Visuospatial Function in Early Alzheimer’s Disease—The Use of the Visual Object and Space Perception (VOSP) Battery Nata ´ lia Bezerra Mota Quental*, Sonia Maria Dozzi Brucki, Orlando Francisco Amodeo Bueno Department of Psychobiology of the Federal University of Sa ˜o Paulo, Sa ˜o Paulo, Sao Paulo, Brazil Abstract Alzheimer’s disease (AD) is the most frequent cause of dementia. The clinical symptoms of AD begin with impairment of memory and executive function followed by the gradual involvement of other functions, such as language, semantic knowledge, abstract thinking, attention, and visuospatial abilities. Visuospatial function involves the identification of a stimulus and its location and can be impaired at the beginning of AD. The Visual Object and Space Perception (VOSP) battery evaluates visuospatial function, while minimizing the interference of other cognitive functions. Objectives: To evaluate visuospatial function in early AD patients using the VOSP and determine cutoff scores to differentiate between cognitively healthy individuals and AD patients. Methods: Thirty-one patients with mild AD and forty-four healthy elderly were evaluated using a neuropsychological battery and the VOSP. Results: In the VOSP, the AD patients performed more poorly in all subtests examining object perception and in two subtests examining space perception (Number Location and Cube Analysis). The VOSP showed good accuracy and good correlation with tests measuring visuospatial function. Conclusion: Visuospatial function is impaired in the early stages of AD. The VOSP battery is a sensitive battery test for visuospatial deficits with minimal interference by other cognitive functions. Citation: Quental NBM, Brucki SMD, Bueno OFA (2013) Visuospatial Function in Early Alzheimer’s Disease—The Use of the Visual Object and Space Perception (VOSP) Battery. PLoS ONE 8(7): e68398. doi:10.1371/journal.pone.0068398 Editor: Jerson Laks, Federal University of Rio de Janeiro, Brazil Received July 7, 2012; Accepted May 31, 2013; Published July 16, 2013 Copyright: ß 2013 Quental et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This work was supported by Fundac ¸a ˜ o de Amparo a Pesquisa do Estado de Sa ˜o Paulo (FAPESP–Sa ˜o Paulo Research Foundation) and Associac ¸a ˜o Fundo de Incentivo a ` Pesquisa (AFIP–Research Incentive Fund Association). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: natalia_mota@hotmail.com Introduction Dementia is a syndrome characterized by the impairment of cognitive functions, such as memory, language, abstraction, organization, planning, attention, and visuospatial skills [1]. These deficits, which are associated with a decline in the performance of everyday activities, are crucial for the diagnosis of dementia [2]. In general, the course of AD begins with the impairment of memory and executive functions followed by the gradual involvement of other functions, including complex visual disturbance [3,4]. Visuospatial function in AD can be impaired at the beginning of the disease, declining gradually with the progression of the disease, and can lead to visual agnosia [5]. The visuospatial deficits appear primarily as difficulties with reading, problems in discriminating form and color, an inability to perceive contrast, difficulties in visual spatial orientation and motion detection, agnosia and difficulty in developing visual strategies [6]. These deficits are related to the presence os neuropathology in the visual association cortex [4]. Katz and Rimmer [7] observed numerous plaques and neurofibrillary tangles in the visual association areas in patients without primary visual deficits, which may underlie these deficits. The assessment of these deficits is important in providing more diagnostic information for dementia and new perspectives for intervention. Visuospatial function involves identification of a stimulus and its location. The tasks of identifying and locating objects activate different cortical areas, such as Brodmann area 5 of the superior parietal lobe, the parieto-occipital junction and the premotor areas [7,8,9]. As well as these tasks activate distinct neural circuits that project from the striate cortex and to the occipitotemporal (ventral pathway) and occipitoparietal (dorsal pathway) cortices, respec- tively [10,11]. The ventral pathway acts in the visual recognition of objects, whereas the dorsal pathway acts in the recognition of space [12]. Most neuropsychological tests that evaluate visuospatial func- tion require other cognitive skills [13]. For example, the Cubes test (WAIS-III), Rey Complex Figure test, and the clock drawing test require visuoconstructive skills [2], and Hooper’s Test requires analysis and visual synthesis. However, some tests assess only visual orientation and consist of finding objects in space. Some tests PLOS ONE | www.plosone.org 1 July 2013 | Volume 8 | Issue 7 | e68398 ˜