The Virtual Shop: A new immersive virtual reality environment and scenario for the assessment of everyday memory

Naturalistic assessments in virtual reality and in real life help resolve the age-prospective memory paradox

 Cognitive aging researchers have long reported "paradoxical" age differences in prospective memory (PM), with age deficits in laboratory settings and age benefits (or no deficits) in real-world settings. We propose a theoretical account that explains this "age-PM-paradox" as a consequence of both methodological factors and developmental changes in cognitive abilities and personality traits. To test this account, young  and older  adults   performed a series of naturalistic PM tasks in the lab and real world. Age-related PM deficits were observed in both lab-based tasks where demands were implemented using virtual reality and in-person role-playing. In contrast, older adults performed equal to or better than young adults on both real-world tasks, where demands were implemented in participants' daily lives. Consistent with our proposed account, an index of these "paradoxical" effects was partially predicted by age-related differences in working memory, vigilance, agreeableness, and neuroticism, whose predictive utility varied across task settings.

Assessing the usability of an immersive virtual reality grocery store in healthy controls

BACKGROUND

Immersive virtual reality (IVR) as a research platform to study human behaviors is an emerging field and may be useful for studying self-care management, especially in the gap between formal healthcare recommendations and day-to-day living. Self-care activities, such as grocery shopping, can be challenging for people with chronic illness. We developed an IVR environment that simulates a real-life grocery store and conducted a usability study to demonstrate the safety and acceptability of IVR as an experimental environment.

METHODS

This study was a three-arm randomized control trial involving 24 participants, conducted as a usability study to evaluate aspects of the experimental condition including the effectiveness of a training exposure, the occurrence of undesirable effects associated with IVR, and participants' experiences of realism, immersion, and spatial presence. The experiment, using a head mounted device and handheld controllers, included a 10-minute training exposure, followed by one of three unique 30-minute experimental conditions which exposed participants to different combinations of tasks and stimuli, and a post-experience interview. We measured controller errors, undesirable symptoms associated with IVR, and the perception of realism, immersion, and spatial presence.

RESULTS

Participants used controllers effectively to interact within the IVR environment. Hand controller use errors were fewer during the experimental conditions compared to the training exposure. Minimal undesirable IVR symptoms were reported. Presence was rated in the middle range with no significant differences based on experimental condition. Overall, user experience feedback was positive.

CONCLUSIONS

We demonstrated that participants could engage in our IVR environment without excessive error or experiencing undesirable effects and confirmed that the virtual experience attained a level of presence necessary to effectively engage in the study. These findings give us confidence that this IVR intervention designed to explore instrumental activities of daily living is safe, effective and provides a credible, controlled simulated community-like setting.

Systematic review of memory assessment in virtual reality: evaluating convergent and divergent validity with traditional neuropsychological measures

Introduction

The evaluation of memory is a crucial aspect of both cognitive research and clinical applications, as it offers valuable insights into an individual's cognitive wellbeing and performance. Conventional neuropsychological assessments represent the established method for assessing different aspects of memory. Recent technological advancements, specifically in the field of virtual reality (VR), have introduced novel methods for evaluating memory.

Objective

This systematic review aims to examine the current state of memory assessment using VR technologies, assessing the degree of convergence and divergence between VR-based memory assessments and conventional neuropsychological tests.

Method

A systematic review of the literature was conducted searching PubMed, PsycINFO, Web of Science databases, leading to the incorporation of 24 studies. Studies were grouped according to the examined memory domain (episodic, prospective, spatial domain). Convergence and divergence validity were examined for each, and information on software and hardware features was collected.

Results

This review demonstrates a notable alignment between VR-based memory assessments and conventional neuropsychological tests. Moreover, VR tasks have shown to exhibit associations with executive functions and overall cognitive performance. The inclusion of various ecological contexts, such as residential environments, commercial establishments, and simulated scenarios, serves to augment the ecological validity of memory evaluations conducted in VR.

Discussion

The findings indicate that VR assessments demonstrate a functional perspective by effectively capturing the dynamic relationship between memory, executive functions, and overall cognitive performance. Nevertheless, it is imperative to acknowledge and tackle certain constraints that may hinder the widespread adoption and utilization of VR tasks. These limitations encompass factors such as restricted accessibility to VR tasks and the presence of heterogeneity in VR hardware and software. The dynamic and ever-changing nature of VR technology presents a range of potential avenues for future investigation and utilization in the domain of memory evaluation.

Development and validation of a novel Context-Based Prospective Memory Task among neurotypical adults

PURPOSE

To address the paucity and potential of context-based prospective memory (PM) assessment tasks suitable to Indian ethnicity, the study aimed to develop a novel context-based PM task and determine its psychometric properties among neurotypical adults.

METHODS

Rendered images in 2-D were extracted from a 3-D shopping mall, where PM and ongoing tasks were embedded within them to provide participants with a semi-immersive experience. The design and scoring of the novel task were constructed in alignment with the Memory for Intentions Screening Test. Fifty neurotypical adults in and around Mangaluru were recruited. The Memory of Intentions Test (MIST) and novel context-based PM task were administered.

RESULTS

The validity of the novel task was established with a Content Validity Index of 0.98. The intraclass correlation for the test-retest reliability of the novel context-based PM task was 0.92 (p<0.001) and the inter-rater reliability was 0.98 (p<0.001). The internal consistency of the six subscales was high (Cronbach's α= 0.86), and the Spearman-Brown coefficient indicated a strong split-half reliability of 0.87. Spearman's correlation showed that the trials exhibited strong connections to the dichotomic characteristics of the subscales to which they belonged. Further, McNemar's test suggested similar profiles of the participants for the MIST and novel task.

CONCLUSION

The results of the present study suggest that the novel context-based PM task offers good validity and reliability measures, providing valuable insight into the mechanisms of PM, and therefore, could be ideal for inclusion in a battery of cognitive assessments.

Comparing episodic memory outcomes from walking augmented reality and stationary virtual reality encoding experiences

Episodic Memory (EM) is the neurocognitive capacity to consciously recollect personally experienced events in specific spatio-temporal contexts. Although the relevance of spatial and temporal information is widely acknowledged in the EM literature, it remains unclear whether and how EM performance and organisation is modulated by self-motion, and by motor- and visually- salient environmental features (EFs) of the encoding environment. This study examines whether and how EM is modulated by locomotion and the EFs encountered in a controlled lifelike learning route within a large-scale building. Twenty-eight healthy participants took part in a museum-tour encoding task implemented in walking Augmented Reality (AR) and stationary Virtual Reality (VR) conditions. EM performance and organisation were assessed immediately and 48-hours after trials using a Remember/Familiar recognition paradigm. Results showed a significant positive modulation effect of locomotion on distinctive EM aspects. Findings highlighted a significant performance enhancement effect of stairway-adjacent locations compared to dead-end and mid-route stimuli-presentation locations. The results of this study may serve as design criteria to facilitate neurocognitive rehabilitative interventions of EM. The underlying technological framework developed for this study represents a novel and ecologically sound method for evaluating EM processes in lifelike situations, allowing researchers a naturalistic perspective into the complex nature of EM.

Exploring the usability of the virtual reality module LEAF CAFÉ: a qualitative think-aloud study

BACKGROUND

The global healthcare system faces increasing strain from our ageing population, primarily due to the growing prevalence of age-related health conditions such as dementia. While modern healthcare technology offers potential solutions, it frequently lacks user-friendliness for older adults. Virtual Reality (VR) has emerged as a promising tool for diagnosing cognitive impairment, offering innovative solutions where traditional methods may fall short. This study explores older adults' perspectives on the usability of a newly designed VR module for cognitive assessment.

METHODS

During a 100-min session, participants were asked to engage and complete recall and recognition tasks within the VR module (think-aloud approach) and provide feedback upon completion (semi-structured interviews). Audio materials were transcribed for analysis and recordings of the users' interactions with the module were annotated to provide additional context. These combined textual data were analysed using content coding and thematic analysis to identify themes that reflect how participants used the module's features and what features are desirable to support that process better.

RESULTS

Participants (N = 10; Mean age = 73.3, SD = 7.53, range = 65-83 years) perceived the VR module as user-friendly and endorsed its potential as a cognitive screener due to its engaging and immersive nature. Older adults highlighted three key aspects of the module: the usefulness of the platform's ability to offer a comprehensive and reliable evaluation of an individual's cognitive abilities; the need to present concise and relevant content to optimise engagement and use; and the importance of overcoming barriers to support implementation. Suggested game improvements centred on food recognition and adjusting difficulty levels. Barriers to implementation included technology challenges for older adults and concerns about the game's suitability for everyday scenarios. Participants stressed the need for reliable implementation strategies, proposing locations such as libraries and advocating for home-based screening.

CONCLUSION

Continued improvements in accessibility suggest that VR tools could help with diagnosing cognitive impairment in older adults. Using a simulated environment to assess cognitive status might fill the gap between current diagnostic methods, aiding treatment planning and early intervention. However, these findings should be approached cautiously, as more research is needed to fully grasp the potential impact of VR tools in this context.

Assessment of a virtual sensory laboratory for consumer sensory evaluations

As technology advances in the field of food sciences, the sensory experience of food consumption remains complex and influenced by various factors. Traditional consumer testing, often conducted in isolated booth environments, presents challenges in terms of construct validity and user engagement for perception formation. The growing accessibility and sophistication of virtual reality (VR) technology offer a promising avenue for research. This study focuses on the assessment of a virtual sensory laboratory, seamlessly integrating traditional sensory practices into the virtual realm to explore disparities in consumer responses, especially in sensory analysis. The virtual laboratory, designed for compatibility with VR gear, closely resembles a sensory booth. The virtual environment enables the researchers to change the visual clues of the products being tested as well as the surroundings (e.g., colors, furniture, or even the environment). Additionally, the level of immersion can be enhanced by playing any type of music, if needed. One crucial question is to assess the opinions of the participants, if they feel comfortable in the created environment. Specific participant numbers are omitted, and the study engages participants. The success of this initiative could signify a substantial advance in analysis and cost savings, adding a layer of significance to the study's potential impact on optimizing research practices. The study lays the groundwork for optimal VR practices and anticipates further exploration with immersive elements to deepen our understanding of how virtual reality influences consumer behaviour in food selection compared to traditional sensory methods.

The effects of age on objective and subjective recollection after visiting a virtual apartment

While aging has been associated with decreased retrieval of episodic memory details, subjective ratings about memory quality seem to remain stable. This suggests that subjective memory judgments are based on different information according to age. Here, we tested the hypothesis that older people would rather base their subjective judgments on the retrieval of personal elements (such as emotions and thoughts), whereas younger people would rather base their judgments on the retrieval of event-related elements (such as time, place, and perceptual details). Sixty participants (20 to 79 years old) performed eight actions in a virtual apartment and were then asked to verbally recall each action with a maximum of associated elements and to rate the subjective quality of their memories. The elements reported were classified into "person-related" and "event-related" categories. Executive functions, memory performance on traditional memory tasks, and subjects' perception of memory functioning were also evaluated. Results revealed that aging was associated with reduced retrieval of event-related elements, which was explained by decreasing executive resources. However, age did not affect the retrieval of person-related elements, and the subjective memory judgments of older people were not based on these elements to a greater extent than those of younger people. Finally, our results highlight the value of virtual reality (VR) in memory evaluations since subjects' perception of memory functioning was associated with their performance in the VR task but not in traditional memory tasks.

The underwood project: A virtual environment for eliciting ambiguous threat

Threatening environments can be unpredictable in many different ways. The nature of threats, their timing, and their locations in a scene can all be uncertain, even when one is acutely aware of being at risk. Prior research demonstrates that both temporal unpredictability and spatial uncertainty of threats elicit a distinctly anxious psychological response. In the paradigm presented here, we further explore other facets of ambiguous threat via an environment in which there are no concrete threats, predictable or otherwise, but which nevertheless elicits a building sense of danger. By incorporating both psychological research and principles of emotional game design, we constructed this world and then tested its effects in three studies. In line with our goals, participants experienced the environment as creepy and unpredictable. Their subjective and physiological response to the world rose and fell in line with the presentation of ambiguously threatening ambient cues. Exploratory analyses further suggest that this ambiguously threatening experience influenced memory for the virtual world and its underlying narrative. Together the data demonstrate that naturalistic virtual worlds can effectively elicit a multifaceted experience of ambiguous threat with subjective and cognitive consequences.

Keeping track of reality: embedding visual memory in natural behaviour

Since immersive virtual reality (IVR) emerged as a research method in the 1980s, the focus has been on the similarities between IVR and actual reality. In this vein, it has been suggested that IVR methodology might fill the gap between laboratory studies and real life. IVR allows for high internal validity (i.e., a high degree of experimental control and experimental replicability), as well as high external validity by letting participants engage with the environment in an almost natural manner. Despite internal validity being crucial to experimental designs, external validity also matters in terms of the generalizability of results. In this paper, we first highlight and summarise the similarities and differences between IVR, desktop situations (both non-immersive VR and computer experiments), and reality. In the second step, we propose that IVR is a promising tool for visual memory research in terms of investigating the representation of visual information embedded in natural behaviour. We encourage researchers to carry out experiments on both two-dimensional computer screens and in immersive virtual environments to investigate visual memory and validate and replicate the findings. IVR is valuable because of its potential to improve theoretical understanding and increase the psychological relevance of the findings.

The role of bodily self-consciousness in episodic memory of naturalistic events: an immersive virtual reality study

Recent studies suggest that the human body plays a critical role in episodic memory. Still, the precise relationship between bodily self-consciousness (BSC) and memory formation of specific events, especially in real-life contexts, remains a topic of ongoing research. The present study investigated the relationship between BSC and episodic memory (EM) using immersive virtual reality (VR) technology. Participants were immersed in an urban environment with naturalistic events, while their visuomotor feedback was manipulated in three within-subjects conditions: Synchronous, Asynchronous, and No-body. Our results show that asynchronous visuomotor feedback and not seeing one's body, compared to synchronous feedback, decrease the sense of self-identification, self-location and agency, and sense of presence. Moreover, navigating in the Asynchronous condition had a detrimental impact on incidental event memory, perceptual details, contextual association, subjective sense of remembering, and memory consolidation. In contrast, participants in the No-Body condition were only impaired in egocentric spatial memory and the sense of remembering at ten-day delay. We discuss these findings in relation to the role of bodily self-representation in space during event memory encoding. This study sheds light on the complex interplay between BSC, sense of presence, and episodic memory processes, and strengthens the potential of embodiment and VR technology in studying and enhancing human cognition.

Memory rehabilitation during the COVID-19 pandemic

BACKGROUND

Loss of cognitive and executive functions is a problem that affects people of all ages. That is why it is important to perform exercises for memory training and prevent early cognitive deterioration. The aim of this work was to compare the cognitive performance of the participants after an intervention by using two mnemonic techniques to exercise memory functions (paired-associate learning and method of loci).

METHODS

A longitudinal study was conducted with 21 healthy participants aged 18 to 55 years over a 2-month period. To assess the impact of this proposal, the NEUROPSI brief battery cognitive assessment test was applied before and after the intervention. In each session, a previous cognitive training was carried out using the paired-associate learning technique, to later perform a task based on the loci method, all from a smart device-based application. The accuracy response and reaction times were automatically collected in the app.

RESULTS

After the intervention, a statistically significant improvement was obtained in the neuropsychological assessment (NEUROPSI neuropsychological battery) reflected by the Wilcoxon paired signed-rank test (P < .05).

CONCLUSION

The task based on the method of loci also reflected the well-known age-related effects common to memory assessment tasks. Episodic memory training using the method of loci can be successfully implemented using a smart device app. A stage-based methodological design allows to acquire mnemic skills gradually, obtaining a significant cognitive improvement in a short period of time.

Everyday memory in patients with depression: An explorative pilot study using an ecological assessment paradigm

BACKGROUND

People with major depressive disorder (MDD) often experience significant memory problems in their daily lives, which, however, frequently do not correspond to standardized memory test (SMT) results. The present pilot study aimed to examine the everyday memory performance of people with MDD by means of an ecological assessment paradigm (EAP).

METHODS

Participants were unexpectedly called one week after their neuropsychological test assessment and asked about their memories of specific details of the former test situation. Associations of this EAP with SMT, subjective everyday memory problems, and symptom coping were exploratively analyzed.

RESULTS

The study involved 22 MDD inpatients (M = 42.5 years, 64% female) and 22 comparable healthy control persons. MDD patients showed a significantly reduced performance in the EAP as well as in the SMT and they reported more memory problems in their daily lives. However, the EAP was not related to SMT results assessed a week before. Moreover, only the EAP was significantly associated with subjective daily memory problems and (distraction) coping style in the MDD group.

CONCLUSIONS

The EAP appears to better reflect the everyday memory problems of persons with depression than standardized test procedures. However, the findings need to be validated by further research with larger samples.

Influence of Hand Tracking in Immersive Virtual Reality for Memory Assessment

Few works analyze the parameters inherent to immersive virtual reality (IVR) in applications for memory evaluation. Specifically, hand tracking adds to the immersion of the system, placing the user in the first person with full awareness of the position of their hands. Thus, this work addresses the influence of hand tracking in memory assessment with IVR systems. For this, an application based on activities of daily living was developed, where the user must remember the location of the elements. The data collected by the application are the accuracy of the answers and the response time; the participants are 20 healthy subjects who pass the MoCA test with an age range between 18 to 60 years of age; the application was evaluated with classic controllers and with the hand tracking of the Oculus Quest 2. After the experimentation, the participants carried out presence (PQ), usability (UMUX), and satisfaction (USEQ) tests. The results indicate no difference with statistical significance between both experiments; controller experiments have 7.08% higher accuracy and 0.27 ys. faster response time. Contrary to expectations, presence was 1.3% lower for hand tracking, and usability (0.18%) and satisfaction (1.43%) had similar results. The findings indicate no evidence to determine better conditions in the evaluation of memory in this case of IVR with hand tracking.

Automatic Detection of Cognitive Impairment with Virtual Reality

Cognitive impairment features in neuropsychiatric conditions and when undiagnosed can have a severe impact on the affected individual's safety and ability to perform daily tasks. Virtual Reality (VR) systems are increasingly being explored for the recognition, diagnosis and treatment of cognitive impairment. In this paper, we describe novel VR-derived measures of cognitive performance and show their correspondence with clinically-validated cognitive performance measures. We use an immersive VR environment called VStore where participants complete a simulated supermarket shopping task. People with psychosis (k=26) and non-patient controls (k=128) participated in the study, spanning ages 20-79 years. The individuals were split into two cohorts, a homogeneous non-patient cohort (k=99 non-patient participants) and a heterogeneous cohort (k=26 patients, k=29 non-patient participants). Participants' spatio-temporal behaviour in VStore is used to extract four features, namely, route optimality score, proportional distance score, execution error score, and hesitation score using the Traveling Salesman Problem and explore-exploit decision mathematics. These extracted features are mapped to seven validated cognitive performance scores, via linear regression models. The most statistically important feature is found to be the hesitation score. When combined with the remaining extracted features, the multiple linear regression model resulted in statistically significant results with R2 = 0.369, F-Stat = 7.158, p(F-Stat) = 0.000128.

Virtual reality technology in neuropsychological testing: A systematic review

Neuropsychological testing aims to measure individuals' cognitive abilities (e.g. memory, attention), analysing their performance on specific behavioural tasks. Most neuropsychological tests are administered in the so-called 'paper-and-pencil' modality or via computerised protocols. The adequacy of these procedures has been recently questioned, with more specific concerns about their ecological validity, i.e. the relation between test scores observed in the laboratory setting and the actual everyday cognitive functioning. In developing more ecological tasks, researchers started to implement virtual reality (VR) technology as an administration technique focused on exposing individuals to simulated but realistic stimuli and environments, maintaining at the same time a controlled laboratory setting and collecting advanced measures of cognitive functioning. This systematic review aims to present how VR procedures for neuropsychological testing have been implemented in the last years. We initially explain the rationale for supporting VR as an advanced assessment tool, but we also discuss the challenges and risks that can limit the widespread implementation of this technology. Then, we systematised the large body of studies adopting VR for neuropsychological testing, describing the VR tools' distribution amongst different cognitive functions through a PRISMA-guided systematic review. The systematic review highlighted that only very few instruments are ready for clinical use, reporting psychometric proprieties (e.g. validity) and providing normative data. Most of the tools still need to be standardised on large cohorts of participants, having published only limited data on small samples up to now. Finally, we discussed the possible future directions of the VR neuropsychological test development linked to technological advances.

Validity and diagnostic performance of a virtual reality-based supermarket application "MEMOSHOP" for assessing episodic memory in normal and pathological aging

Objective

MEMOSHOP is a virtual reality (VR)-based supermarket application for assessing episodic memory in aging. The aim of this study was to examine its construct validity against the gold standard paper-and-pencil neuropsychological test for clinical memory assessment in mild cognitive impairment (MCI) in older adults.

Methods

Patients with isolated subjective cognitive complaints (SCCs) or MCI were recruited in the Bordeaux Memory Clinic (MEMENTO cohort). Cognitively normal elderly controls were also recruited. MEMOSHOP allows a near-ecological evaluation of episodic memory during a usual daily life activity, i.e. shopping at the supermarket. MEMOSHOP and the gold standard Free and Cued Selective Reminding Test (FCSRT: French adaptation) were administered to all participants to assess episodic memory. Non-parametric tests and receiver operating characteristic curves were computed to compare their performances.

Results

Twenty-nine patients (21 females, age = 71 years ±7) and 29 matched controls were evaluated. The performance trends observed with MEMOSHOP and FCSRT on free and cued recall were associated (p < .01) and comparable (p < .0001), without any participants' groups interaction. Although easier than FCSRT in free recall for participants, MEMOSHOP demonstrated better diagnostic performance based on cued recall in isolated SCCs/MCI patients (p < .05).

Conclusion

MEMOSHOP demonstrated its reliability and validity for VR-based episodic memory assessment in the early stage of MCI and is potentially of interest for use in memory clinic settings.

A virtual reality platform for memory evaluation: Assessing effects of spatial strategies

Human spatial memories are usually evaluated using computer screens instead of real arenas or landscapes where subjects could move voluntarily and use allocentric cues to guide their behavior. A possible approach to fill this gap is the adoption of virtual reality, which provides the opportunity to create spatial memory tasks closer to real-life experience. Here we present and evaluate a new software to create experiments using this technology. Specifically, we have developed a spatial memory task that is carried out in a computer-assisted virtual environment where participants walk around a virtual arena using a joystick. This spatial memory task provides an immersive environment where the spatial component is constantly present without the use of virtual reality goggles. The design is similar to that of tasks used for animal studies, allowing a direct comparison across species. We found that only participants who reported using spatial cues to guide their behavior showed significant learning and performed significantly better during a memory test. This tool allows evaluation of human spatial memory in an ecological environment and will be useful to develop a wide range of other tasks to assess spatial cognition.

EPELI: a novel virtual reality task for the assessment of goal-directed behavior in real-life contexts

A recently developed virtual reality task, EPELI (Executive Performance in Everyday LIving), quantifies goal-directed behavior in naturalistic conditions. Participants navigate a virtual apartment, performing household chores given by a virtual character. EPELI aims to tap attention, executive function, and prospective memory. To ensure its applicability to further research and clinical work and to study its relationship to relevant background factors, we examined several key properties of EPELI in 77 typically developing 9–13-year-old children. These included EPELI’s internal consistency, age and gender differences, sensitivity to gaming experience, head-mounted display (HMD) type, and verbal recall ability, as well as its relationships with parent-rated everyday executive problems. Of the eight EPELI measures, the following six showed acceptable internal consistency: task and navigation efficacy, number of correctly performed tasks and overall actions, time monitoring, and controller movement. Some measures were associated with age, gender, or verbal encoding ability. Moreover, EPELI performance was associated with parent-rated everyday executive problems. There were no significant associations of gaming background, task familiarity, or HMD type with the EPELI measures. These results attest to the reliability and ecological validity of this new virtual reality tool for the assessment of attention, executive functions, and prospective memory in children.

User Experience during an Immersive Virtual Reality-Based Cognitive Task: A Comparison between Estonian and Italian Older Adults with MCI

Mild cognitive impairment (MCI) is an early stage of cognitive abilities loss and puts older adults at higher risk of developing dementia. Virtual reality (VR) could represent a tool for the early assessment of this pathological condition and for administering cognitive training. This work presents a study evaluating the acceptance and the user experience of an immersive VR application representing a supermarket. As the same application had already been assessed in Italy, we aimed to perform the same study in Estonia in order to compare the outcomes in the two populations. Fifteen older adults with MCI were enrolled in one Rehabilitation Center of Estonia and tried the supermarket once. Afterwards, they were administered questionnaires aimed at evaluating their technology acceptance, sense of presence, and cybersickness. Estonian participants reported low side effects and discrete enjoyment, and a sense of presence. Nonetheless, their intention to use the technology decreased after the experience. The comparison between Italian and Estonian older adults showed that cybersickness was comparable, but technology acceptance and sense of presence were significantly lower in the Estonian group. Thus, we argue that: (i) cultural and social backgrounds influence technology acceptance; (ii) technology acceptance was rather mediated by the absence of positive feelings rather than cybersickness.

Cognitive Decline Detection for Alzheimer's Disease Patients Through an Activity of Daily Living (ADL)

There are conventional screening instruments for the detection of cognitive impairment, but they have a reduced ecological validity and the information they present could be biased. This study aimed at evaluating the effectiveness and usefulness of a task based on an activity of daily living (ADL) for the detection of cognitive impairment for an Alzheimer's disease (AD) population. Twenty-four participants were included in the study. The AD group (ADG) included twelve older adults (12 female) with AD (81.75±7.8 years). The Healthy group (HG) included twelve older adults (5 males, 77.7 ± 6.4 years). Both groups received a ADL-based intervention at two time frames separated 3 weeks. Cognitive functions were assessed before the interventions by using the MEC-35. The test-retest method was used to evaluate the reliability of the task, as well as the Intraclass Correlation Coefficient (ICC). The analysis of the test-retest reliability of the scores in the task indicated an excellent clinical relevance for both groups. The hypothesis of equality of the means of the scores in the two applications of the task was accepted for both the ADG and HG, respectively. The task also showed a significant high degree of association with the MEC-35 test (rho = 0.710, p = 0.010) for the ADG. Our results showed that it is possible to use an ADL-based task to assess everyday memory intended for cognitive impairments detection. In the same way, the task could be used to promote cognitive function and prevent dementia.

ObReco-2: Two-step validation of a tool to assess memory deficits using 360° videos

Traditional neuropsychological evaluations are usually carried out using psychometric paper and pencil tests. Nevertheless, there is a continuous discussion concerning their efficacy to capture life-like abilities. The introduction of new technologies, such as Virtual Reality (VR) and 360° spherical photos and videos, has improved the ecological validity of the neuropsychological assessment. The possibility of simulating realistic environments and situations allows clinicians to evaluate patients in realistic activities. Moreover, 360° photos and videos seem to provide higher levels of graphical realism and technical user-friendliness compared to standard VR, regardless of their limitations in terms of interactivity. We developed a novel 360° tool, ObReco-2 (Object Recognition version 2), for the assessment of visual memory which simulates a daily situation in a virtual house. More precisely, patients are asked to memorize some objects that need to be moved for a relocation. After this phase, they are asked to recall them after 15 min and later to recognize them in the same environment. Here we present a first study about the usability of ObReco-2, and a second one exploring its clinical efficacy and updated usability data. We focused on Free Recall and Recognition scores, comparing the performances obtained by the participants in the standard and the 360° test. The preliminary results support the use of 360° technology for enhancing the ecological value of standard memory assessment tests.

Design Considerations for Immersive Virtual Reality Applications for Older Adults: A Scoping Review

Immersive virtual reality (iVR) has gained considerable attention recently with increasing affordability and accessibility of the hardware. iVR applications for older adults present tremendous potential for diverse interventions and innovations. The iVR literature, however, provides a limited understanding of guiding design considerations and evaluations pertaining to user experience (UX). To address this gap, we present a state-of-the-art scoping review of literature on iVR applications developed for older adults over 65 years. We performed a search in ACM Digital Library, IEEE Xplore, Scopus, and PubMed (1 January 2010–15 December 2019) and found 36 out of 3874 papers met the inclusion criteria. We identified 10 distinct sets of design considerations that guided target users and physical configuration, hardware use, and software design. Most studies carried episodic UX where only 2 captured anticipated UX and 7 measured longitudinal experiences. We discuss the interplay between our findings and future directions to design effective, safe, and engaging iVR applications for older adults.

Age-Related Performance in Using a Fully Immersive and Automated Virtual Reality System to Assess Cognitive Function

Introduction

Cognition generally declines gradually over time due to progressive degeneration of the brain, leading to dementia and eventual loss of independent functions. The rate of regression varies among the six cognitive domains (perceptual motor, executive function, complex attention, learning and memory, social cognition and language). Current modality of cognitive assessment using neuropsychological paper-and-pencil screening tools for cognitive impairment such as the Montreal Cognitive Assessment (MoCA) has limitations and is influenced by age. Virtual reality (VR) is considered as a potential alternative tool to assess cognition. A novel, fully immersive automated VR system (Cognitive Assessment using Virtual Reality, CAVIRE) has been developed to assess the six cognitive domains. As cognition is associated with age, VR performance is postulated to vary with age using this system.

Aims

This is a feasibility study to evaluate the VR performance of cognitively healthy adults aged between 35 and 74 years old, based on the performance score and completion time using the CAVIRE system.

Methods

Conducted in a public primary care clinic in Singapore, 25 multi-ethnic Asian adults were recruited in each of the four age groups in years: (1) 35–44; (2) 45–54; (3) 55–64, and (4) 65–74. The eligibility criteria included a MoCA score of 26 or higher to reflect normal cognition and understanding English instructions. They completed common daily activities ranging from brushing teething to shopping, across 13 VR segments. Their performances scores and completion time were automatically computed by the CAVIRE system. These VR performance indices were compared across the four age groups using one-way ANOVA, F-test of the hypothesis, followed by pair-wise comparisons in the event of a significant F-test (p < 0.05).

Results

One participant dropped out from Group 1. The demographic characteristics of 99 participants were similar across the 4 age groups. Overall, younger participants in Groups 1 and 2 attained higher VR performance scores and shorter completion time, compared to those in Groups 3 and 4, in all six cognitive domains (all p < 0.05).

Conclusion

The CAVIRE VR performance scores and completion time significantly differ between the younger and older Asian participants with normal cognition. Enhancements to the system are needed to establish the age-group specific normal performance indices.

Examining the Academic Trends in Neuropsychological Tests for Executive Functions Using Virtual Reality: Systematic Literature Review

Background

In neuropsychology, fully immersive virtual reality (VR) has been spotlighted as a promising tool. It is considered that VR not only overcomes the existing limitation of neuropsychological tests but is also appropriate for treating executive functions (EFs) within activities of daily living (ADL) due to its high ecological validity. While fully immersive VR offers new possibilities of neuropsychological tests, there are few studies that overview the intellectual landscape and academic trends in the research related to mainly targeted EFs with fully immersive VR.

Objective

The objective of this study is to get an overview of the research trends that use VR in neuropsychological tests and to analyze the research trends using fully immersive VR neuropsychological tests with experimental articles.

Methods

This review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were searched in three web databases using keywords related to VR, EFs, and cognitive abilities. The study was conducted in two steps, keyword analysis and in-depth systematic review. In the web database search from 2000 to 2019, 1167 articles were initially collected, of which 234 articles in the eligibility phase were used to conduct keyword analysis and a total of 47 articles were included for systematic review.

Results

In keyword analysis, the number of articles focused on dementia including the keywords “MCI,” “SCD,” and “dementia” were highlighted over the period, rather than other symptoms. In addition, we identified that the use of behavioral and physiological data in virtual environments (VEs) has dramatically increased in recent studies. In the systematic review, we focused on the purpose of study, assessment, treatment, and validation of usability and structure. We found that treatment studies and uncategorized studies including presence and cybersickness issues have emerged in the recent period. In addition, the target symptoms and range of participants were diversified.

Conclusions

There has been a continuously increasing interest in dealing with neuropsychology by using fully immersive VR. Target cognitive abilities have been diversified, as well as target symptoms. Moreover, the concept of embodied cognition was transplanted in this research area.

Diagnostic Validity of the Smart Aging Serious Game: An Innovative Tool for Digital Phenotyping of Mild Neurocognitive Disorder

BACKGROUND

The Smart Aging Serious Game (SASG) is an ecologically-based digital platform used in mild neurocognitive disorders. Considering the higher risk of developing dementia for mild cognitive impairment (MCI) and vascular cognitive impairment (VCI), their digital phenotyping is crucial. A new understanding of MCI and VCI aided by digital phenotyping with SASG will challenge current differential diagnosis and open the perspective of tailoring more personalized interventions.

OBJECTIVE

To confirm the validity of SASG in detecting MCI from healthy controls (HC) and to evaluate its diagnostic validity in differentiating between VCI and HC.

METHODS

161 subjects (74 HC: 37 males, 75.47±2.66 mean age; 60 MCI: 26 males, 74.20±5.02; 27 VCI: 13 males, 74.22±3.43) underwent a SASG session and a neuropsychological assessment (Montreal Cognitive Assessment (MoCA), Free and Cued Selective Reminding Test, Trail Making Test). A multi-modal statistical approach was used: receiver operating characteristic (ROC) curves comparison, random forest (RF), and logistic regression (LR) analysis.

RESULTS

SASG well captured the specific cognitive profiles of MCI and VCI, in line with the standard neuropsychological measures. ROC analyses revealed high diagnostic sensitivity and specificity of SASG and MoCA (AUCs > 0.800) in detecting VCI versus HC and MCI versus HC conditions. An acceptable to excellent classification accuracy was found for MCI and VCI (HC versus VCI; RF: 90%, LR: 91%. HC versus MCI; RF: 75%; LR: 87%).

CONCLUSION

SASG allows the early assessment of cognitive impairment through ecological tasks and potentially in a self-administered way. These features make this platform suitable for being considered a useful digital phenotyping tool, allowing a non-invasive and valid neuropsychological evaluation, with evident implications for future digital-health trails and rehabilitation.

Usability and Effectiveness of Immersive Virtual Grocery Shopping for Assessing Cognitive Fatigue in Healthy Controls: Protocol for a Randomized Controlled Trial

BACKGROUND

Cognitive fatigue (CF) is a human response to stimulation and stress and is a common comorbidity in many medical conditions that can result in serious consequences; however, studying CF under controlled conditions is difficult. Immersive virtual reality provides an experimental environment that enables the precise measurement of the response of an individual to complex stimuli in a controlled environment.

OBJECTIVE

We aim to examine the development of an immersive virtual shopping experience to measure subjective and objective indicators of CF induced by instrumental activities of daily living.

METHODS

We will recruit 84 healthy participants (aged 18-75 years) for a 2-phase study. Phase 1 is a user experience study for testing the software functionality, user interface, and realism of the virtual shopping environment. Phase 2 uses a 3-arm randomized controlled trial to determine the effect that the immersive environment has on fatigue. Participants will be randomized into 1 of 3 conditions exploring fatigue response during a typical human activity (grocery shopping). The level of cognitive and emotional challenges will change during each activity. The primary outcome of phase 1 is the experience of user interface difficulties. The primary outcome of phase 2 is self-reported CF. The core secondary phase 2 outcomes include subjective cognitive load, change in task performance behavior, and eye tracking. Phase 2 uses within-subject repeated measures analysis of variance to compare pre- and postfatigue measures under 3 conditions (control, cognitive challenge, and emotional challenge).

RESULTS

This study was approved by the scientific review committee of the National Institute of Nursing Research and was identified as an exempt study by the institutional review board of the National Institutes of Health. Data collection will begin in spring 2021.

CONCLUSIONS

Immersive virtual reality may be a useful research platform for simulating the induction of CF associated with the cognitive and emotional challenges of instrumental activities of daily living.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04883359; http://clinicaltrials.gov/ct2/show/NCT04883359.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/28073.

Library for universal virtual reality experiments (luVRe): A standardized immersive 3D/360° picture and video database for VR based research

Virtual reality is a promising tool for experimental psychology, enhancing the ecological validity of psychological science. The advantage of VR is that it enables researchers to study emotional and cognitive processes under realistic conditions while maintaining strict experimental control. To make it easier for scientists to get into the world of VR research and to improve the comparability of scientific results, we have created and validated a standardized set of 3D/360° videos and photos. Study 1 investigated the electrophysiological differences between motivational and emotional reactions exhibited under immersive VR and conventional 2D conditions. The obtained frontal alpha asymmetries show diverge patterns between the two conditions giving rise to further speculations that associated psychological processes exhibit more natural functional properties under immersive conditions. The feeling of being at the center of a realistic VR environment creates a sense of self-relevance. In VR, motivational tendencies and emotional reactions are related to objects or persons within the vicinity of the participant and not to the stimuli presented on a screen. Study 2, investigating the memory performance for VR videos as opposed to a conventional 2D screen presentation, provides evidence that memory formed under immersive conditions created more profound memory traces. This so-called memory superiority effect for the VR conditions might again result from the feeling of being in a scene, thus facilitating the formation of autobiographical memory. The implementation of VR experiments using the database is straightforward as it does neither require much technical equipment nor a high level of VR expertise.

Multimodal immersive trail making-virtual reality paradigm to study cognitive-motor interactions

BACKGROUND

Neuropsychological tests of executive function have limited real-world predictive and functional relevance. An emerging solution for this limitation is to adapt the tests for implementation in virtual reality (VR). We thus developed two VR-based versions of the classic Color-Trails Test (CTT), a well-validated pencil-and-paper executive function test assessing sustained (Trails A) and divided (Trails B) attention-one for a large-scale VR system (DOME-CTT) and the other for a portable head-mount display VR system (HMD-CTT). We then evaluated construct validity, test-retest reliability, and age-related discriminant validity of the VR-based versions and explored effects on motor function.

METHODS

Healthy adults (n = 147) in three age groups (young: n = 50; middle-aged: n = 80; older: n = 17) participated. All participants were administered the original CTT, some completing the DOME-CTT (14 young, 29 middle-aged) and the rest completing the HMD-CTT. Primary outcomes were Trails A and B completion times (t_A, t_B). Spatiotemporal characteristics of upper-limb reaching movements during VR test performance were reconstructed from motion capture data. Statistics included correlations and repeated measures analysis of variance.

RESULTS

Construct validity was substantiated by moderate correlations between the'gold standard' pencil-and-paper CTT and the VR adaptations (DOME-CTT: t_A 0.58, t_B 0.71; HMD-CTT: t_A 0.62, t_B 0.69). VR versions showed relatively high test-retest reliability (intraclass correlation; VR: t_A 0.60-0.75, t_B 0.59-0.89; original: t_A 0.75-0.85, t_B 0.77-0.80) and discriminant validity (area under the curve; VR: t_A 0.70-0.92, t_B 0.71-0.92; original: t_A 0.73-0.95, t_B 0.77-0.95). VR completion times were longer than for the original pencil-and-paper test; completion times were longer with advanced age. Compared with Trails A, Trails B target-to-target VR hand trajectories were characterized by delayed, more erratic acceleration and deceleration, consistent with the greater executive function demands of divided vs. sustained attention; acceleration onset later for older participants.

CONCLUSIONS

The present study demonstrates the feasibility and validity of converting a neuropsychological test from two-dimensional pencil-and-paper to three-dimensional VR-based format while preserving core neuropsychological task features. Findings on the spatiotemporal morphology of motor planning/execution during the cognitive tasks may lead to multimodal analysis methods that enrich the ecological validity of VR-based neuropsychological testing, representing a novel paradigm for studying cognitive-motor interactions.

Getting started with virtual reality for sensory and consumer science: Current practices and future perspectives

While virtual reality (VR) has become increasingly popular in food-related research, there has been a lack of clarity, precision, and guidelines regarding what exactly constitutes a virtual reality study, as well as the options available to the researcher for designing and implementing it. This review provides a practical guide for sensory and consumer scientists interested in exploring the emerging opportunities offered by VR. We take a deep dive into the components that make up a VR study, including hardware, software, and response measurement methods, all the while being grounded in immersion and presence theory. We then review how these building blocks are put together to create two major categories of research scenarios: product selection, which can be entirely created in VR, and food evaluation, which involve tasting products in real life. For each category, we review current literature with a focus on experimental design, then highlight future avenues and technical development opportunities within sensory and consumer research. Finally, we evaluate limitations and ethical issues in VR food research, and offer future perspectives which go above and beyond ensuring ecological validity in product testing.

A Virtual Kitchen Protocol to Measure Everyday Memory Functioning for Meal Preparation

In this study, we developed the Virtual Kitchen Protocol (VKP), a virtual reality-based measure of everyday memory functioning for meal preparation tasks. We investigated the construct validity of the VKP by comparing the performance of young adults (n = 41) and older adults without (n = 52) and with (n = 7) a neurocognitive diagnosis, as well as by examining correlations with standardized measures of verbal and visual memory. The results show that young adults had higher recall than older adults and that the VKP was sensitive to neurocognitive impairment among older adults. The VKP demonstrated moderate to high correlations with other memory tests. These results support the construct validity of the VKP and suggest that it holds promise as a virtual reality-based measure of memory for meal preparation tasks.

Cognitive and Emotional Mapping With SEEG

Mapping of cortical functions is critical for the best clinical care of patients undergoing epilepsy and tumor surgery, but also to better understand human brain function and connectivity. The purpose of this review is to explore existing and potential means of mapping higher cortical functions, including stimulation mapping, passive mapping, and connectivity analyses. We examine the history of mapping, differences between subdural and stereoelectroencephalographic approaches, and some risks and safety aspects, before examining different types of functional mapping. Much of this review explores the prospects for new mapping approaches to better understand other components of language, memory, spatial skills, executive, and socio-emotional functions. We also touch on brain-machine interfaces, philosophical aspects of aligning tasks to brain circuits, and the study of consciousness. We end by discussing multi-modal testing and virtual reality approaches to mapping higher cortical functions.

Using Virtual Reality to Assess and Promote Transfer of Memory Training in Older Adults With Memory Complaints: A Randomized Controlled Trial

In this proof-of-concept study, we assessed the potential for immersive virtual reality (VR) to measure transfer following strategic memory training, and whether efficacy and transfer are increased when training is complemented by practice in an immersive virtual environment. Forty older adults with subjective memory complaints were trained with the method of loci. They were randomized to either a condition where they practiced the strategy in VR (n = 20) or a control condition where they were familiarized with VR using a non-memory task (n = 20). Training efficacy was measured with word recall, and transfer of the training benefit was measured with a recall task completed in two VR tasks (primary outcomes) as well as a self-report memory questionnaire (secondary outcomes). Testing was administered before (PRE), midway (POST 3), and after (POST 6) training. Participants improved their scores on word recall. Regarding transfer measures, participants improved their performance in the two VR recall tasks but not on the self-report memory questionnaire. No significant group effect was observed. Improvement was found when comparing PRE to POST 3 with no further improvement at POST 6. Thus, strategic memory training improved the memory of seniors with memory complaints on word recall and a transfer task relying on a VR scenario that resembles real-life. However, no evidence supporting an increase in transfer effects was found when enriching training with VR memory exercises.

Serious video games and virtual reality for prevention and neurorehabilitation of cognitive decline because of aging and neurodegeneration

PURPOSE OF REVIEW

Cognitive decline because of aging and neurodegeneration has become increasingly prevalent. This calls for the implementation of efficacious, motivating, standardized and widely available cognitive interventions for the elderly. In this context, serious video games and virtual reality may represent promising approaches. Here, we review recent research on their potential for cognitive prevention and neurorehabilitation of age-related cognitive decline and mild cognitive impairment (MCI).

RECENT FINDINGS

The majority of currently available data in this evolving domain lacks the methodological quality to draw reliable conclusions on the potential of novel technology for cognitive training in older people. However, single well designed randomized controlled trials have reported promising effects of cognitive interventions involving serious video games and virtual reality. The cognitive benefits of exergames promoting physical exercise with and without combined cognitive training remain unclear.

SUMMARY

The immersion into stimulating and motivating environments along with training content based on neuroscientific and neuropsychological models may represent a significant advance as compared with conventional computerized cognitive training. Additional research with sound methodology including sufficient sample sizes, active control groups and meaningful outcome measures of everyday function is needed to elucidate the potential of serious video games and virtual reality in multifactorial neurorehabilitation of cognitive decline in aging and neurodegeneration.

Development and Validation of a Virtual Reality-Based Training Program for Promoting Subjective Well-Being

OBJECTIVE

Enhancing subjective well-being is an effective way to improve mental health. This study aimed to validate a virtual realitybased interactive feedback program as an intervention tool for promoting subjective well-being.

METHODS

Thirty-six males participated in this program, consisting of three tasks constructed based on the theories of positive psychology: 'Experience-based problem recognition task', 'Future self-based success story expression task', and 'Strength expression task'. Participants rated visual analog scores associated with each of the tasks' contents. The concurrent validity of task scores was evaluated by correlations with the psychological scale scores.

RESULTS

The total task score was positively correlated with scores of Mental Health Continuum-Short Form (MHC-SF) emotional wellbeing and psychological well-being, Rosenberg's Self-Esteem Scale, Dispositional Hope Scale agency dimension and pathways dimension, and Life Orientation Test Revised, but not with MHC-SF social well-being scores. After controlling for the effects of the other task scores, the task scores had linear relationships with certain psychological assessments.

CONCLUSION

Since the task scores are closely related to indicators of well-being, self-esteem, hope, and optimism, the program contents are well associated with certain aspects of subjective well-being and thus may be available for training that improves subjective well-being through interactive feedback.

Head-Mounted Display-Based Application for Cognitive Training

Virtual Reality (VR) has had significant advances in rehabilitation, due to the gamification of cognitive activities that facilitate treatment. On the other hand, Immersive Virtual Reality (IVR) produces outstanding results due to the interactive features with the user. This work introduces a VR application for memory rehabilitation by walking through a maze and using the Oculus Go head-mounted display (HMD) technology. The mechanics of the game require memorizing geometric shapes while the player progresses in two modes, autonomous or manual, with two levels of difficulty depending on the number of elements to remember. The application is developed in the Unity 3D video game engine considering the optimization of computational resources to improve the performance in the processing and maintaining adequate benefits for the user, while the generated data is stored and sent to a remote server. The maze task was assessed with 29 subjects in a controlled environment. The obtained results show a significant correlation between participants’ response accuracy in both the maze task and a face–pair test. Thus, the proposed task is able to perform memory assessments.

The Construction and Validation of a Sustainable Tourism Development Evaluation Model

As climate change, food crises, sustainable development, and ecological conservation gain traction, the revival of traditional fishing villages has become an important governmental policy for Taiwan. To reduce cognitive bias, the choice experiment method was applied to construct an attribute function in fishing village tourism coupled with virtual reality headsets. Conditional logit and random parameter logit models were employed to estimate tourism utility functions. Moreover, a latent class model was employed to determine whether hetxerogeneous preferences regarding fishing village travel existed. The sampling sites were distributed across the Dongshi area. In total, 612 tourists and 170 local residents were interviewed. After incomplete questionnaires were removed, 816 valid questionnaires remained, representing 95.83% of the total questionnaires. Older residents and residents with shorter histories of education were inclined to increase land development and utilization by reducing natural landscapes; tourists preferred preserving landscapes and preventing land development. Residents with more education believed that local landscape imagery was essential. Tourists who were more educated, with high incomes, and those who were older believed that a selling platform incorporating local industries and products within the villages would be attractive for other tourists.

Being in the Past and Perform the Future in a Virtual World: VR Applications to Assess and Enhance Episodic and Prospective Memory in Normal and Pathological Aging

The process of aging commonly features a gradual deterioration in cognitive performance and, in particular, the decline of memory. Despite the increased longevity of the world’s population, the prevalence of neurodegenerative conditions, such as dementia, continues to be a major burden on public health, and consequently, the latest research has been focused on memory and aging. Currently, the failure of episodic and Prospective memory (PM) is one of the main complaints in the elderly, considered among the early symptoms of dementia. It is therefore increasingly important to define more clearly the boundaries between normal and pathological aging. Recently, researchers have begun to build and apply Virtual Environments (VE) to the explicit purpose of better understanding the performance of episodic and PM in complex and realistic contexts, with the perspective of further developing effective training procedures that depend on reliable cognitive assessment methods. Virtual technology offers higher levels of realism than “pen and paper” testing and at the same time more experimental control than naturalistic settings. In this mini-review article, we examine the outcomes of recently available studies on virtual reality technology applications developed for the assessment and improvement of episodic and/or PM. To consider the latest technology, we selected 29 articles that have been published in the last 10 years. These documents show that VR-based technologies can provide a valid basis for screening and treatment and, through increased sensory stimulation and enriched environments reproducing the scenarios of everyday life, could represent effective stimulating experiences even in pathological aging.

The design, evaluation, and reporting on non-pharmacological, cognition-oriented treatments for older adults: Results of a survey of experts

INTRODUCTION

Cognitive decline and dementia significantly affect independence and quality of life in older adults; therefore, it is critical to identify effective cognition-oriented treatments (COTs; eg, cognitive training, rehabilitation) that can help maintain or enhance cognitive functioning in older adults, as well as reduce dementia risk or alleviate symptoms associated with pathological processes.

METHODS

The Cognitive Intervention Design Evaluation and Reporting (CIDER), a working group from the Non-Pharmacological Interventions Professional Interest Area (NPI-PIA) of the Alzheimer's Association conducted as survey in 2017 with experts in COTs worldwide. The survey's aims were three-fold: (1) determine the common attitudes, beliefs, and practices of experts involved in the COTs research targeting older people; (2) identify areas of relative agreement and disagreement among experts in the field; and (3) offer a critical review of the literature, including recommendations for future research.

RESULTS

The survey identified several areas of agreements among experts on critical features of COTs, and on study design and outcome measures. Nevertheless, there were some areas with relative disagreement. Critically, expert opinions were not always supported by scientific evidence, suggesting that methodologic improvements are needed regarding design, implementation, and reporting of COTs. There was a clear consensus that COTs provide benefits and should be offered to cognitively unimpaired older adults, mild cognitive impairment (MCI), and mild dementia, but opinions differed for moderate and severe dementia. In addition, there is no consensus on the potential role of COTs in dementia prevention, indicating that future research should prioritize this aspect.

DISCUSSION

Evidence of COTs in older adults is encouraging, but additional evidence is needed to enhance dementia prevention. Consensus building and guidelines in the field are critical to improve and accelerate the development of high-quality evidence for COTs in cognitively unimpaired older adults, and those with MCI and dementia.

The Role of Virtual Reality in Improving Health Outcomes for Community-Dwelling Older Adults: Systematic Review

Background

Virtual reality (VR) delivered through immersive headsets creates an opportunity to deliver interventions to improve physical, mental, and psychosocial health outcomes. VR app studies with older adults have primarily focused on rehabilitation and physical function including gait, balance, fall prevention, pain management, and cognition. Several systematic reviews have previously been conducted, but much of the extant literature is focused on rehabilitation or other institutional settings, and little is known about the effectiveness of VR apps using immersive headsets to target health outcomes among community-dwelling older adults.

Objective

The objective of this review was to evaluate the effectiveness of VR apps delivered using commercially available immersive headsets to improve physical, mental, or psychosocial health outcomes in community-dwelling older adults.

Methods

Peer-reviewed publications that included community-dwelling older adults aged ≥60 years residing in residential aged care settings and nursing homes were included. This systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness evidence. The title of this review was registered with JBI, and the systematic review protocol was registered with the International Prospective Register of Systematic Reviews.

Results

In total, 7 studies that specifically included community-dwelling older adults were included in this review. VR apps using a head-mounted display led to improvements in a number of health outcomes, including pain management, posture, cognitive functioning specifically related to Alzheimer disease, and a decreased risk of falls. A total of 6 studies reported a statistically significant difference post VR intervention, and 1 study reported an improvement in cognitive function to reduce navigational errors. Only one study reported on the usability and acceptability of the interventions delivered through VR. While one study used a distraction mechanism for pain management, none of the studies used gaming technology to promote enjoyment.

Conclusions

Interventions to improve health outcomes through VR have demonstrated potential; however, the ability to synthesize findings by primary outcome for the older adult population is not possible. A number of factors, especially related to frailty, usability, and acceptability, also need to be explored before more substantial recommendations on the effectiveness of VR interventions for older adults can be made.

Trial Registration

PROSPERO CRD42019143504; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143504

In Medio Stat Virtus: intermediate levels of mind wandering improve episodic memory encoding in a virtual environment

Episodic memory encoding is highly influenced by the availability of attentional resources. Mind wandering corresponds to a shift of attention toward task-unrelated thoughts. Few studies, however, have tested this link between memory encoding and mind wandering. The goal of the present work was to systematically investigate the influence of mind wandering during encoding on episodic memory performances in an ecological setting. Fifty-two participants were asked to navigate in a virtual urban environment. During the walk, they encountered different scenes that, unbeknownst to the participants, were target items presented in a subsequent recognition task associated with a Remember-Know-Guess paradigm. Each item triggered, after a random interval, a thought probe assessing current mind wandering. We found a significant linear positive relationship between the ratio of correctly recognized items and the overall mind wandering reported after the task. Moreover, we found a quadratic reversed U-shaped relationship between the probability of giving a 'Remember' response and both on-line and mind wandering reported a posteriori. The nearer to the medium value the level of mind wandering was, the higher was the probability to have a recollection-based recognition. Our results indicate that in a complex environment, the highest probability of actually remembering a scene would be when participants present a medium attentional level: neither distracted by inner thoughts nor too focused on the environment. This open attentional state would allow a better global processing of the environment by preventing one's attention from being captured by internal thoughts or narrowed by an over-focusing on the environment.

Feasibility of a virtual reality-based interactive feedback program for modifying dysfunctional communication: a preliminary study

Background

Functional communication is vital in many areas of daily life, and modifying dysfunctional communication has been emphasized in various social areas, including family and school. The present preliminary study addressed the feasibility of a virtual reality (VR)-based interactive feedback program for the modification of dysfunctional communication.

Methods

Thirty-seven healthy young males completed psychological assessments associated with functional communication and participated in the VR-based program, consisting of the three tasks of ‘exploring the communication style,’ ‘practicing functional communication,’ and ‘expressing empathy.’ Behavioral parameters were recorded based on the participants’ choices among available options and the visual analog scale scores that resulted in responses to questions in the tasks.

Results

Participants completed the program without dropping-out and reported 10.76 (SD, 9.66) in the Simulator Sickness Questionnaire and 106.97 (SD, 16.66) in the Presence Questionnaire. In exploring the communication style, there was no difference between the dysfunction level-with family and dysfunction level-with a friend, but only the dysfunction level-with family showed significant correlations with the level of communication with parents. In practicing functional communication, the communication scores with the placating, blaming, and computing styles significantly increased according to the repetition of trials. In expressing empathy, the empathetic feeling score was negatively correlated with the perspective-taking score, whereas the emotional intensity score was positively correlated with the level of differentiation of the self.

Conclusion

These results suggest that the program may have a tolerable level of cybersickness, an adequate level of presence, an improvement in the behavioral parameters that may reflect the important aspects of communication, and a proper reflection of psychological states or interpersonal characteristics. The use of this program can be an important starting point for the development of a more convenient method for delivering VR programs designed to modify dysfunctional communication, which can further increase computerized dissemination.

Design of a 3D Platform for Immersive Neurocognitive Rehabilitation

In recent years, advancements in human–computer interaction (HCI) have enabled the development of versatile immersive devices, including Head-Mounted Displays (HMDs). These devices are usually used for entertainment activities as video-gaming or augmented/virtual reality applications for tourist or learning purposes. Actually, HMDs, together with the design of ad-hoc exercises, can also be used to support rehabilitation tasks, including neurocognitive rehabilitation due to strokes, traumatic brain injuries, or brain surgeries. In this paper, a tool for immersive neurocognitive rehabilitation is presented. The tool allows therapists to create and set 3D rooms to simulate home environments in which patients can perform tasks of their everyday life (e.g., find a key, set a table, do numerical exercises). The tool allows therapists to implement the different exercises on the basis of a random mechanism by which different parameters (e.g., objects position, task complexity) can change over time, thus stimulating the problem-solving skills of patients. The latter aspect plays a key role in neurocognitive rehabilitation. Experiments obtained on 35 real patients and comparative evaluations, conducted by five therapists, of the proposed tool with respect to the traditional neurocognitive rehabilitation methods highlight remarkable results in terms of motivation, acceptance, and usability as well as recovery of lost skills.

Episodic Memory Assessment and Remediation in Normal and Pathological Aging Using Virtual Reality: A Mini Review

Life expectancy is constantly increasing in developed countries. Unfortunately, a longer life does not always correspond to a healthier life, as even normal aging is associated with cognitive decline and increased risk factors for neurodegenerative diseases. Episodic memory (EM) is one of the most vulnerable cognitive functions in aging, and its decline is the hallmark of typical Alzheimer's disease. This memory system is defined as the ability to acquire and recollect personally experienced episodes associated with a specific affective, spatial, and temporal context. However, most of the neuropsychological and experimental tasks currently employed to assess EM consist in learning simple material (e.g., list of words) in highly stereotyped contexts. In the same vein, classical paper-and-pencil or numeric remediation tools have shown their limitations in the transfer of acquired skills to daily life. Virtual reality (VR), thanks to its immersive properties, and the possibility of delivering realistic and complex scenarios, seems a promising tool to address the limitations of the assessment and remediation of EM. Here, we review existing studies employing VR in normal and pathological aging to assess and reeducate EM. Overall, we show that VR has been mainly used via non-immersive systems. Further studies should, therefore, test the impact of different degrees of immersion. Moreover, there is a lack of VR remediation tools specifically targeting EM. We propose that future studies should fill this gap, addressing in particular the adaptivity of VR remediation protocols.

Deception and Shopping Behavior Among Current Cigarette Smokers: A Web-Based, Randomized Virtual Shopping Experiment

BACKGROUND

Virtual stores can be used to identify influences on consumer shopping behavior. Deception is one technique that may be used to attempt to increase the realism of virtual stores.

OBJECTIVE

The objective of the experiment was to test whether the purchasing behavior of participants in a virtual shopping task varied based on whether they were told that they would receive the products they selected in a virtual convenience store (a form of deception) or not.

METHODS

We recruited a US national sample of 402 adult current smokers by email from an online panel of survey participants. They completed a fully automated randomized virtual shopping experiment with a US $15 or US $20 budget in a Web-based virtual convenience store. We told a random half of participants that they would receive the products they chose in the virtual store or the cash equivalent (intervention condition), and the other random half simply to conduct a shopping task (control condition). We tested for differences in demographics, tobacco use behaviors, and in-store purchases (outcome variable, assessed by questionnaire) by experimental condition.

RESULTS

The characteristics of the participants (398/402, 99.0% with complete data) were comparable across conditions except that the intervention group contained slightly more female participants (103/197, 52.3%) than the control group (84/201, 41.8%; P=.04). We did not find any other significant differences in any other demographic variables or tobacco use, or in virtual store shopping behaviors, including purchasing any tobacco (P=.44); purchasing cigarettes (P=.16), e-cigarettes (P=.54), cigars (P=.98), or smokeless tobacco (P=.72); amount spent overall (P=.63) or on tobacco (P=.66); percentage of budget spent overall (P=.84) or on tobacco (P=.74); number of total items (P=.64) and tobacco items purchased (P=.54); or total time spent in the store (P=.07).

CONCLUSIONS

We found that telling participants that they will receive the products they select in a virtual store did not influence their purchases. This finding suggests that deception may not affect consumer behavior and, as a result, may not be necessary in virtual shopping experiments.