Michael Hornberger

University of East Anglia | UEA · Norwich Medical School

Classic findings of impaired allocentric (observer-independent) spatial learning and memory in individuals with lesions to the hippocampus provide strong support for the long-held view that the hippocampus is necessary for supporting a cognitive map of one’s environment. Most of these studies assess navigation in vista-space virtual reality (VR) en...

Recent research evidence demonstrates that the inability to orient oneself and navigate space is an early indicator of Alzheimer’s Disease. The video game Sea Hero Quest (SHQ) was designed to assess the players’ navigation ability, and several research works analysed the SHQ data using simple metrics such as length and time of navigation paths. Exp...

A challenge associated with driving vehicles can be navigating to the destination. While driving experience would seem beneficial for improving navigation skill, it remains unclear how driving experience relates to wayfinding ability. Using the mobile video game-based wayfinding task Sea Hero Quest, which is predictive of real-world navigation, we...

Everyone learns differently, but individual performance is often ignored in favour of a group-level analysis. Using data from four different experiments, we show that generalised linear mixed models (GLMMs) and extensions can be used to examine individual learning patterns. Producing ellipsoids and cluster analyses based on predicted random effects...

Overconfidence and the Dunning-Kruger effect have been reported in many cognitive domains. However, there is little examination in the field of spatial navigation. Here, we examined overconfidence in navigation ability in 376,836 participants from 46 countries. We tested navigation using our virtual wayfinding task in the app-based video game Sea H...

Recent evidence suggests that greater reliance on GPS-assisted devices is associated with poorer navigation ability. Contrastingly, studies have shown that video gaming can enhance navigation ability. While gender differences in navigation ability in favour of men are well-reported, it remains unclear if the effects of reliance on GPS and video gam...

Background Early evidence in using online cognitive assessments show that they potentially offer a feasible and resource efficient alternative to in-person clinical assessments in evaluating cognitive performance, yet there is currently little understanding about how these assessments relate to traditional, in-person cognitive tests. Objectives We...

Background: Despite an urgent need for multi-domain lifestyle interventions to reduce dementia risk there is a lack of interventions which are informed by theory and evidence based behaviour change strategies and no interventions in this domain have investigated the feasibility or effectiveness of behaviour change maintenance. Objectives: We tested...

Aims and method: We aimed to establish cut-off scores to stage dementia on the Addenbrooke's Cognitive Examination-III (ACE-III) and the Mini-Addenbrooke's Cognitive Examination (M-ACE) compared with scores traditionally used with the Mini-Mental State Examination (MMSE). Our cross-sectional study recruited 80 patients and carers from secondary ca...

Spatial cognition is associated with Alzheimer's disease (AD) biomarkers in the symptomatic stages of the disease. We investigated whether cerebrospinal fluid (CSF) biomarkers (phosphorylated-tau [p-tau] and β-amyloid) are associated with poorer spatial cognition in clinically normal older adults. Participants were 1875 clinically normal adults (ag...

Cranberry (poly)phenols may have potential health benefits. Circulating (poly)phenol metabolites can act as mediators of these effects, but they are subjected to an extensive inter-individual variability. This study aimed to quantify both plasma and urine (poly)phenol metabolites following a 12-week intake of a cranberry powder in healthy older adu...

Aging may diminish social cognition, which is crucial for interaction with others, and significant changes in this capacity can indicate pathological processes like dementia. However, the extent to which non-specific factors explain variability in social cognition performance, especially among older adults and in global settings, remains unknown. A...

Global cognitive changes in older age impact driving behaviour and road safety, but how specific cognitive functions impact specific driving behaviours is little known on a population level, despite clear implications for driving policy and evaluation during ageing. The present study aimed to establish how cognitive functioning relates to driving b...

There is an active debate concerning the association of handedness and spatial ability. Past studies used small sample sizes within a single country. Determining the effect of handedness on spatial ability requires a large, cross-cultural sample of participants, and a navigation task with real-world validity. Here, we overcome these challenges via...

Despite extensive research on navigation, it remains unclear which features of an environment predict how difficult it will be to navigate. We analysed 478,170 trajectories from 10,626 participants who navigated 45 virtual environments in the research app-based game Sea Hero Quest. Virtual environments were designed to vary in a range of properties...

Most measures of naturalistic human memory instruct participants to recall personally-experienced episodes in narrative format. These narratives contain non-episodic details, such as general knowledge of the world, or personal knowledge about one’s life circumstances that are elevated with aging. As this non-episodic content is incidental to the in...

Spatial navigation is a multi-faceted behaviour drawing on many different aspects of cognition. Visuospatial abilities, such as spatial working memory and mental rotation, in particular, may be key factors. A range of tests have been developed to assess visuospatial processing and memory, but how such tests relate to navigation ability remains uncl...

The ability to navigate is supported by a wide network of brain areas which are particularly vulnerable to disruption brain injury, including traumatic brain injury (TBI). Wayfinding and the ability to orient back to the direction you have recently come (path integration) may likely be impacted in daily life but have so far not been tested with pat...

Background Several long-term chronic illnesses are known to be associated with an increased risk of dementia independently, but little is known how combinations or clusters of potentially interacting chronic conditions may influence the risk of developing dementia. Methods 447 888 dementia-free participants of the UK Biobank cohort at baseline (20...

Alzheimer’s disease (AD) is the most common cause of dementia worldwide. Increasing evidence points to the thalamus as an important hub in the clinical symptomatology of the disease, with the ‘limbic thalamus’ been described as especially vulnerable. In this work, we examined thalamic atrophy in early-onset AD (EOAD) and late-onset AD (LOAD) compar...

Background The risk of dementia is higher in women than men. The metabolic consequences of estrogen decline during menopause accelerate neuropathology in women. The use of hormone replacement therapy (HRT) in the prevention of cognitive decline has shown conflicting results. Here we investigate the modulating role of APOE genotype and age at HRT in...

Path integration changes may precede a clinical presentation of Alzheimer's disease by several years. Studies to date have focused on how spatial cell changes affect path integration in preclinical AD. However, vestibular input is also critical for intact path integration. Here, we developed the vestibular rotation task that requires individuals to...

Humans show a remarkable capacity to navigate various environments using different navigation strategies, and we know that strategy changes across the life span. However, this observation has been based on studies of small sample sizes. To this end, we used a mobile app-based video game (Sea Hero Quest) to test virtual navigation strategies and mem...

Spatial cognition has emerged as a promising cognitive fingerprint for the detection of Alzheimer’s disease (AD). Despite evidence that spatial cognition is highly sensitive to AD dementia and is apparent even in adults at‐genetic‐risk of AD, the association between spatial cognition and AD biomarkers in cognitively normal adults is unknown. This s...

Background: Assess how APOE genotype can differentially affect cortical and subcortical memory structures in biomarker-confirmed early and late-onset Alzheimer's Disease (EOAD-LOAD). Methods: Eighty-seven CSF biomarker-confirmed AD patients were classified according to their APOE genotype and age at onset. 28 were EOAD APOE4 carriers (+EOAD), 21...

We show that previously reported sex differences in sleep architecture and the deleterious effects of sleep loss on vigilance shown in younger people are also present in healthy older adults. Sleep loss and time of the day had minimal effects on memory and spatial navigation performance in this age group. Our results suggest that biological sex sho...

This study found that sleep quality was the strongest independent predictor of mental health in older adults, especially in men. Similarly, lower sleep quality was independently associated with poorer physical health; however this was only found in women. Sleep quality should therefore be considered alongside the assessment and treatment of physica...

Vascular cognitive impairment (VCI) is the second most prevalent form of dementia, but little is known about the early cognitive and neuroimaging markers. Spatial navigation deficits are an emerging marker for Alzheimer's disease (AD), yet less is known about spatial orientation deficits sensitive to VCI. This case report follows up on the first VC...

We sought to systematically review and meta-analy the role of cerebral blood flow (CBF) in the medial temporal lobe (MTL) using arterial spin labeling magnetic resonance imaging (ASL-MRI) and compare this in patients with Alzheimer’s disease (AD), individuals with mild cognitive impairment (MCI), and cognitively normal adults (CN). The prevalence o...

Background Advances in medicine and public health mean that people are living longer; however, a significant proportion of that increased lifespan is spent in a prolonged state of declining health and wellbeing which places increasing pressure on medical, health and social services. There is a social and economic need to develop strategies to preve...

Objectives : To compare the magnitude of cognitive impairment against age-expected levels across the immune mediated inflammatory diseases (IMIDs: systemic lupus erythematosus [SLE], rheumatoid arthritis [RA], axial spondyloarthritis [axSpA], psoriatic arthritis [PsA], psoriasis [PsO]). Methods : A pre-defined search strategy was implemented in Me...

Cognitive abilities can vary widely. Some people excel in certain skills, others struggle. However, not all those who describe themselves as gifted are. One possible influence on self-estimates is the surrounding culture. Some cultures may amplify self-assurance and others cultivate humility. Past research has shown that people in different countri...

Our results suggest that APOE-ɛ4 carriership in healthy elderly adults has a limited impact on subjective and objective sleep quality and daytime sleepiness measures with evidence for a decrease in circadian rest-activity amplitude and a marginal decrease in the percentage of TST in N2. Further in-depth analyses are required to clarify whether diff...

Spatial navigation impairments in Alzheimer’s disease (AD) have been suggested to underlie patients experiencing spatial disorientation. Though many studies have highlighted navigation impairments for AD patients in virtual reality (VR) environments, the extent to which these impairments predict a patient’s risk for spatial disorientation in the re...

Mentalizing and emotion recognition are impaired in behavioral variant frontotemporal dementia (bvFTD). It is not clear whether these abilities are also disturbed in other conditions with prominent frontal lobe involvement, such as progressive supranuclear palsy (PSP). Our aim was to investigate social cognition (facial emotion recognition, recogni...

Measures of social cognition have now become central in neuropsychology, being essential for early and differential diagnoses, follow-up, and rehabilitation in a wide range of conditions. With the scientific world becoming increasingly interconnected, international neuropsychological and medical collaborations are burgeoning to tackle the global ch...

Background: The risk of dementia is higher in women than men. The metabolic consequences of estrogen decline during menopause accelerates neuropathology in women. The use of hormone replacement therapy (HRT) in the prevention of cognitive decline has shown conflicting results. Here we investigate the modulating role of APOE genotype and age at HRT...

Where we grow up can define us in many ways: how we speak, what activities we do, and who we might spend our life with. We have recently found that it can also impact the ability to navigate.1 Growing up in a city has, on average, a negative impact on navigation skill. This insight may be important for the development of new tools to aid the diagno...

Measures of social cognition have now become central in neuropsychology, being essential for early and differential diagnoses, follow-up and rehabilitation in a wide range of conditions. With the scientific world becoming increasingly interconnected, international neuropsychological and medical collaborations are burgeoning to tackle the global cha...

Path integration changes may precede a clinical presentation of Alzheimer disease by several years. Studies to date have focused on how grid cell changes affect path integration in preclinical AD. However, vestibular input is also critical for intact path integration. Here, we developed a naturalistic vestibular task that requires individuals to ma...

Background Ageing is highly associated with cognitive decline and modifiable risk factors such as diet are believed to protect against this process. Specific dietary components and in particular, (poly)phenol-rich fruits such as berries have been increasingly recognised for their protection against age-related neurodegeneration. However, the impact...

Background Spatial disorientation is one of the earliest and most distressing symptoms seen in patients with Alzheimer disease (AD) and can lead to them getting lost in the community. Although it is a prevalent problem worldwide and is associated with various negative consequences, very little is known about the extent to which outdoor navigation p...

Purpose: To explore carers’ views and acceptability of internet-delivered, therapist-guided, self-help Acceptance and Commitment Therapy (ACT) for family carers of people with dementia (iACT4CARERS). Methods: A qualitative approach with semi-structured interviews was employed with family carers (N=23) taking part in a feasibility study of iACT4CARE...

The cultural and geographical properties of the environment have been shown to deeply influence cognition and mental health1–6. Living near green spaces has been found to be strongly beneficial7–11, and urban residence has been associated with a higher risk of some psychiatric disorders12–14—although some studies suggest that dense socioeconomic ne...

Impairment of navigation is one of the earliest symptoms of Alzheimer’s disease (AD), but to date studies have involved proxy tests of navigation rather than studies of real life behaviour. Here we use GPS tracking to measure ecological outdoor behaviour in AD. The aim was to use data-driven machine learning approaches to explore spatial metrics wi...

Recent evidence has implicated areas within the posterior parietal cortex (PPC) as among the first to show pathophysiological changes in Alzheimer’s disease (AD). Focal brain damage to the PPC can cause optic ataxia, a specific deficit in reaching to peripheral targets. The present study describes a novel investigation of peripheral reaching abilit...

This study aimed to explore therapists’ perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruite...

Navigation ability varies widely across humans. Prior studies have reported that being younger and a male has an advantage for navigation ability. However, these studies have generally involved small numbers of participants from a handful of western countries. Here, we review findings from our project Sea Hero Quest, which used a video game for mob...

Background: Docosahexaenoic acid (DHA) is the main long chain omega-3 polyunsaturated fatty acids in the brain and accounts for 30% to 40% of fatty acids in the grey matter of the human cortex. Although the influence of circulating DHA levels on memory function is widely researched, its association with brain volumes is under investigated and its...

The hippocampus is regarded as the pivotal structure for episodic memory symptoms associated with Alzheimer’s disease (AD) pathophysiology. However, what is often overlooked is that the hippocampus is ‘only’ one part of a network of memory critical regions, the Papez circuit. Other Papez circuit regions are often regarded as less relevant for AD as...

Objectives: The feasibility of research into internet-delivered guided self-help Acceptance and Commitment Therapy (ACT) for family carers of people with dementia is not known. This study assessed this in an uncontrolled feasibility study. Method: Family carers of people with dementia with mild to moderate anxiety or depression were recruited fr...

Detection of incipient cognitive impairment and dementia pathophysiology is critical to identify preclinical populations and target potentially disease modifying interventions towards them. There are currently concerted efforts for such detection for Alzheimer's disease (AD). By contrast, the examination of cognitive markers and their relationship...

Background: Docosahexaenoic acid (DHA) is the main long chain omega-3 polyunsaturated fatty acids in the brain and accounts for 30% to 40% of fatty acids in the grey matter of the human cortex. Although the influence of circulating DHA levels on memory function is widely researched, its association with brain volumes is under investigated and its a...

Parkinson’s disease (PD) is the second most common neurodegenerative disease worldwide, characterized by symptoms of bradykinesia, rigidity, postural instability, and tremor. Recently, there has been a growing focus on the relationship between the gut and the development of PD. Emerging to the forefront, an interesting concept has developed suggest...

Objectives To compare the cognitive ability of people with rheumatoid arthritis (RA) with healthy controls (HCs). Methods People with RA were recruited from the Norfolk Arthritis Register (NOAR), a population-based cohort study of people with inflammatory arthritis. Data on aged-matched HCs (people with no cognitive impairment) came from the compa...

Docosahexaenoic acid is the main long-chain omega-3 polyunsaturated fatty acids in the brain and accounts for 30-40% of fatty acids in the grey matter of the human cortex. Although the influence of docosahexaenoic acid on memory function is widely researched, its association with brain volumes is under investigated and its association with spatial...

Research suggests that tests of memory fidelity, feature binding and spatial navigation are promising for early detection of subtle behavioural changes related to Alzheimer’s disease. In the absence of longitudinal data, one way of testing the early detection potential of cognitive tasks is through the comparison of individuals at different genetic...

Amyotrophic lateral sclerosis and behavioural variant frontotemporal dementia are two different diseases recognized to overlap at clinical, pathological and genetic characteristics. Both conditions are traditionally known for relative sparing of episodic memory. However, recent studies have disputed that with the report of patients presenting with...

Introduction L’influence des facteurs culturels sur les capacités à interagir efficacement avec nos pairs reste mal comprise. Cette question est centrale car la plupart des tests sont développés dans des contextes très spécifiques non représentatifs de la population mondiale. Objectifs À travers une étude internationale, nous souhaitions tester l’...

BACKGROUND Spatial disorientation is one of the earliest and most distressing symptoms seen in patients with Alzheimer disease (AD) and can lead to them getting lost in the community. Although it is a prevalent problem worldwide and is associated with various negative consequences, very little is known about the extent to which outdoor navigation p...

Background: Differentiating patients with behavioral variant frontotemporal dementia (bvFTD) from Alzheimer's Disease (AD) is important as these two conditions have distinct treatment and prognosis. Using episodic impairment and medial temporal lobe atrophy as a tool to make this distinction has been debatable in the recent literature, as some pat...

Introduction Dementia prevalence continues to increase, and effective interventions are needed to prevent, delay or slow its progression. Higher adherence to the Mediterranean diet (MedDiet) and increased physical activity (PA) have been proposed as strategies to facilitate healthy brain ageing and reduce dementia risk. However, to date, there have...

Spatial trajectories are ubiquitous and complex signals. Their analysis is crucial in many research fields, from urban planning to neuroscience. Several approaches have been proposed to cluster trajectories. They rely on hand-crafted features, which struggle to capture the spatio-temporal complexity of the signal, or on Artificial Neural Networks (...

Research suggests that tests of memory fidelity, feature binding and spatial navigation are promising for early detection of subtle behavioural changes related to Alzheimer's disease (AD). In the absence of longitudinal data, one way of testing the early detection potential of cognitive tasks is through the comparison of individuals at different ge...