Wayfinding – how we find our way between places – involves thinking (or cognitive) processes such as memory, concentration, and decision making as well as keeping track the direction you are travelling and distance from your destination.
Navigation skills are an important part of maintaining independence in daily life. It’s something we take for granted so it can be unnerving to find yourself getting lost on a route you thought you knew. While cognition in MS has been well studied, there has been very little research into how MS affects navigation skills. In what they believe to be the first study of its kind, researchers investigated wayfinding skills in people with MS.
Researchers in the Netherlands recruited 359 people with MS and compared them to a group who did not have MS, matched for age, gender and education level. Participants were asked to rate their navigation skills, disability level and cognitive ability. Practical navigation skills were measured using an online navigation task.
Overall, the results from people with MS were similar to people who did not have MS, but there were some differences. The study found that people with MS, especially those who rated themselves as having cognitive problems, had less confidence in their navigation skills and did less well in the practical online task. The study indicated that people with MS were less successful at recognising and remembering landmarks; this may help to identify practical solutions for people who experience problems. The researchers conclude that greater attention should be paid to navigation skills particularly for those who are experiencing other cognitive difficulties.
Many people with MS talk about 'brain fog' or 'cog fog' to describe the feeling that their thinking processes (also known as cognition) are sometimes not as organised or reliable as they used to be before they had MS. Wayfinding – how we find our way between places – involves a range of thinking processes such as memory, concentration, and decision making as well as keeping track of your direction and distance from your destination.
Although people with MS can experience difficulties with wayfinding, there has been very little research into how MS affects navigation skills. In what they believe to be the first study of its kind, researchers investigated navigation skills in people with MS.
How this study was carried out
Researchers in the Netherlands recruited 359 people with MS and compared them to a group who did not have MS, matched for age, gender and education level.
All participants were asked to rate their navigation skills by completing the Wayfinding Questionnaire (PDF, 340KB). This consists of 22 questions which cover three key aspects of navigation; confidence in finding your way around in an unknown environment, anxiety about losing your way, and the ability to estimate distances. People with MS also completed questionnaires to self-assess disability level (EDSS) and cognitive ability.
To measure practical wayfinding skills, all participants carried out an online navigation task. This involved studying a route through a virtual environment and carrying out five tasks that assessed different components of navigation ability such as recognising landmarks and identifying your position within the environment.
Overall, the results from people with MS were similar to people who did not have MS, but there were some differences. Researchers found that people with MS had significantly greater anxiety about getting lost and rated themselves less able to estimate distances than people who did not have MS. In the online navigation task, people with MS were also less successful at remembering landmarks.
When the results for people with MS were analysed in more detail, some differences within the group emerged. Walking ability is known to influence wayfinding skills; in the online navigation task, people who were more mobile scored better at recognising the location of a landmark within the environment. However, age also affects this wayfinding skill; when age was factored into the analysis, the difference between high and low mobility groups was no longer apparent.
People with MS who assessed themselves as having more cognitive difficulties also rated themselves as having poorer navigation skills and had greater anxiety about losing their way. They also did less well in the online navigation task, particularly in recognising landmarks and judging distances between landmarks.
Whether it's finding your way around an unknown building, such as a hospital, or following a well-known route to visit family or friends, navigation skills are an important part of maintaining independence in daily life. It's something we take for granted but planning and following a route from one location to another involves a range of thinking, or cognitive, processes. When we remember a route, we either remember a complete route on a map pictured in our head, or we remember it as a chain of locations, or landmarks. If you use the chain approach, forgetting one link can be disastrous. The study indicated that people with MS were less successful at recognising and remembering landmarks which may help to identify practical solutions for people who experience difficulties.
Because of the large number of participants, this study relied on a self-assessment of cognitive abilities. A study using clinical assessment of cognitive skills would add further information on the impact of MS on navigation skills.
Van der Ham IJM, et al.
Spatial navigation performance in people with multiple sclerosis - a large-scale online study.
Multiple Sclerosis and Related Disorders 2022 Feb; 58: 103423.
Find out more about problems with wayfinding
It can be unnerving to find yourself getting lost on a route you thought you knew, but there are often practical solutions to help you overcome this. For example, check routes on maps in advance and if you need to, make a photocopy or brief route notes for reference. This will help in two ways. By thinking about the route in advance and preparing the route notes, you will have reminded yourself of the way. You will also have the notes for guidance when travelling.
As with other cognitive problems, other external factors such as fatigue can also contribute, so always make sure you are well rested before a journey.
Further suggestions for managing problems with wayfinding and other cognitive problems are covered in our Staying Smart resource.
