Guest Blog, Dr Michael Hornberger: Spatial disorientation in Alzheimer’s disease – What are the implications for car driving?

Posted on the 29th January 2021

We are pleased to welcome Dr Michael Hornberger as a guest blogger.  Michael and his team are researching how spatial navigation changes as we age.  Read all about it in the blog below, or scroll down to see how you can take part.

Setting The Scene

Driving is such an essential part of our lives, not only when we work but also in retirement when many people are dependent on the car to get around, especially if they live in more rural areas. However, surprisingly little is known on how the cognitive changes during ageing impact our driving. This becomes particularly relevant when older people develop the first symptoms of dementia, which might impact their driving behaviour.

Everyone knows that people with Alzheimer’s disease have memory problems, but few people know about the other common symptom in Alzheimer’s disease – spatial disorientation. Spatial disorientation in Alzheimer’s disease can have far more serious consequences than memory problems. One serious consequence is that it can lead to people becoming disoriented or even lost, which in turn can impact our driving behaviour. Understanding spatial disorientation and its impact on driving has emerged a critical aspect, therefore.

What is spatial disorientation?

Spatial disorientation refers to being unsure of where we are. We all can feel at times disoriented and unsure where we are. The perfect example is when we are travelling and are in a town which we have not been before. In that town, we can get easily disorientated or lost, without the help of a map, a navigation App or a GPS.

It is completely normal to feel disoriented and lost in unfamiliar environment. However, the difference in Alzheimer’s disease is that people also disoriented or lost in familiar environments, such as the town or neighbourhood where they lived for many years. It can even occur in their own house, where they are unsure where different rooms in the house are and they literally become lost in their own house and have to open all the doors to see what is behind.

There is a perfect description of this scenario in the film ‘Still Alice’, which is about a woman with early onset dementia, played by the Julianne Moore. In one scene in the film, the character Alice needs to go to the toilet but does not know anymore where the bathroom is, resulting in her having an incontinence accident. This is quite a common scenario and very aptly depicted in the movie.

If spatial disorientation problems are so common, how come then that they are less noted than memory problems?

There are several reasons why this might be the case. For example, the memory problems are simply more prominent and ‘overshadow’ any other symptoms, such as spatial disorientation. In fact, we often see that people are more concerned about their memory than spatial disorientation symptoms.

Spatial disorientation is also a more of a ‘private’ symptom. What do I mean by that? Private in this sense means that the person with dementia might experience feeling slightly disorientated at times but the people around the person might not notice the disorientation if it is not completely obvious. For example, the person with dementia just hesitates briefly on an outing but it is unclear whether they are not sure where they are or whether they might just have thought of something.

Finally, a reason why those spatial disorientation symptoms are less noted, is that our brain can compensate for them for quite a long time. We have two navigation systems in our brain, a map-based and a viewpoint-based navigation system. We use both navigation systems interchangeably when navigating the world and if one is faulty or affected by a disease, such as Alzheimer’s disease we can often compensate with the other navigation system.

Commonly Alzheimer’s disease affects more the map-based navigation system at the beginning of the disease, which means that we can compensate our navigation with our viewpoint-based navigation system.

Spatial disorientation often therefore only becomes obvious to others when the disease has more advanced, as we cannot compensate anymore our spatial deficits. It is therefore important to remember that spatial disorientation is an early symptom in Alzheimer’s disease but only seems to ’emerge’ to others later.

This is an important point, once a person struggles to know where they are and to find their way around, they are more vulnerable to finding their way in the outdoor environment or potentially even get lost. However, the effect of cognitive or spatial navigation changes on car driving have – so far – been virtually unexplored, despite being very common when cognitive changes occur.

Dr Michael Hornberger and his research team at the University of East Anglia are trying to rectify this shortcoming and are about to start a new research project which will investigate how cognitive and spatial navigation changes might impact on car driving in older people and those with cognitive impairment.

The DECISION Research Study

Driver Effect of Cognitive Impairment and Spatial Orientation and Navigation (DECISION for short) is a research study funded by the UK Department for Transport.

The study investigates how everyday car driving can change in older drivers.

We are looking for current drivers to register their interest in our research, ready for the study to go live in early 2021.

The DECISION project is a UK Department for Transport funded research project which will consist of an online study and an in-person study. For the online study people over the age of 65 who actively drive can take part and are asked to complete online questionnaires and cognitive tests, related to their driving history and cognition, including spatial navigation.

The in-person study will allow a more in-depth assessment of cognitive and spatial navigation performance and will also use cutting-edge sensor technology to measure car telemetry in participant’s cars during their everyday driving. This will allow establishing whether potentially cognitive and spatial navigation changes impact our everyday driving and if so, what changes are affected.


To participate in our study, you need to meet all of the following criteria:

  • Aged at least 65 years.
  • Holder of a valid driving licence.
  • Currently driving.

If you are interested in taking part in the DECISION study, please visit their website to register your interest at:

You can take part in the online, in-person or both study parts. Participation is completely voluntary. Your participation will be greatly appreciated as it will inform future policies on how to assess driving changes in older people and those with earliest cognitive changes, such as in dementia.

Click here to register

The DECISION Research Team

Dr. Michael Hornberger

Dr. Hornberger is the Professor of Applied Dementia Research at the Norwich Medical School, University of East Anglia. Prof. Hornberger is the lead researcher of the DECISION Study.

Dr. Mary Fisher-Morris

Dr. Morris is a chartered psychologist and sits on the Secretary of State for Transport’s Honorary Medical Advisory Panel on Driving and Psychiatric Disorders. Dr. Fisher-Morris is co-lead of the DECISION Study.

Dr. Stephen Jeffs

Dr. Stephen Jeffs is a research psychologist with extensive expertise in testing older participants. Dr. Jeffs is the research associate for the DECISION project and will lead the recruitment and testing of participants.

Read more posts...

Interested in being the next RAD Fellow? Find out more…

Listen back to yesterday’s Dementia Researcher livestream, where Alzheimer’s Research UK’s Head of Research, Rosa Sancho, RAD CEO Bridge Barker and RAD Fellows, Dr Emily Lane-Hill and Dr Maura Malpetti talk about how to become...

Posted 21 Jul 2022