阿茲海默氏症 (Alzheimer’s disease; AD) 是相當常見的老年失智症，據調查，AD病人中，約有半數出現認路障礙，且迷路通常發生於熟悉的環境中。過去針對AD病人的認路研究發現，多數AD病人對熟悉地標的再認，行為表現與正常人無差別，且部分病人仍能描繪出迷路地區的平面圖，顯示在地標與認知地圖存在的情況下，AD病人仍會有迷路的情況發生。
　　心智旋轉 (mental rotation)，是個體將腦中景物的空間關係，做自動化旋轉的能力。正常人能夠利用平面地圖，以想像的方式於其中行進，並在轉彎處運用心智旋轉的能力，判斷應左轉或右轉。過去研究發現AD病人的心智旋轉能力退化，無法用想像的方式於平面路徑圖中行走；推測此能力的缺損，造成AD病人在地標與地圖記憶存在的情況下，仍無法在真實環境中判斷方向。
　　本研究納入40位早期AD病人與22位正常受試者，並將AD病人依日常生活中是否經歷方向判斷困難，分為AD無方向障礙組 (18人) 及AD方向障礙組 (22人)。本研究運用「左右辨識測驗」、「圖形旋轉測驗」、「路線-地圖測驗」來評估受試者的心智旋轉能力，並運用「虛擬城市指向測驗」來檢測受試者將地圖做心智旋轉後判斷方向的能力。
本研究發現早期AD病人在各項測試中表現與正常受試者無異。比較AD無方向障礙組與AD方向障礙組病人，發現兩組病人在「左右辨識測驗」、「圖形旋轉測驗」及「虛擬城市指向測驗」的表現無異，但無方向障礙組病人在「路線-地圖測驗」的錯誤率較高。結果顯示早期AD病人的心智旋轉能力尚無明顯退化，有方向障礙的病人仍維持良好的心智旋轉能力，推測心智旋轉能力的退化並非造成病人迷路的主因。

Alzheimer’s disease (AD) is a common degenerative disease among elders. According to previous researches, about half of the population of AD patients suffered from topographical disorientation, and often experienced a loss of direction in familiar environments. Previous behavioral research have found that most early AD patients could recognize landmarks in their familiar surroundings, and some AD patients could construct maps of the areas where they had gotten lost, indicating that AD patients might experience getting lost despite their ability to preserve memories of landmarks and maps.
Mental rotation is the ability to mentally rotate spatial representations in different perspectives. Normally, people can imagine themselves moving on a surfaced map and determine which way to turn through their ability of mental rotation. Previous studies showed that AD patients could not perceive themselves to walk on a surfaced map, indicating that their inability to determine the correct direction would be due to the degeneration of mental rotation ability, and this would be the reason why AD patients got lost despite their preserved memories of landmarks and maps.
The present study included forty early AD patients and twenty-two normal controls. This study further divided the AD patients into two groups according to the experiences of directional confusion in their daily life. Eighteen of the AD patients had not experienced directional confusion (AD-noDC) and twenty-two of them had (AD-DC). Right-left Orientation Test (RLOT), Figure Rotation Test (FRT), Money Road-map Test (MRMT) were used to assess their mental rotation ability. Virtual City Pointing Task (VC) was used to assess their ability to mentally rotate a map and make directional judgment.
The results showed that the early AD patients performed as well as the normal controls in all tests. Comparing AD-noDC with AD-DC, the AD-noDC participants performed as well as the AD-DC participants in RLOT, FRT and VC but worse than AD-DC in MRMT. The present study showed that the early AD patients still preserved the mental rotation ability, and the degeneration of mental rotation ability would not be a main reason for early AD patients to experience getting lost.

中文部分
孔繁鐘、孔繁錦 (2000) 編譯。DSM-Ⅳ 精神疾病診斷準則手冊。台北市：合記圖書出版社。
白明奇 (2002)。早期阿茲海默氏症病患之認路能力研究。(博士論文，中正大學，2002)。全國博碩士論文資訊網，090CCU00071012。
林克能、郭啟中、王培寧 (2002)。中文版臨床失智評量評量者間信度研究。2002年神經醫學聯合學術研討會，花蓮慈濟醫院。
林克能、劉秀枝 (2003)。臨床失智評量表。台灣神經學雜誌，12(3)，153-165。
徐榮隆、陳威宏、邱浩彰、沈幸梅 (2000)。不同時期失智症之認知功能。台灣醫學，4(4)，371-378。
陳達夫、邱銘章、湯麗玉、林忠蔚、史宛玉、陳榮基 (2003)。失智症盛行率調查報告。台灣臨床失智症學會。
郭乃文、劉秀枝、王珮芳、廖光淦、甄瑞興、林恭平、陳組裕、徐道昌(1988)。「簡短式智能評估」之中文施測與常模建立。復健醫學雜誌，16， 52-59。
郭乃文、劉秀枝、王珮芳、徐道昌 (1989)。中文版「簡短式智能評估」 （MMSE） 之簡介。臨床醫學月刊，23，39-42。
劉景寬 (2003)。台灣失智症研究。台灣神經學雜誌，12 supplement(1)，152-159。
西文部分
Aguirre, G. K., & D'Esposito, M. (1999). Topographical disorientation: a synthesis and taxonomy. Brain, 122, 1613-1628.
Aretz, A. J., & Wickens, C. (1992). The mental rotation of map displays. Human Performance, 5(4), 303-28.
Armstrong, C. L., & Cloud, B. (1998). The emergence of spatial rotation deficits in dementia and normal aging. Neuropsychology, 12(2), 208-217.
Astur, R. S., Tropp, J., Sava, S., Constable, R. T., & Markus, E. J. (2004). Sex differences and correlations in a virtual Morris water task, a virtual radial arm maze, and mental rotation. Behav Brain Res, 151, 103-15.
Benton, A. L., Hamsher, K. deS., Varney, N. R., & Spreen, O. (1983). Contributions to neuropsychological assessment: A clinical manual. New York: Oxford University Press.
Brouwers, P., Cox, C., Martin, A., Chase, T., & Fedio, P. (1984). Differential Perceptual-Spatial Impairment in Huntington's and Alzheimer's Dementias. Arch Neurol, 41(10), 1073-1076.
Buckner, R. L. (2004). Memory and executive function in aging and AD: multiple factors that cause decline and reserve factors that compensate. Neuron, 44, 195-208.
Cherrier, M. M., Mendez, M., & Perryman, K. (2001). Route Learning Performance in Alzheimer Disease Patients. Neuropsychiatry, Neuropsychology, and Behavioral Neurology Vol. 14(3), 159–168.
Cummings, J. L., Mega, M., Gray, K., Rosemberg-Thompson, S., Carusi, D. A., & Gornbei, J. (1994). The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308-2314.
Driscoll, I., Hamilton, D. A., Yeo, R. A., Brooks, W. M., & Sutherland, R. J. (2005). Virtual navigation in humans: the impact of age, sex, and hormones on place learning. Horm Behav, 47, 326-335.
Drzezga, A., Riemenschneider, M., & Strassner, B. (2005). Cerebral glucose metabolism in patients with AD and different APOE genotypes. Neurology, 64, 102-107.
Folstein, M., Folstein, S., & McHugh, P. (1975). Mini-Mental State: a practical method for grading the cognitive impairment of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198.
Fuh, J. L., Liu, C. K., Mega, M. S., Wang, S. J., & Cummings, J. L. (2001). Behavioral disorders and caregiver reaction in Taiwanese patients with Alzheimer’s disease. International Psychogeriatrics, 13(1), 121-128.
Fujii, T., Moscovitch, M., & Nadel, L. (2000). Memory consolidation, retrograde amnesia and the temporal lobes. In: Handbook of neuropsychology, Vol 2 (Cermak LS, ed), pp 199–226. Amsterdam: Elsevier.
Gauthier, I., Hayward, W. G., Tarr, M. J., Anderson, A. W., Skudlarski, P., & Gore, J. C. (2002). BOLD activity during mental rotation and viewpoint-dependent object recognition. Neuron, 34, 161-171.
Golledge, R. G. (1999). Human wayfinding and cognitive map. In: Colledge RG ed. Wayfinding Behavior. Baltimore: The Johns Hopkins University Press, 1999, 5-45.
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A., & Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry,140, 566-572.
Jack, C. R. Jr, Petersen, R. C., O’Brien, P. C., & Tangalos, E. G. (1992). MR-based hippocampal volumetry in the diagnosis of Alzheimer’s disease. Neurology 42, 183–8.
Jheng, S. S., & Pai, M. C. (2009). Cognitive map in patients with mild Alzheimer's disease: A computer-generated arena study. Behavioural Brain Research, 200(1), 42-47.
Jordan, K., Heinze, H. J., Lutz, K., Kanowski, M., & Jäncke, L. (2001). Cortical Activations during the Mental Rotation of Different Visual Objects. NeuroImage, 13(1), 143-152.
Kalman, J., Magloczky, E., Janka, Z., (1995). Disturbed Visuospatial Orientation in the Early-stage of Alzheimers Dementia. Archives of Gerontology and Geriatrics 21(1), 27-34.
Kantarci, K., Xu, Y. C., Shiung, M. M., O’Brien, P. C., Cha, R. H., Smith, G.E., Ivnik, R. J., Boeve, B. F., Edland, S. D., Kokmen, E., Tangalos, E. G., Petersen, R. C., & Jack, C. R. Jr. (2002). Comparative Diagnostic Utility of Different MR Modalities in Mild Cognitive Impairment and Alzheimer’s Disease. Dement Geriatr Cogn Disord 14, 198–207.
Leiter, R. G. (1979). Instruction manual for the Leiter International Performance scale. Wood Dale, Il: Stoelting Press.
Levine, M. (1982). You-Are-Here Maps: Psychological Considerations. Environment and Behavior, 14(2), 221-237.
Lineweaver, T. T., Salmon, D. P., Bondi, M. W., & Corey-Bloom, J. (2005) Differential effects of Alzheimer's disease and Huntington's disease on the performance of mental rotation. J Int Neuropsychol 11(1), 30-39.
Liu, C. K., Lin, R. T., Chen, Y. F., Tai, C. T., Yen, Y. Y., & Howng, S. L. (1996). Prevalence of dementia in an urban area in Taiwan. Journal of the Formosan Medical Association, 95(10), 762-768.
Lobben, A. K. (2007). Navigational Map Reading: Predicting Performance and Identifying Relative Influence of Map-Related Abilities. Annals of the Association of American Geographers, 97(1), 64–85.
Maguire, E. A., Burgess, N., Donnett, J. G., O'Keefe, J., & Frith, C. D. (1997) Knowing where things are: parahippocampal involvement in encoding object locations in virtual large-scale space. J Cognit Neurosci, in press.
Malinowski, J. C. (2001). Mental rotation and real-world wayfinding. Perceptual and Mortor Skills 92 (1), 19-30.
Moffat, S., Hampson, E., & Hatzipantelis, M. (1998). Navigation in a virtual maze: sex differences and correlation with psychometric measures of spatial ability in humans. Evol Human Behav, 19, 73-87.
Monacelli, A. M., Cushman, L. A., Kavcic, V., & Duffy, C. J. (2003). Spatial disorientation in Alzheimer’s disease. Neurology, 61(11), 1491-1497.
Money, J. (1976) A standardized road map test of direction sense. Manual. San Rafael, CA: Academic Therapy Publications.
Morris, J. C., Heyman, A., Mohs, R. C., Hughes, J. P., van Belle, G., Fillenbaum, G., Mellits, E. D., & Clark, C. (1989). The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology, 39, 1159-65.
Morris, R., Garrud, P., Rawlins, J., & O'Keefe, J. (1982). Place navigation impaired in rats with hippocampal lesions. Nature 297, 681-683.
Morris, R. G. (1981). Spatial localization does not require the presence of local cues. Learn Motiv, 12, 239-260.
Mosconi, L., Sorbi, S., de Leon, M. J., Li, Y., Nacmias, B., Myoung, P. S., Tsui, W., Ginestroni, A., Bessi, V., Fayyazz, M., Caffarra, P., & Pupi, A. (2006). Hypometabolism exceeds atrophy in presymptomatic early-onset familial Alzheimer’s disease. J Nucl Med, 47, 1778-1786.
Moscovitch, M., Nadel, L., Winocur, G., Gilboa, A., & Rosenbaum, S. (2006). The cognitive neuroscience of remote episodic, semantic and spatial memory. Curr Opin Neurobiol 16, 179–190.
O'Keefe, J., & Dostrovsky, J. (1971). The hippocampus as a spatial map. Preliminary evidence from unit activity in the freely-moving rat. Brain Res. 34, 171-175.
Pai, M. C., & Hsiao, S. (2002a). Incipient symptoms of AD and effect of education on the onset age: a study of 155 Taiwanese patients. Acta Neurologica Taiwanica, 11(Jun): 66-69.
Pai, M. C., & Hsiao, S. (2002b). Wayfinding problems in Alzheimer’s disease: a study of 123 Taiwanese patients. Acta Neurol Taiwan, 11 (abstract).
Pai, M. C., & Jacobs, W. J. (2004). Topographical disorientation in community-residing patients with Alzheimer disease. Int J Geriatric Psychiatry 19, 250-5.
Pai, M. C., Jia, P. S., & Jacobs, W. J. (2005). Early Alzheimer’s patients recognize familiar landmarks well enough. Soc. Neurosci Abstr.
Pai, M. C., & Jacobs W. J. (2007). Navigational Disorders in Patients with Alzheimer’s Disease. Alzheimer's Disease Research Trends.
Pai, M. C. (2008). Topographical Disorientation: Viewpoints from Behavioral Neurology. Acta Neurologica Taiwanica, 17, 267-274.
Piaget, J. (1960). Psychology of intelligence. Paterson, N.J.: Littlefield, Adams.
Pietrini, P., Furey, M. L., Alexander, G. E., Mentis, M. J., Dani, A., Guazzelli, M., Rapoport, S. I., & Schapiro, M. B. (1999). Association between brain functional failure and dementia severity in Alzheimer’s disease: resting versus stimulation PET study. Am J Psychiatry, 156, 470-473.
Podzebenko, K., Egan, G. F., & Watson, J. D. (2002). Widespread dorsal stream activation during a parametric mental rotation task, revealed with functional magnetic resonance imaging. Neuroimage, 15, 547-558.
Podzebenko, K., Egan, G. F., & Watson, J. D. (2005). Real and imaginary rotary motion processing: functional parcellation of the human parietal lobe revealed by fMRI. J Cogn Neurosci, 17, 24-36.
Rainville, C., Marchand, N., & Passini, R. (2002). Performances of patients with a dementia of the Alzheimer type in the standardized road-map test of direction sense. Neuropsychologia, 40, 567-573.
Rosenbaum, R. S., Priselac, S., Köhler, S., Black, S. E., Gao, F., Nadel, L., & Moscovitch, M. (2000). Remote spatial memory in an amnesic person with extensive bilateral hippocampal lesions. Nature Neuroscience, 3, 1044-1048.
Rosenbaum, R. S., Winocur, G., & Moscovitch, M. (2001). New views on old memories: re-evaluating the role of the hippocampal complex. Behav Brain Res 127, 183–97.
Rosenbaum, R. S., Ziegler, M., Winocur, G., Grady, C. L., & Moscovitch, M. (2004) I have often walked down this street before: fMRI studies on the hippocampus and other structures during mental navigation of an old environment. Hippocampus 14, 826–835.
Rosenbaum, R. S., Gao, F. Q., Richards, B., Black, S. E., & Moscovitch, M. (2005). “Where to?”Remote memory for spatial relations and landmark identity in former taxi drivers with Alzheimer’sdisease and encephalitis. J Cogn Neurosci 17, 446-62.
Brunsdon, R., Nickels, L., & Coltheart, M. (2007). Topographical disorientation: Towards an integrated framework for assessment. Neuropsychological Rehabilitation 17 (1), 34–52.
Sluimer, J. D., van der Flier, W. M., Karas, G. B., van Schijndel, R., Barnes, J., Boyes, R. G., Cover, K. S., Olabarriaga, S. D., Fox, N. C., Scheltens, P., Vrenken, H., & Barkhof, F. (2009). Accelerating regional atrophy rates in the progression from normal aging to Alzheimer's disease. European Radiology, 19(12), 2826-2833.
Teng, E. L., Hasegawa, K., Homma, A., Imai, Y., Larson, E., Graves, A., Sugimoto, K., Yamaguchi, T., Sasaki, H., Chiu, D., & White, L. R. (1994). The Cognitive Ability Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia. International Psychogeriatrics, 6(1), 45-58.
Tolman, E. C. (1948). Cognitive Maps in Rats and Man. Psychological Review 55, 189-208.
Tu, M. C., & Pai, M. C. (2006). Getting lost for the first time in patients with Alzheimer’s disease. Int Psychogeriatr 18, 67-70.
Vingerhoets, G., de Lange, F. P., Vandemaele, P., Deblaere, K., & Achten, E. (2002). Motor imagery in mental rotation: an fMRI study. Neuroimage, 17, 1623-1633.
Wang, H. L., Golob, E., Bert, A., Nie, K., Chu, Y., Dick, M. B., Mandelkern, M., & Su, M. Y. (2009). Alterations in Regional Brain Volume and Individual MRI-Guided Perfusion in Normal Control, Stable Mild Cognitive Impairment, and MCI-AD Converter. Journal of Geriatric Psychiatry and Neurology, 22(1), 35-45.
Yassa, M. A., Verduzco, G., Cristinzio, C., & Bassett, S. S. (2008). Altered fMRI activation during mental rotation in those at genetic risk for Alzheimer disease. Neurology, 70, 1898-1904.