Abstract
Background
Spatial navigation impairments emerge early in Alzheimer’s disease, but assessments targeting these deficits remain underutilised or impractical for cognitive screening. The Spatial Performance Assessment for Cognitive Evaluation (SPACE) is a newly developed digital tool that evaluates spatial navigation deficits associated with cognitive impairment.
Methods
We assessed spatial navigation ability using SPACE in 300 older adults recruited from memory clinics and the general community. Participants were classified across different levels of cognitive impairment using the Clinical Dementia Rating (CDR) scale. Performance in SPACE was compared with clinical diagnosis, standard cognitive assessments, and demographic models using Area Under the ROC Curve (AUC), sensitivity, and specificity.
Results
We show that SPACE reliably distinguishes CDR levels, exceeding the accuracy of demographic models and matching or surpassing most traditional neuropsychological tests. Including SPACE significantly increases the AUC for distinguishing between no dementia from mild dementia (0.76 to 0.94), no dementia from moderate dementia (0.79 to 0.95), and questionable dementia from mild dementia (0.70 to 0.91), all with consistently high sensitivity and specificity. A shortened version of SPACE, lasting less than 11 minutes, reduces administration time by 40% while maintaining high diagnostic accuracy. Cross-validation analyses confirm the reliability and robustness of these models.
Conclusions
These findings highlight the potential of digital spatial navigation assessments to advance early detection, contributing to scalable and accessible healthcare.
Plain language summary
Problems with spatial navigation ability, such as finding one’s way around unfamiliar places, can appear early in Alzheimer’s disease, but they are not often assessed in routine cognitive tests. This study examined a newly developed digital tool, the Spatial Performance Assessment for Cognitive Evaluation (SPACE), designed to measure these navigation difficulties. We tested SPACE in 300 individuals from memory clinics and the general community and compared it with clinical diagnosis and standard cognitive assessments. SPACE accurately distinguished between individuals with no dementia, mild dementia, and moderate dementia. A shorter version of SPACE ( < 11 minutes) was also capable to distinguish between clinical diagnosis with high accuracy. These findings suggest that simple digital tests of spatial navigation ability could help detect cognitive impairment and make dementia screening more accessible and practical for the general population.
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Data availability
The data used in this study were collected under ethical approval from the NHG DSRB, Singapore (reference number: 2021/01160). Due to participant confidentiality and institutional data protection policies, the data are not publicly available. De-identified data may be made available to qualified researchers for research purposes upon reasonable request, subject to approval by the NHG DSRB and execution of an appropriate institutional data use agreement. Access may be restricted to non-commercial research use and may require compliance with local data protection regulations. Requests for access should be directed to the corresponding authors: Giorgio Colombo: gicolombo@ethz.ch Victor R. Schinazi: vschinaz@bond.edu.au. The authors will acknowledge receipt of requests within two weeks and aim to provide a decision regarding data access within four weeks, contingent upon DSRB review and institutional requirements. Source data underlying Figs. 2 and 4 are available in the Figshare repository at https://doi.org/10.6084/m9.figshare.3111967998.
Code availability
The code used for the statistical analyses reported in this manuscript is publicly available in the Figshare repository at https://doi.org/10.6084/m9.figshare.3111967998. The analyses were implemented in R using publicly available packages and executed in RStudio (version 2024.12.0 + 467).
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Acknowledgements
This research is supported by the National Research Foundation Singapore (NRF) under its Campus for Research Excellence and Technological Enterprise (CREATE) programme.
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G.C., K.M., and V.R.S. conceived the study. G.C., J.G., and V.R.S. were responsible for software conceptualisation and development. E.C., J.R.C., and M.K.P.L. were responsible for participant recruitment and data collection. E.C., C.P.C., M.J.H.L., and P.N.G.G. provided clinical oversight and contributed to data collection coordination. G.C. and V.R.S. curated and analysed the data. G.C., K.M., and V.R.S. contributed to data interpretation. K.M. procured ethics approval. G.C. wrote the first draft of the manuscript and prepared the data visualisations. G.C., W.R.T., and V.R.S. contributed to critical revisions and substantive refinement of the manuscript. V.R.S. supervised the project. All authors reviewed and approved the final manuscript.
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Colombo, G., Minta, K., Taylor, W.R. et al. Spatial navigation as a digital marker for clinically differentiating cognitive impairment severity. Commun Med (2026). https://doi.org/10.1038/s43856-026-01484-y
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DOI: https://doi.org/10.1038/s43856-026-01484-y
