Journal Mobile Options
Table of Contents
Vol. 17, No. 3, 2004
Issue release date: March 2004
Dement Geriatr Cogn Disord 2004;17:174–180

Getting Lost: Directed Attention and Executive Functions in Early Alzheimer’s Disease Patients

Chiu Y.-C. · Algase D. · Whall A. · Liang J. · Liu H.-C. · Lin K.-N. · Wang P.-N.
aChang-Gung University, Department and Graduate Institute of Nursing, Taoyuan, Taiwan; bUniversity of Michigan School of Nursing, and cUniversity of Michigan School of Public Health, Ann Arbor, Mich., USA; dNeurological Institute, Taipei Veterans General Hospital, and eDepartment of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


This study explores the link between directed attention (DA) and getting lost behavior (GLB) in early Alzheimer’s disease (AD) using a cross-sectional design with 3 groups. Based on their dementia levels, 116 community-dwelling participants were recruited from a teaching hospital in Taiwan and classified as the non-demented control, questionably demented, and mild AD groups. Statistical analyses include Pearson correlations, one-way ANOVA, and multiple regressions. Attentional impairments, consisting of distractibility, impulsivity, and executive function problems, significantly predict GLB in familiar and unfamiliar environments. Irritability and executive function problems are associated with mental difficulties in choosing a turn, whereas the use of way-finding strategies reduces GLB. Future interventions may include: (a) mental hygiene of aging; (b) programs targeted at improving attentional function and effective way-finding, and (c) inclusion of DA tests in a routine clinical neuropsychological examination for early detection and accurate diagnosis of dementia.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Kaplan S, Kaplan R: Cognition and Environment: Functioning in an Uncertain World. Ann Arbor, Ulrich’s Book, 1983.
  2. Algase DL: Wandering in dementia. Annu Rev Nurs Res 1999;17:185–217.
  3. Ballard CG, Mohan RN, Handy CB, Patel A: Wandering in dementia suffers. Int J Geriatr Psychiatry 1991 6:611–614.
  4. Passini R, Rainville C, Marchand N, Joanette Y: Wayfinding in dementia of the Alzheimer’s type: Planning abilities. J Clin Exp Neuropsychol 1995;17:820–832.
  5. McShane R, Gedling K, Keene J, Fairburn C, Jacoby R, Hope T: Getting lost in dementia: A longitudinal study of a behavioral symptom. Int Psychogeriatr 1998;10:253–260.
  6. Hwang J, Yang C, Tsai S, Liu K: Behavioral disturbances in psychiatric inpatients with dementia of the Alzheimer’s types in Taiwan. Int J Geriatr Psychiatry 1997;12:902–906.
  7. Woods B: Promoting well-being and independence for people with dementia. Int J Geriatr Psychiatry 1999;14:97–109.
  8. Henderson VW, Mack W, Williams BW: Spatial disorientation in Alzheimer’s disease. Arch Neurol 1989;46:391–394.
  9. de Leon MJ, Potegal M, Gurland B: Wandering and parietal signs in senile dementia of the Alzheimer’s type. Neuropsychobiology 1984;11:155–167.
  10. Tetewsky SJ, Duffy CJ: Visual loss and getting lost in Alzheimer’s disease. Neurology 1999;52:958–965.
  11. Benton AL: Disorders of spatial orientation; in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology. New York, Wiley, 1969, pp 212–228.
  12. Liu L, Guathier L, Gauthier S: Spatial disorientation in persons with early senile dementia of the Alzheimer’s type. Am J Occup Ther 1990;45:67–74.
  13. Lezak MD: The problem of assessing executive functions. Int J Psychol 1982;17:281–297.
  14. Baddeley AD: Working Memory. Oxford, Clarendon Press, 1986.
  15. Ishiai S, Okiyama R, Koyama Y, Seki K: Unilateral spatial neglect in Alzheimer’s disease: A line bisection study. Acta Neurol Scand 1996;93:219–224.
  16. Brain WR: Visual disorientation with special reference to lesions of the right cerebral hemisphere. Brain 1941;64:244–272.
  17. Mesulam MM: Principles of Behavioral Neurology. Philadelphia, Davis, 1985.
  18. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorder. Washington, American Psychiatric Association, 1999.
  19. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA work group under the auspices of the Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984;34:939–944.
  20. Huges CP, Berg L, Danziger Weal: A new clinical scale for staging of dementia. Br J Psychiatry 1982;140:566–572.
  21. Teng, EL, Hasegawa K, Homma A, Imai Y, Larson E, Graves A, Sugimoto K, Yamaguchi T, Sasaki H, Chiu D, White LR: The cognitive abilities screening instrument (CASI): A practical test for cross-cultural epidemiological studies of dementia. Int Psychogeriatr 1994;6:45–58.
  22. Lin KN, Wang PN, Liu CY, Chen WT, Lee YC, Liu HC: Cutoff scores of the cognitive abilities screening instrument, Chinese version in screening of dementia. Dement Geriatr Cogn Disord 2002;14:176–182.
  23. Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental state’: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  24. Hasegawa K: The clinical assessment of dementia in the aged: A dementia screening scale for psychogeriatric patients; in Bergerner M, Lehr U, Lang E, Schmitz-Scherzer R (eds): Aging in the Eighties and Beyond. New York, Springer, 1983, pp 207–218.
  25. Hasegawa K, Homma A, Imai Y: An epidemiological study of age-related dementia in the community. Int Geriatr Psychiatry 1986;1:45–55.
  26. Tent EL, Chiu HC: The modified Mini-Mental State (3MS) Examination. J Clin Psychiatry 1987;48:314–317.
  27. Sheikh JI, Yesavage JA: Geriatric Depression Scale (GDS): Recent evidence and development of a short form; in Brink TL (ed): Clinical Gerontology: A Guide to Assessment and Intervention. New York, Hawthorn, 1986, pp 165–173.
  28. Lu CH, Liu CY, Yu S: Depressive disorders among Chinese elderly in a suburban community. Public Health Nurs 1998;15:196–200.
  29. Rouleau I, Salmon DP, Butters N, Kennedy C, McGuire K: Quantitative and qualitative analyses of clock drawing in Alzheimer’s and Huntington’s disease. Brain Cogn 1992;18:70–87.
  30. Royall DR, Cordes JA, Polk M: CLOX: An executive clock drawing task. J Neurol Neurosurg Psychiatry 1998;64:588–594.
  31. Cimprich B: Attentional Fatigue and Restoration in Individuals with Cancer; dissertation. Ann Arbor, University of Michigan, 1990.
  32. Cimprich B: Attentional fatigue following breast cancer surgery. Res Nurs Health 1992;15:199–207.
  33. Chiu YH: Getting Lost Behavior and Directed Attention impairments in Taiwanese Patients with Early Alzheimer’s Disease. Ann Arbor, University of Michigan, 2002.
  34. Skelton RW, Bukach CM, Laurance HE, Thomas K, Jacobs W: Humans with traumatic brain injuries show place-learning deficits in computer-generated virtual space. J Clin Exp Neuropsychol 2000;22:157–175.
  35. Waltz CF, Strickland OL, Lenz ER: Measurement in Nursing Research, ed 2. Philadelphia, Davis, 1991.
  36. Helkala EL, Laulumaa V, Soininen H, Riekkinen PJ: Different error patterns of episodic and semantic memory in Alzheimer’s disease and Parkinson’s disease with dementia. Neuropsychologia 1989;27:1241–1248.
  37. Pai MC, Hsiao SS: Human navigation and homing failure. 4th Zeelandia Symposium on Behavioral Neuroscience, 2001.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50