Skip to main content Accessibility help
×
Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-18T08:49:27.440Z Has data issue: false hasContentIssue false

Chapter 5 - Changes in Visuospatial, Visuoperceptual, and Navigational Ability in Aging

Published online by Cambridge University Press:  30 November 2019

Kenneth M. Heilman
Affiliation:
University of Florida
Stephen E. Nadeau
Affiliation:
University of Florida
Get access

Summary

Aging-related changes in visual sensory processing, visual perception, and visuospatial cognition are well documented and contribute to substantial disability in the older adult population. This chapter reviews neuropsychological and neurobiological bases of disorders of face recognition, form perception, object recognition, mental/spatial imagery, spatial memory, and environmental navigation, and discusses how the aging process affects functional brain systems underlying these complex disorders.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Blumenfeld, H. Neuroanatomy through Clinical Cases. Sunderland, MA: Sinauer Associates; 2018.Google Scholar
Monge, ZA, Madden, DJ. Linking cognitive and visual perceptual decline in healthy aging: the information degradation hypothesis. Neuroscience and Biobehavioral Reviews. 2016;69:166–73.Google Scholar
Andersen, GJ. Aging and vision: changes in function and performance from optics to perception. Wiley Interdisciplinary Reviews Cognitive Science. 2012;3(3):403–10.CrossRefGoogle ScholarPubMed
Salvi, SM, Akhtar, S, Currie, Z. Ageing changes in the eye. Postgraduate Medical Journal. 2006;82:581–7.Google Scholar
Owsley, C. Vision and aging. Annual Review of Vision Science. 2016;2:255–71.CrossRefGoogle ScholarPubMed
Marshall, J. The ageing retina: physiology or pathology. Eye (London). 1987;1:282–95.Google Scholar
van den Berg, TJTP, van Rijn, LJ, Kaper-Bongers, R, Vonhoff, DJ, Volker-Dieben, HJ, Grabner, G, et al. Disability glare in the aging eye: assessment and impact on driving. Journal of Optometry. 2009;2(3):112–18.CrossRefGoogle Scholar
Spear, PD. Neural bases of visual deficits during aging. Vision Research. 1993;33(18):2589–609.Google Scholar
Coppinger, NW. The relationship between critical flicker frequency and chronologic age for varying levels of stimulus brightness. Journal of Gerontology. 1955;10(1):4852.Google Scholar
Moschner, C, Baloh, RW. Age-related changes in visual tracking. Journal of Gerontology. 1994;49(5):M235M238.CrossRefGoogle ScholarPubMed
Lindenberger, U, Baltes, PB. Sensory functioning and intelligence in old age: a strong connection. Psychology and Aging. 1994;9(3):339–55.CrossRefGoogle ScholarPubMed
Toner, CK, Reese, BE, Neargarder, S, Riedel, TM, Gilmore, GC, Cronin-Golomb, A. Vision-fair neuropsychological assessment in normal aging, Parkinson’s disease and Alzheimer’s disease. Psychology and Aging. 2012;27:785.Google Scholar
Boutet, I, Meinhardt-Injac, B. Age differences in face processing: the role of perceptual degradation and holistic processing. The Journals of Gerontology Series B, Psychological Sciences and Social Sciences, gbx172, https://doi.org/10.1093/geronb/gbx172.Google Scholar
Chaby, L, Narme, P. Processing facial identity and emotional expression in normal aging and neurodegenerative diseases. Psychologie et Neuropsychiatrie du Vieillissement. 2009;7:3142.Google ScholarPubMed
Flicker, C, Ferris, SH, Crook, T, Bartus, RT. Impaired facial recognition memory in aging and dementia. Alzheimer Disease and Associated Disorders. 1990;4(1):4354.Google Scholar
Edmonds, EC, Glisky, EL, Bartlett, JC, Rapcsak, SZ. Cognitive mechanisms of false facial recognition in older adults. Psychology and Aging. 2012;27(1):5460.Google Scholar
Brickman, AM, Khan, UA, Provenzano, FA, Yeung, LK, Suzuki, W, Schroeter, H, et al. Enhancing dentate gyrus function with dietary flavanols improves cognition in older adults. Nature Neuroscience. 2014;12:1798–803.Google Scholar
Memon, A, Bartlett, J, Rose, R, Gray, C. The aging eyewitness: effects of age on face, delay, and source-memory ability. The Journals of Gerontology Series B, Psychological Sciences and Social Sciences. 2003;58(6):P338P345.Google Scholar
Maylor, EA. Recognizing and naming faces: aging, memory retrieval, and the tip of the tongue state. Journal of Gerontology. 1990;45(6):P215P226.Google Scholar
Smith, ML, Cottrell, GW, Gosselin, F, Schyns, PG. Transmitting and decoding facial expressions. Psychological Science. 2005;16:184–9.Google Scholar
Chaby, L, Narme, P, George, N. Older adults’ configural processing of faces: role of second-order information. Psychology and Aging. 2011;26(1):71–9.CrossRefGoogle ScholarPubMed
Rossion, B. Picture-plane inversion leads to qualitative changes of face perception. Acta Psychologica. 2008;128:274–89.Google Scholar
Andersen, GJ, Atchley, P. Age-related differences in the detection of three-dimensional surfaces from optic flow. Psychology and Aging. 1995;21:7485.CrossRefGoogle Scholar
Insel, N, Ruiz-Luna, ML, Permenter, M, Vogt, J, Erickson, CA, Barnes, CA. Aging in rhesus macaques is associated with changes in novelty preference and altered saccade dynamics. Behav Neurosci. 2008;122:1328–42.CrossRefGoogle ScholarPubMed
Burke, SN, Barnes, CA. Senescent synapses and hippocampal circuit dynamics. Trends in Neurosciences. 2010;33:153–61.CrossRefGoogle ScholarPubMed
Rapp, PR, Amaral, DG. Recognition memory deficits in a subpopulation of aged monkeys resemble the effects of medial temporal lobe damage. Neurobiology of Aging. 1991;12:481–6.Google Scholar
Shamy, JL, Buonocore, MH, Makaron, LM, Amaral, DG, Barnes, CA, Rapp, PR. Hippocampal volume is preserved and fails to predict recognition memory impairment in aged rhesus monkeys (Macaca mulatta). Neurobiology of Aging. 2006;27:1405–15.CrossRefGoogle ScholarPubMed
Burke, SN, Maurer, AP, Nematollahi, S, Uprety, A, Wallace, JL, Barnes, CA. Advanced age dissociates dual functions of the perirhinal cortex. Journal of Neuroscience. 2014;34:467–80.Google Scholar
Liu, P, Gupta, N, Jing, Y, Zhang, H. Age-related changes in polyamines in memory-associated brain structures in rats. Neuroscience. 2008;155:789–96.Google Scholar
Burke, SN, Ryan, L, Barnes, CA. Characterizing cognitive aging of recognition memory and related processes in animal models and in humans. Frontiers in Aging Neuroscience. 2012;4(15):113.CrossRefGoogle ScholarPubMed
Bartko, SJ, Winters, BD, Cowell, RA, Saksida, LM, Bussey, TJ. Perceptual functions of perirhinal cortex in rats: zero-delay object recognition and simultaneous oddity discriminations. Journal of Neuroscience. 2007;27:2548–59.CrossRefGoogle ScholarPubMed
Bussey, TJ, Saksida, LM, Murray, EA. Impairments in visual discrimination after perirhinal cortex lesions: testing “declarative” vs. “perceptual-mnemonic” views of perirhinal cortex function. European Journal of Neuroscience. 2003;17:649–60.CrossRefGoogle ScholarPubMed
Burke, SN, Wallace, JL, Hartzell, AL, Nematollahi, S, Plange, K, Barnes, CA. Age-associated deficits in pattern separation functions of the perirhinal cortex: a cross-species consensus. Behavioral Neuroscience. 2011;125:836–47.Google Scholar
Murray, EA, Bussey, TJ. Perceptual-mnemonic functions of the perirhinal cortex. Trends in Cognitive Sciences. 1999;3:142–51.Google Scholar
Rolls, ET, Treves, A. Neural Networks and Brain Function. New York: Oxford University Press; 1998.Google Scholar
Barense, MD, Rogers, TT, Bussey, TJ, Saksida, LM, Graham, KS. Influence of conceptual knowledge on visual object discrimination: insights from semantic dementia and MTL amnesia. Cerebral Cortex. 2010;20(11):2568–82.Google Scholar
Behrmann, M, Lee, AC, Geskin, JZ, Graham, KS, Barense, MD. Temporal lobe contribution to perceptual function: a tale of three patient groups. Neuropsychologia. 2016;90:3345.Google Scholar
Devlin, JT, Price, CJ. Perirhinal contributions to human visual perception. Current Biology: CB. 2007;17(17):1484–8.Google Scholar
Barense, MD, Henson, RN, Graham, KS. Perception and conception: temporal lobe activity during complex discriminations of familiar and novel faces and objects. Journal of Cognitive Neuroscience. 2011;23(10):3052–67.Google Scholar
Gaynor, LS, Curiel, RE, Penate, A, Rosselli, M, Burke, SN, Wicklund, M, et al. Visual object discrimination impairment as an early predictor of mild cognitive impairment and Alzheimer’s disease. Journal of the International Neuropsychological Society. 2019 May 21:1–11.Submitted.Google Scholar
Duara, R, Loewenstein, DA, Greig, MT, Potter, E, Barker, W, Raj, A, et al. Pre-MCI and MCI: neuropsychological, clinical, and imaging features and progression rates. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry. 2011;19(11):951–60.CrossRefGoogle ScholarPubMed
Loewenstein, DA, Greig, MT, Schinka, JA, Barker, W, Shen, Q, Potter, E, et al. An investigation of PreMCI: subtypes and longitudinal outcomes. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. 2012;8(3):172–9.CrossRefGoogle ScholarPubMed
Fidalgo, CO, Changoor, AT, Page-Gould, E, Lee, AC, Barense, MD. Early cognitive decline in older adults better predicts object than scene recognition performance. Hippocampus. 2016;26(12):1579–92.Google Scholar
Arriagada, PV, Marzloff, K, Hyman, BT. Distribution of Alzheimer-type pathologic changes in nondemented elderly individuals matches the pattern in Alzheimer’s disease. Neurology. 1992;42(9):1681–8.CrossRefGoogle ScholarPubMed
Braak, H, Braak, E. Neuropathological stageing of Alzheimer-related changes. Acta Neuropathologica. 1991;82(4):239–59.Google Scholar
Khan, UA, Liu, L, Provenzano, FA, Berman, DE, Profaci, CP, Sloan, R, et al. Molecular drivers and cortical spread of lateral entorhinal cortex dysfunction in preclinical Alzheimer’s disease. Nature Neuroscience. 2014;17(2):304–11.CrossRefGoogle ScholarPubMed
Olsen, RK, Yeung, LK, Noly-Gandon, A, D’Angelo, MC, Kacollja, A, Smith, VM, et al. Human anterolateral entorhinal cortex volumes are associated with cognitive decline in aging prior to clinical diagnosis. Neurobiology of Aging. 2017;57:195205.Google Scholar
Sone, D, Imabayashi, E, Maikusa, N, Okamura, N, Furumoto, S, Kudo, Y, et al. Regional tau deposition and subregion atrophy of medial temporal structures in early Alzheimer’s disease: a combined positron emission tomography/magnetic resonance imaging study. Alzheimer’s and Dementia. 2017;9:3540.Google ScholarPubMed
Huber, CM, Yee, C, May, T, Dhanala, A, Mitchell, CS. Cognitive decline in preclinical Alzheimer’s disease: amyloid-beta versus tauopathy. Journal of Alzheimer’s Disease: JAD. 2018;61(1):265–81.Google ScholarPubMed
Park, DC, Polk, TA, Park, R, Minear, M, Savage, A, Smith, MR. Aging reduces neural specialization in ventral visual cortex. Proceedings of the National Academy of Sciences of the United States of America. 2004;101(35):13091–5.Google ScholarPubMed
Park, DC, Reuter-Lorenz, P. The adaptive brain: aging and neurocognitive scaffolding. Annual Review of Psychology. 2009;60:173–96.Google Scholar
Reuter-Lorenz, PA, Park, DC. Human neuroscience and the aging mind: a new look at old problems. The Journals of Gerontology Series B, Psychological Sciences and Social Sciences. 2010;65(4):405–15.Google Scholar
Spence, I, Feng, J. Video games and spatial cognition. Review of General Psychology. 2010;14:92104.CrossRefGoogle Scholar
Klencklen, G, Despres, O, Dufour, A. What do we know about aging and spatial cognition? Reviews and perspectives. Ageing Research Reviews. 2012;11(1):123–35.Google Scholar
Kosslyn, SM, Koenig, O, Barret, A, Cave, CB, Tang, J, Gabrieli, JDE. Evidence for two types of spatial representations: hemispheric specialization for categorical and coordinate relations. Journal of Experimental Psychology Human Perception and Performance. 1989;15:723–35.CrossRefGoogle ScholarPubMed
Baumann, O, Mattingley, JB. Dissociable roles of the hippocampus and parietal cortex in processing of coordinate and categorical spatial information. Frontiers in Human Neuroscience. 2014;8:73.CrossRefGoogle ScholarPubMed
Meadmore, KL, Dror, II, Bucks, RS. Lateralisation of spatial processing and age. Laterality. 2008;14:113.Google Scholar
Bruyer, R, Scailquin, J-C, Coibion, P. Dissociation between categorical and coordination spatial computations: modulation by cerebral hemispheres, tasks properties, mode of response, and age. Brain and Cognition. 1997;33:245–77.Google Scholar
Colombo, D, Serino, S, Tuena, C, Pedroli, E, Dakanalis, A, Cipresso, P, et al. Egocentric and allocentric spatial reference frames in aging: a systematic review. Neuroscience and Biobehavioral Reviews. 2017;80:605–21.Google Scholar
Zhang, H, Ekstrom, A. Human neural systems underlying rigid and flexible forms of allocentric spatial representation. Human Brain Mapping. 2013;34(5):1070–87.Google Scholar
Burgess, N. Spatial cognition and the brain. Annals of the New York Academy of Sciences. 2008;1124:7797.CrossRefGoogle ScholarPubMed
Wolbers, T, Hegarty, M. What determines our navigational abilities? Trends in Cognitive Sciences. 2010;14(3):138–46.Google Scholar
Burgess, N. Spatial cognition and the brain. Annals of the New York Academy of Sciences. 2008;1124:7797.CrossRefGoogle ScholarPubMed
Jager, G, Postma, A. On the hemispheric specialization for categorical and coordinate spatial relations: a review of the current evidence. Neuropsychologia. 2003;41(4):504–15.CrossRefGoogle ScholarPubMed
Ruotolo, F, van der Ham, IJ, Iachini, T, Postma, A. The relationship between allocentric and egocentric frames of reference and categorical and coordinate spatial information processing. Quarterly Journal of Experimental Psychology. 2011;64:1138–56.Google Scholar
Lester, AW, Moffat, SD, Wiener, JM, Barnes, CA, Wolbers, T. The aging navigational system. Neuron. 2017;95(5):1019–35.Google Scholar
Lich, M, Bremmer, F. Self-motion perception in the elderly. Frontiers of Human Neuroscience. 2014;8:681.Google Scholar
Adamo, DE, Briceno, EM, Sindone, JA, Alexander, NB, Moffat, SD. Age differences in virtual environment and real world path integration. Frontiers in Aging Neuroscience. 2012;4:26.Google Scholar
Bates, SL, Wolbers, T. How cognitive aging affects multisensory integration of navigational cues. Neurobiology of Aging. 2014;35:2761–9.Google Scholar
Arshad, Q, Seemungal, BM. Age-related vestibular loss: current understanding and future research directions. Frontiers in Neurology. 2016;7:231.Google Scholar
Daugherty, AM, Yuan, P, Dahle, CL, Bender, AR, Yang, Y, Raz, N. Path complexity in virtual water maze navigation: differential associations with age, sex, and regional brain volume. Cerebral Cortex. 2015;25(9):3122–31.Google Scholar
Turner, SM, Gaynor, LS, Ellison, CN, Dunn, CB, Janus, CM, Bauer, RM. Qualitative measurement of spatial navigation task reveals reduced allocentric search strategy use in normal and abnormal aging. 16th Annual Meeting of the American Academy of Clinical Neuropsychology; June 21, 2018; San Diego, CA, 2018.Google Scholar
Moffat, SD, Resnick, SM. Effects of age on virtual environment place navigation and allocentric cognitive mapping. Behavioral Neuroscience. 2002;116(5):851–9.Google Scholar
Dror, IE, Kosslyn, SM. Mental imagery and aging. Psychology and Aging. 1994;9:90102.Google Scholar
Raz, N, Briggs, SD, Marks, W, Acker, JD. Age-related deficits in generation and manipulation of mental images: II. The role of dorsolateral prefrontal cortex. Psychology and Aging. 1999;14(3):436–44.Google Scholar
Kalkstein, J, Checksfield, K, Bollinger, J, Gazzaley, A. Diminished top-down control underlies a visual imagery deficit in normal aging. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience. 2011;31(44):15768–74.Google Scholar
Gabbard, C. Mental representation for action in the elderly: implications for movement efficiency and injury risk. Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society. 2015;34(3):NP202NP212.Google Scholar
Decety, J, Grezes, J. Neural mechanisms subserving the perception of human actions. Trends in Cognitive Sciences. 1999;3:172–8.Google Scholar
Cacola, P, Roberson, J, Gabbard, C. Aging in movement representations for sequential finger movements: a comparison between young, middle aged, and older adults. Brain and Cognition. 2013;82:15.Google Scholar
Zapparoli, L, Invernizzi, P, Gndola, M, Verardi, M, Berlingeri, M, Sherna, M, et al. Mental images across the adult lifespan: a behavioural and fMRI investigation of motor execution and motor imagery. Experimental Brain Research. 2013;224(4):519–40.CrossRefGoogle ScholarPubMed
Gabbard, C, Cacola, P, Cordova, A. Is there an advanced aging effect on the ability to mentally represent action? Archives of Gerontology and Geriatrics. 2011;53:206–9.Google Scholar
Allali, G, van der Meulen, M, Beauchet, O, Rieger, SW, Vuilleumier, P, Assal, F. The neural basis of age-related changes in motor imagery of gait: an fMRI study. The Journals of Gerontology Series A, Biological Sciences and Medical Sciences. 2014;69(11):1389–98.Google Scholar
Cherry, KE, Park, DC, Donaldson, H. Adult age differences in spatial memory: effects of structural context and practice. Experimental Aging Research. 1993;19(4):333–50.CrossRefGoogle ScholarPubMed
Jiang, HK, Owyang, V, Hong, JS, Gallagher, M. Elevated dynorphin in the hippocampal formation of aged rats: relation to cognitive impairment on a spatial learning task. Proceedings of the National Academy of Sciences of the United States of America. 1989;86:2948–51.Google Scholar
Kadar, T, Silbermann, M, Brandeis, R, Levy, A. Age-related structural changes in the rat hippocampus: correlation with working memory deficiency. Brain Research. 1990;512:113–20.Google Scholar
Antonova, E, Parslow, D, Brammer, M, Dawson, GR, Jackson, SHD, Morris, RG. Age-related neural activity during allocentric spatial memory. Memory 2009;17:125–43.CrossRefGoogle ScholarPubMed
Devlin, AS. Mind and Maze: Spatial Cognition and Environmental Behavior. Westport, CT: Greenwood Press; 2001.Google Scholar
Moffat, SD, Zonderman, AB, Resnick, SM. Age differences in spatial memory in a virtual environment navigation task. Neurobiology of Aging. 2001;22(5):787–96.Google Scholar
Moffat, SD. Aging and spatial navigation: what do we know and where do we go? Neuropsychology Review. 2009;19(4):478–89.CrossRefGoogle ScholarPubMed
Rodgers, MK, Sindone, JA, 3rd, Moffat, SD. Effects of age on navigation strategy. Neurobiology of Aging. 2012;33(1):202 e15–22.Google Scholar
Harris, MA, Wiener, JM, Wolbers, T. Aging specifically impairs switching to an allocentric navigation strategy. Frontiers in Aging Neuroscience. 2012;4:29.Google Scholar
O’Keefe, J, Nadel, L. The Hippocampus as a Cognitive Map. New York: Oxford University Press; 1978.Google Scholar
Moffat, SD, Elkins, W, Resnick, SM. Age differences in the neural systems supporting human allocentric spatial navigation. Neurobiology of Aging. 2006;27(7):965–72.Google Scholar
Janzen, G, Wagensveld, B, van Turennout, M. Neural representation of navigational relevance is rapidly induced and long lasting. Cerebral Cortex. 2007;17:975–81.Google Scholar
Allard, S, Gosein, V, Cuello, AC, Ribeiro-de-Silva, A. Changes with aging in the dopaminergic and noradrenergic innervation of rat neocortex. Neurobiology of Aging. 2011;32:2244–53.CrossRefGoogle ScholarPubMed
Grudzien, A, Shaw, P, Weintraub, S, Bigio, E, Mash, DC, Mesulam, MM. Locus coeruleus neurofibrillary degeneration in aging, mild cognitive impairment, and early Alzheimer’s disease. Neurobiology of Aging. 2007;28:327–35.Google Scholar
Zhong, JY, Moffat, SD. Age-related differences in associative learning of landmarks and heading directions in a virtual navigation task. Frontiers in Aging Neuroscience. 2016;8:122.Google Scholar
Wiener, JM, Kmecova, H, de Condappa, O. Route repetition and route retracing effects of cognitive aging. Frontiers in Aging Neuroscience. 2012;4:7.Google Scholar
Umarova, RM. Adapting the concepts of brain and cognitive reserve to post-stroke cognitive deficits: implications for understanding neglect. Cortex; A Journal Devoted to the Study of the Nervous System and Behavior. 2017;97:327–38.Google Scholar
Pijnacker, J, Verstraten, P, van Damme, W, Vandermeulen, J, Steenbergen, B. Rehabilitation of reading in older individuals with macular degeneration: a review of effective training programs. Neuropsychology, Development, and Cognition Section B, Aging, Neuropsychology and Cognition. 2011;18(6):708–32.CrossRefGoogle ScholarPubMed
Starkstein, SE, Jorge, RE, Robinson, RG. The frequency, clinical correlates, and mechanism of anosognosia after stroke. Canadian Journal of Psychiatry/Revue canadienne de psychiatrie. 2010;55(6):355–61.Google Scholar
Stoerig, P. Functional rehabilitation of partial cortical blindness? Restorative Neurology and Neuroscience. 2008;26(4–5):291303.Google Scholar
Cooke, DM, McKenna, K, Fleming, J. Development of a standardized occupational therapy screening tool for visual perception in adults. Scandinavian Journal of Occupational Therapy. 2005;12(2):5971.CrossRefGoogle ScholarPubMed
Riva, G, Rizzo, A, Alpini, D, Attree, EA, Barbieri, E, Bertella, L, et al. Virtual environments in the diagnosis, prevention, and intervention of age-related diseases: a review of VR scenarios proposed in the EC VETERAN Project. Cyberpsychology & Behavior: The Impact of the Internet, Multimedia and Virtual Reality on Behavior and Society. 1999;2(6):577–91.Google Scholar
Pulido, Herrera E. Location-based technologies for supporting elderly pedestrian in “getting lost” events. Disability and Rehabilitation Assistive Technology. 2017;12(4):315–23.Google Scholar
Maniglia, M, Cottereau, BR, Soler, V, Trotter, Y. Rehabilitation approaches in macular degeneration patients. Frontiers in Systems Neuroscience. 2016;10:107.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×