A cognitive–motor framework for spatial navigation in aging and early-stage Alzheimer's disease

Spatial navigation is essential for wellbeing and independence and shows significant declines as part of age-related neurodegenerative disorders, such as Alzheimer's disease. Navigation is also one of the earliest behaviors impacted by this devastating disease. Neurobiological models of aging and spatial navigation have focused primarily on the cognitive factors that account for impaired navigation abilities during the course of healthy aging and early stages of preclinical and prodromal Alzheimer's disease. The contributions of physical factors that are essential to planning and executing movements during successful navigation, such as gait and dynamic balance, are often overlooked despite also being vulnerable to early stages of neurodegenerative disease. We review emerging evidence that spatial navigation and functional mobility each draw on highly overlapping sensory systems, cognitive processes, and brain structures that are susceptible to healthy and pathological aging processes. Based on this evidence, we provide an alternative to models that have focused primarily on spatial navigation as a higher order cognitive function dependent on brain areas such as the hippocampus and entorhinal cortex. Instead, we argue that spatial navigation may offer an ecologically valid cognitive-motor phenotype of age-related cognitive dysfunction. We propose that dual cognitive-motor deficits in spatial navigation may arise from early changes in neuromodulatory and peripheral sensory systems that precede changes in regions such as the entorhinal cortex.