ISSN 2397-5628 Journal of Geriatric Care and Research 2019, Vol 6, No 1 Short Review Spatial navigation: a behavioural biomarker for improved dementia diagnosis? John Hudson Abstract Spatial navigation offers a fresh approach to the identification and early diagnosis of dementia, including Alzheimer's disease in the pre-clinical phase. The Sea Hero Quest game has been developed to detect subtle impairments in navigational performance at a very early stage. It has been found to perform better than traditional dementia screening tools and memory assessment scales currently used for identifying persons genetically at-risk of developing Alzheimer’s disease. Key words Aged, Alzheimer's disease, Big Data, Dementia, Spatial Navigation, Video Games Introduction There are currently 44 million people living with dementia worldwide, but the figure could triple to approximately 135 million by 2050. 1 A key component in strategies to address this epidemic, internationally, involves the drive to improve rates of early and accurate diagnosis. In the UK, the National Dementia Strategy 2 and Prime Minister’s Challenge 3 stress the importance increasing dementia diagnoses; with a view to ensuring patients obtain suitable treatment and support. Early and accurate diagnosis of dementia is an important, if elusive, goal for other reasons; including the vital role it has to play in research aimed at discovering more effective pharmacological and non-pharmacological treatments. Trustworthy methods of diagnosis should assist researchers with the design of drug trials, better allocation of suitable pre-clinical subjects within trials, and means of assessing the effectiveness of the new treatments being tested. There is a substantial body of research investigating various biomarkers to improve early detection of the neurodegenerative pathologies which may be active decades before symptoms become notable at the stage of clinical diagnosis. As a general rule of thumb, all things being equal, non-invasive biomarkers are preferable to invasive ones; on grounds of cost, convenience and the avoidance of patient harm or discomfort. The diagnosis of dementia is based mostly on tests for memory and cognitive symptoms, currently. This article examines new possibilities for dementia diagnosis at an early stage, before patients show signs of memory loss detectable by widely-used assessment scales. Spatial disorientation is reported to be a fairly common symptom of Alzheimer’s disease and perhaps other forms of dementia. Subtle spatial navigation problems may precede memory symptoms, and this phenomenon offers interesting diagnostic opportunities. What is Sea Hero Quest (SHQ)? Sea Hero Quest is an online game developed by Glitchers game developers, 4 on behalf of Deutsche Telekom 5 in partnership with Alzheimer’s Research UK, University College London and the University of East Anglia. This software first hit the news headlines in November 2016, when it was instrumental in demonstrating how persons’ sense of direction and navigational ability typically declines over their lifetime. 6,7 A more immersive virtual reality version of the game, called Sea Hero Quest VR, further enhanced the scope to collect additional data complementary to that from Sea Hero Quest mobile. Big Data Analysis Over 4 million players have submitted data for researchers, merely by playing. The game has been used to generate “big data” on differing patterns of wayfinding performance internationally. Some familiar cultural and sexual stereotypes appeared to be confirmed, when it emerged that men and women employed different spatial navigation strategies. Men appeared to demonstrate a slightly better sense of direction than women, and people from the Nordic nations (Finland, Sweden, Norway and Denmark) tended to outperform players from the rest of the world. 8,9 The purpose of these comparisons, which may appear potentially invidious and stereotyped when considered superficially, was to develop global benchmarks of healthy navigational behaviour, on a mass population level, taking into account how these may vary according to the demographics of particular players / 20