Use of a Virtual Environment to Engage Motor and Postural Abilities in Elderly Subjects With and Without Mild Cognitive Impairment (MAAMI Project)

Alzheimer's disease diagnosis in the metaverse

BACKGROUND AND OBJECTIVE

The importance of early diagnosis of Alzheimer's Disease (AD) is by no means negligible because no cure has been recognized for it rather than some therapies only lowering the pace of progression. The research gap reveals information on the lack of an automatic non-invasive approach toward the diagnosis of AD, in particular with the help of Virtual Reality (VR) and Artificial Intelligence. Another perspective highlights that current VR studies fail to incorporate a comprehensive range of cognitive tests and consider design notes for elderlies, leading to unreliable results.

METHODS

This paper tried to design a VR environment suitable for older adults in which three cognitive assessments namely: ADAS-Cog, Montreal Cognitive Assessment (MoCA), and Mini Mental State Exam (MMSE), are implemented. Moreover, a 3DCNN-ML model was trained based on the corresponding cognitive tests and Magnetic Resonance Imaging (MRI) with different modalities using the Alzheimer's Disease Neuroimaging Initiative 2 (ADNI2) dataset and incorporated into the application to predict if the patient suffers from AD.

RESULTS

The model has undergone three experiments with different modalities (Cognitive Scores (CS), MRI images, and CS-MRI). As for the CS-MRI experiment, the trained model achieved 97%, 95%, 95%, 96%, and 94% in terms of precision, recall, F1-score, AUC, and accuracy respectively. The considered design notes were also assessed using a new proposed questionnaire based on existing ones in terms of user experience, user interface, mechanics, in-env assistance, and VR induced symptoms and effects. The designed VR system provided an acceptable level of user experience, with participants reporting an enjoyable and immersive experience. While there were areas for improvement, including graphics and sound quality, as well as comfort issues with prolonged HMD use, the user interface and mechanics of the system were generally well-received.

CONCLUSIONS

The reported results state that our method's comprehensive analysis of 3D brain volumes and incorporation of cognitive scores enabled earlier detection of AD progression, potentially allowing for timely interventions and improved patient outcomes. The proposed integrated system provided us with promising insights for improvements in the diagnosis of AD using technologies.

Development of a new computer simulated environment to screen cognition: assessing the feasibility and acceptability of Leaf Café in younger and older adults

BACKGROUND

Existing traditional cognitive screening tools for dementia have various limitations, including overreliance on tests assessing verbal memory and, to a lesser extent, on some aspects of executive functioning. Comprehensive neuropsychological assessment is sensitive to impairment but time-intensive and expensive. Virtual reality may provide a dynamic and unique understanding of cognitive performance and increase the ecological validity of cognitive assessment. The use of virtual reality in screening for cognitive function in older persons is promising, but evidence for its use remains sparse.

OBJECTIVE

Our primary aim was to examine the feasibility and acceptability of a newly developed, virtual reality assessment module, 'Leaf Café', a computer-based program that assesses cognition in an engaging, efficient, and ecologically relevant way. The secondary aim was to assess the ability of the module to discriminate between performances of younger and older adults.

METHODS

A cross-sectional study was carried out in Sydney, Australia, targeting adults aged 18 years and above. Participants completed a traditional cognitive screening tool (Telephone Interview for Cognitive Status-Modified, TICS-M) and Leaf Café, a low-immersive virtual reality module designed to evaluate learning and memory, perceptual-motor function, and executive functioning. The total performance score for each participant, ranging from 0 to 180, was correlated with their cognitive performance assessed by TICS-M, using Pearson's correlation coefficient. Following module completion, participants were presented with an open and closed-question survey to capture their perceptions, attitudes, and feedback on the module, encompassing practicality, acceptability, and enjoyment. Both descriptive and content analyses were employed to interpret the obtained data.

RESULTS

A sample of 131 participants (mean age 54.9 years, SD = 20.8, range 20-85) took part. The majority were female (71.8%) and born in an English-speaking country (75.8%). The mean amount of time spent in the module was 32.8 min (SD = 13.3) with a mean module score of 107.6 (SD = 38.7). Most participants completed the highest level (5; 80.5%). There was a significant correlation between Leaf Café total scores with TICS-M cognitive scores overall, and for both younger (aged 18-64 years) and older adult (aged 65 + years) groups. No significant difference was found on performance between age groups on TICS-M performance, however, younger adults had significantly better performance on the Leaf Café module than older adults (M = 124.1 vs 95.9; p < .001). Participants had similar response proportions regarding user experience with most agreeing that the module was easy to use (84%) and to navigate (85%). Compared with younger adults, older adults had lower rates of agreement on the module's design (36.8% vs 64.3%; p = .020) and support experienced (20.5% vs 53.6%; p = .007). Participants highlighted the significance of practicality and the cognitive challenges presented by the module, in terms of memory strain and user interface concerns. Feedback encompassed different opinions on the usefulness of music, with suggestions for improvements centred around clearer instructions, varied game dynamics, and considerations for diverse user needs.

CONCLUSIONS

Leaf Café is a feasible and acceptable tool to be used for screening for cognitive impairment in older adults and has real-world assessment value. Further verification on the game's utility in detecting cognitive impairment is required.

Digital Intervention For The Management Of Alzheimer's Disease

Alzheimer's disease (AD) is a progressive, multifactorial, chronic, neurodegenerative disease with high prevalence and limited therapeutic options, making it a global health crisis. Being the most common cause of dementia, AD erodes the cognitive, functional, and social abilities of the individual and causes escalating medical and psychosocial needs. As yet, this disorder has no cure and current treatment options are palliative in nature. There is an urgent need for novel therapy to address this pressing challenge. Digital therapeutics (Dtx) is one such novel therapy that is gaining popularity globally. Dtx provides evidence based therapeutic interventions driven by internet and software, employing tools such as mobile devices, computers, videogames, apps, sensors, virtual reality aiding in the prevention, management, and treatment of ailments like neurological abnormalities and chronic diseases. Dtx acts as a supportive tool for the optimization of patient care, individualized treatment and improved health outcomes. Dtx uses visual, sound and other non-invasive approaches for instance-consistent therapy, reminiscence therapy, computerised cognitive training, semantic and phonological assistance devices, wearables and computer-assisted rehabilitation environment to find applications in Alzheimer's disease for improving memory, cognition, functional abilities and managing motor symptom. A few of the Dtx-based tools employed in AD include "Memory Matters", "AlzSense", "Alzheimer Assistant", "smart robotic dog", "Immersive virtual reality (iVR)" and the most current gamma stimulation. The purpose of this review is to summarize the current trends in digital health in AD and explore the benefits, challenges, and impediments of using Dtx as an adjunctive therapy for the management of AD.

[Physical activity in the elderly with a major neurocognitive disorder]

A better knowledge of major neurocognitive disorders and motor learning allows us to propose motor rehabilitation (MR) adapted to subjects with Alzheimer's disease. Recent neuroscientific data on motor functions and cognition allow the construction of physical activity and MR programs, for which the dose-response relationship, content and instructions are determining factors. Further studies are needed to confirm the effectiveness of the methods used.

Virtual Reality as a Technological-Aided Solution to Support Communication in Persons With Neurodegenerative Diseases and Acquired Brain Injury During COVID-19 Pandemic

The COVID-19 poses an ongoing threat to lives around the world and challenges the existing public health and medical service delivery. The lockdown or quarantine measures adopted to prevent the spread of COVID-19 has caused the interruption in ongoing care and access to medical care including to patients with existing neurological conditions. Besides the passivity, isolation, and withdrawal, patients with neurodegenerative diseases experience difficulties in communication due to a limited access to leisure opportunities and interaction with friends and relatives. The communication difficulties may exacerbate the burden on the caregivers. Therefore, assistive-technologies may be a useful strategy in mitigating challenges associated with remote communication. The current paper presents an overview of the use of assistive technologies using virtual reality and virtual body ownership in providing communication opportunities to isolated patients, during COVID-19, with neurological diseases and moderate-to-severe communication difficulties. We postulate that the assistive technologies-based intervention may improve social interactions in patients with neurodegenerative diseases and acquired brain injury-thereby reducing isolation and improving their quality of life and mental well-being.

Virtual Reality Exercise as a Coping Strategy for Health and Wellness Promotion in Older Adults during the COVID-19 Pandemic

The December 2019 COVID-19 outbreak in China has led to worldwide quarantine, as recommended by local governments and the World Health Organization. Particularly affected are older adults (i.e., those aged ≥ 65 years) who are at elevated risk for various adverse health outcomes, including declines in motor ability and physical activity (PA) participation, increased obesity, impaired cognition, and various psychological disorders. Thus, given the secular increases in the older adult population, novel and effective intervention strategies are necessary to improve physical activity behaviors and health in this population. Virtual reality (VR)-integrated exercise is a promising intervention strategy, which has been utilized in healthcare fields like stroke rehabilitation and psychotherapy. Therefore, the purpose of this editorial is to synthesize recent research examining the efficacy and effectiveness of VR exercise in the promotion of favorable health outcomes among the older adults. Results indicate the application of VR exercise to facilitate improved physical outcomes (e.g., enhanced motor ability, reduced obesity), cognition and psychological outcomes. VR exercise has also been observed to be an effective intervention strategy for fall prevention in this population. Future research should employ more rigorous research designs to allow for a more robust quantitative synthesis of the effect of VR exercise on the preceding outcomes to elucidate which type(s) of VR-based PA interventions are most effective in promoting improved health outcomes among older adults. Findings from this study will better inform the development of technology-savvy PA programs for wellness promotion in older adults who practice social distancing and exercise from home under the unprecedented global health crisis.

Use of Immersive Virtual Reality in the Assessment and Treatment of Alzheimer's Disease: A Systematic Review

BACKGROUND

Immersive virtual reality (iVR) allows seamless interaction with simulated environments and is becoming an established tool in clinical research. It is unclear whether iVR is acceptable to people with Alzheimer's disease (AD) dementia or useful in their care. We explore whether iVR is a viable research tool that may aid the detection and treatment of AD.

OBJECTIVES

This review examines the use of iVR in people with AD or mild cognitive impairment (MCI).

METHODS

Medline, PsycINFO, Embase, CINAHL, and Web of Science databases were searched from inception. PRISMA guidelines were used with studies selected by at least two researchers.

RESULTS

Nine studies were eligible for inclusion. None reported any issues with iVR tolerability in participants with MCI and AD on assessment or treatment tasks. One study demonstrated capability for detecting prodromal AD and correlated with neuroanatomical substrates. Two studies showed iVR to have high accuracy in differentiating participants with AD from controls but were not hypothesis driven or with adequate controls measures. In a small validation study and two longitudinal case studies, iVR cognitive training was positively rated but did not demonstrate reliable benefit.

CONCLUSION

iVR is emerging as a viable method of assessing older adults and people with AD. Strongest benefits were seen when closely integrated with theoretical models of neurodegeneration and existing screening methods. Further randomized controlled trials integrated with clinical populations are required. This will consolidate the power of iVR for assessment of MCI and clarify treatment efficacy beyond current applications in physical rehabilitation.

A Mini-Review of Virtual Reality-Based Interventions to Promote Well-Being for People Living with Dementia and Mild Cognitive Impairment

Assistive technology including virtual reality and augmented reality has gained interest as a novel intervention in a range of clinical settings. This technology has the potential to provide mental stimulation, a connection to autobiographical memory through reminiscence, and enhanced quality of life (QoL) to people living with dementia (PLWD) and mild cognitive impairment (MCI). In this mini-review, we examine the available evidence from studies reporting on the potential benefits of virtual and augmented reality to provide enjoyable, leisurely activities that may promote QoL and psychological well-being and facilitate social interaction. In total, 10 studies of varying study designs and durations (5 min to 6 months) using virtual (n = 9) and augmented reality (n = 1) were examined in PLWD (n = 6) and MCI (n= 3), in addition to 1 study that included participants with both conditions. Overall, the virtual experiences were enjoyed by the participants, improved their mood and apathy, and were preferred when compared with nonvirtual experiences. However, small sample sizes and variations in study design limit the generalizability of the results. Nevertheless, the use of virtual and augmented reality technology for PLWD and MCI is a novel and emerging method which may provide cognitive stimulation and improve well-being. Future research should explore the potential application of this technology to promote social interaction in both the community and aged care settings. We suggest future studies in PLWD and MCI assess the effects of more sustained use of virtual and augmented reality technology on psychological outcomes including QoL, apathy, and depressive symptoms, with the incorporation of physiological biomarker outcomes.

Computerized neurocognitive interventions in the context of the brain training controversy

This article presents, in the form of an analytic narrative review, a complete picture of the state-of-the-art, challenges, and perspectives in the field of information and communication technology (ICT)-based neurocognitive interventions for older adults. The narrative particularly focuses on applications aimed at mild cognitive impairment and similar age-related cognitive deficits, which are analyzed in the context of the brain training controversy. Clarifying considerations are provided about the nature and present extent of the brain training debate, regarding the possible influence it has on the support received by research and development initiatives dealing with innovative computerized neurocognitive interventions. It is recommended that, because of the preliminary nature of most data currently available in this area, further research initiatives must be supported in the quest for better effectiveness of computer-based interventions intended for age-related cognitive impairment. The conclusion suggests that advanced ICT-based tools, such as virtual and augmented reality technologies, are the most fitting platforms for applying nonpharmacological computerized neurocognitive interventions.

Interactive design of patient-oriented video-games for rehabilitation: concept and application

PURPOSE

Serious video-games are innovative tools used to train the motor skills of subjects affected by neurological disorders. They are often developed to train a specific type of patients and the rules of the game are standardly defined. A system that allows the therapist to design highly patient-oriented video-games, without specific informatics skills, is proposed.

METHOD

The system consists of one personal computer, two screens, a Kinect™ sensor and a specific software developed here for the design of the video-games. It was tested with the collaboration of three therapists and six patients, and two questionnaires were filled in by each patient to evaluate the appreciation of the rehabilitative sessions.

RESULTS

The therapists learned easily how to use the system, and no serious difficulties were encountered by the patients. The questionnaires showed an overall good satisfaction by the patients and highlighted the key-role of the therapist in involving the patients during the rehabilitative session.

CONCLUSIONS

It was found that the proposed system is effective for developing patient-oriented video-games for rehabilitation. The two main advantages are that the therapist is allowed to (i) develop personalized video-games without informatics skills and (ii) adapt the game settings to patients affected by different pathologies. Implications for rehabilitation Virtual reality and serious video games offer the opportunity to transform the traditional therapy into a more pleasant experience, allowing patients to train their motor and cognitive skills. Both the therapists and the patients should be involved in the development of rehabilitative solutions to be highly patient-oriented. A system for the design of rehabilitative games by the therapist is described and the feedback of three therapists and six patients is reported.