the assessment of the questionnaire. Their study included 940 older adults.
Participants answered questions about how they viewed their navigation and memory abilities. Importantly, the questionnaire asked them to consider both their abilities across their lifetime and their experiences during the previous three months.
This distinction could be useful because people naturally differ in their sense of direction. Someone who has always struggled with maps is different from a person who was once an excellent navigator but has recently started getting lost.
The researchers found that the questionnaire measured two separate but connected areas of thinking. One involved spatial navigation, while the other involved memory.
According to Boord, the results support the questionnaire as a way to measure these abilities in healthy older adults. This is an important first step toward determining whether it could eventually help clinicians recognize meaningful changes associated with cognitive aging.
Wong explained that navigation problems can be a hidden challenge during the early stages of dementia. People may begin having trouble with directions or getting lost even in familiar areas, yet there has not been a simple standardized checklist for clinicians to document these changes.
A structured questionnaire could make those conversations more consistent. Instead of relying only on a patient or family member remembering examples during an appointment, clinicians could ask the same organized questions and track changes over time.
Earlier recognition could have practical benefits beyond diagnosis. If someone is beginning to become disoriented, families may need to think about driving, walking alone, public transport, phone location tools and other safety measures before a serious incident occurs.
However, the SPAM questionnaire is not currently a stand-alone test for Alzheimer’s disease or dementia. Getting lost can happen for many reasons, and a person’s navigation ability can be influenced by vision, anxiety, attention, unfamiliar surroundings, physical health and normal differences in sense of direction.
The current research was also conducted in healthy older adults rather than people already diagnosed with dementia. The researchers say the questionnaire still needs to be tested and validated in people with dementia before it can be confidently used as a clinical tool in that population.
The study was published in Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring. It adds to a growing area of research examining whether changes in navigation can reveal brain changes that conventional memory-focused assessments may overlook.
The findings are promising because the questionnaire is simple, inexpensive and potentially much easier to use than specialized navigation experiments or brain imaging. A practical tool that takes little clinical time could make this overlooked aspect of cognitive health easier to assess.
Still, self-reported information has limits. People may underestimate or overestimate their abilities, and individuals experiencing cognitive decline may not always recognize how much their skills have changed.
For that reason, future research should examine how SPAM scores compare with real-world navigation tests, reports from family members, standard cognitive assessments and biological signs of Alzheimer’s disease. Researchers will also need to learn how accurately the questionnaire distinguishes normal aging from early disease.
Overall, the study does not show that occasional navigation mistakes mean someone has dementia. Instead, it suggests that a clear change in a person’s ability to find their way may contain useful information about cognitive health and deserves more attention in clinical care.
