背景與目的:
認路障礙與迷路是阿茲海默氏症 (Alzheimer’s disease, AD) 患者常見症狀之一，過去研究顯示患者的認路能力與其疾病初期的認知功能、保有和使用認知地圖的能力無關，顯示 AD 在保有和使用空間表徵能力的情況下仍會迷路，推測其迷路現象可能與表徵間轉換能力不佳有關。過去研究已知表徵轉換功能是由後壓部皮質 (Retrosplenial cortex, RSC) 負責，且該腦區的病理變化是偵測早期 AD 的敏感指標，但目前對於不同發病年齡的 AD 在 RSC 的退化程度仍有爭議。因此本研究目的在於探討早發及晚發型 AD 的空間表徵轉換能力是否不同。

方法:
招募 AD 患者及其配偶與社區正常老年人，施測實驗者設計的三個表徵轉換作業。第一，以 Modified Hegarty-Waller Test 探討「他中心轉自我中心」的錯誤類型；第二，以 Picture Taking Test 探討「自我中心轉他中心」的準確程度；最後，以 Heading Orientation Tests 的距離及角度誤差量，探討參與者對熟悉環境的「自我中心轉他中心」能力。

結果:
共 56 人完成本研究，包括 AD 組 29人 (早發型 14人；晚發型 15人)，normal control 組 27 人 (年輕控制組 14 人；老年控制組 13 人)。早發型 AD 在三個表徵轉換作業的表現都較同年齡控制組差，有較多方向錯誤及方位判斷精細度不佳；晚發型 AD 在三個作業的表現與一般健康老年人無顯著差異。

結論:
早發型 AD 在判斷方向的精確度較同年齡健康參與者差，而晚發型 AD 則與健康老年人無異，顯示不同發病年齡的 AD 在表徵轉換能力的下降程度不同。早發型 AD 在自我中心與他中心表徵轉換的能力確實有較 LOAD 不佳的傾向。

Background and objective:
Many Alzheimer’s disease (AD) patients have difficulty in spatial navigation, even in the early stage and in their familiar environment. These patients usually preserve cognitive maps of the environment and egocentric representation, but the translation between them is impaired. The translation is processed by retrosplenial cortex (RSC), when damage may lead to heading disorientation. Researchers have thought that the RSC is more damaged in young onset (YOAD, onset age < 65 years old)) than in late-onset AD (LOAD) in the early stage. This study was to compare the heading orientation between very early YOAD and LOAD and their age-matched controls.

Subjects and methods:
Early AD (CDR 0.5 and 1.0) patients and normal control (NCs) were invited to participate in the study. We used personally familiar street scenes as materials to assess their ability to translate from egocentric to allocentric representations.

Results:
29 AD patients (14 YOAD and 15 LOAD) and 27 NCs (14 young and 13 older NC) completed the study. YOADs showed more deviation in heading orientation than YNC, but LOAD and ONC were equal. The distance estimation and basic visual perceptual abilities show no difference among the four groups.

Conclusion:
The heading disorientation in YOAD is prominent in the very early stage. This is important not only for safety, but also supports the hypothesis that RSC is not equally damaged in early AD of different onset age.

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