Not just scenery: viewing nature pictures improves executive attention in older adults

Exploring Subjective Mental Health Change in Older Adults after Experiencing an Immersive Virtual Reality (IVR) -Based Natural Environment

The study explored subjective mental health change in adults aged 60 to 100 by experiencing immersive virtual reality (IVR)-based on the natural environment. It investigated changes in thinking, behaviour, and emotions from a socioecological perspective. The study conducted quantitative surveys of 540 older adults via IVR who lived in 20 longevity villages in South Korea from Dec. 2022 to Nov. 2023. It also paralleled a qualitative study with 38 of the 540. Study results predicting subjective mental health changes after experiencing IVR in those over 70 showed the highest gladness and happiness. In over 70 compared with 60 to 69 ages, the study found that relieving stress and depression, gladness and happiness, and relaxing the mind have about two-fold subjective mental health changes after experiencing IVR. The study suggests that it can be utilized to promote subjective mental health through the experience of an IVR-based natural environment for older adults.

Encouraging online consumers into making better food choices: The power of nature exposure on healthy food choices

BACKGROUND

online environments can influence food desire and choices. We tested if online calming nature and stressful street environments can affect desire for healthy and unhealthy foods.

METHOD

we asked 238 participants (40 ± 14 yrs) to rate their desire (100 mm VAS) for 7 low calorie nutrient rich foods (Healthy) and 7 high calorie nutrient poor foods (Unhealthy), and perceived stress (state anxiety in STAI), before and after imagining themselves in a control, nature park, or busy street condition.

RESULTS

participants who imagined themselves being in a nature park had a significant higher desire for Healthy foods, than participants in the busy street condition (p < 0.05). Participants in the busy street condition decreased their desire for Healthy foods after they imagined themselves in a busy street (p < 0.05)). However, perceived stress did not impact the association between condition and desire for low calorie foods nor high calorie foods.

CONCLUSION

this study suggests that online environments can have an impact on healthy food desires, which could be of importance for the increased number of food choices which are made in online environments.

Brighten up the Rainbow: Ecology-Based Group Work for LGBTQ+ People

This research was carried out as a pretest-posttest experimental study in order to evaluate the effect of ecology-based group work on 18 LGBTQ+ people living in different districts of Istanbul. The study group of the research carried out between July 2022 and August 2022 consists of 18 LGBTQ+ people, between the ages of 19-22. Study participants were randomly selected for each group and assigned to the experimental and control groups. In addition to the Personal Information Form, the Flourishing Scale, the Nature Relatedness Scale, and the Depression Stress and Anxiety Scale (DASS21) were applied to the study group as pretest-posttest. Socializing, hiking, gardening, and human-animal interaction activities were held in the group work sessions consisting of 6 sessions on Saturdays at 13.00. In addition to all these activities, some documentaries on ecology were also suggested for the participants to watch, to be discussed in different sessions. The collected data were analyzed in the SPSS 22.0 package program. At the end of the group work, it was observed that there was a significant difference in the total scores of the Flourishing Scale, the Nature Relatedness Scale, and Depression Stress and Anxiety Scale (DASS21) of LGBTQ+ people in the experimental group.

Immersion in nature enhances neural indices of executive attention

There is conjecture that our modern urban environments place high demand on our attentional resources, which can become depleted over time and cause mental fatigue. Natural environments, on the other hand, are thought to provide relief from this demand and allow our resources to be replenished. While these claims have been assessed with self-report and behavioral measures, there is limited understanding of the neural mechanisms underlying these attentional benefits. The present randomized controlled trial fills this gap in the literature by using electroencephalography to explore three aspects of attention-alerting, orienting, and executive control-from a behavioral and neural perspective. Participants (N = 92) completed the Attention Network Task before and after either a 40-min walk in nature or a 40-min walk in a control, urban environment. Participants that walked in nature reported their walk to be more restorative than those that walked in the urban environment. Furthermore, the nature group showed an enhanced error-related negativity after their walk, an event-related brain component that indexes executive control capacity, whereas the urban group did not. These findings demonstrate that a 40-min nature walk enhances executive control at a neural level, providing a potential neural mechanism for attention restoration in nature.

Elucidating and Expanding the Restorative Theory Framework to Comprehend Influential Factors Supporting Ageing-in-Place: A Scoping Review

Exposure to stress and attention fatigue resulting from changes in capabilities and residing in environments that do not align with individual needs can adversely impact older adults' mental health and complicate ageing-in-place. Research into the psychological restoration process can help assist in alleviating these issues. Existing research on restoration perspectives has predominantly centred on university students and lacks comprehensive insights into older adults. Consequently, this study seeks to acquire a deeper understanding of the restorative theory framework within the context of ageing populations. We identified and analysed thirty-nine papers on the restoration process of older adults employing the scoping review method. Our findings indicate that adjustments to the general restorative theory framework are imperative for ageing populations. By incorporating additional features-such as being with and familiarity-the framework can more effectively support the development of age-inclusive neighbourhoods that enhance the mental health of the older population and facilitate healthy ageing-in-place. While more in-depth research is required on the restoration process of older adults, this research marks the initial in adapting the general framework to ageing populations. Furthermore, insight is given into how the adapted framework can contribute to help address the challenges of global ageing and support ageing-in-place.

Nature Photographs as Complementary Care in Chemotherapy: A Randomized Clinical Trial

The incidence of cancer cases is increasing worldwide, and chemotherapy is often necessary as part of the treatment for many of these cases. Nature-based interventions have been shown to offer potential benefits for human well-being.

OBJECTIVE

This study aims to investigate the outcome of nature images on clinical symptom management related to chemotherapy.

METHODS

A randomized clinical trial was conducted in an outpatient cancer unit of a private hospital in Brazil, with 173 participants over the age of 18 who were undergoing chemotherapy and had signed an informed consent form. The intervention consisted of the presentation of a 12-min video featuring nature images categorized under the themes of Tranquility, Beauty, Emotions Up, or Miscellany. Images were sourced from the e-Nature Positive Emotions Photography Database (e-NatPOEM), a publicly available collection of affectively rated images. Sociodemographic and clinical data, as well as the participants' connection to nature, were investigated. The Positive Affect/Negative Affect Scale (PANAS) and the Edmonton Symptom Assessment System (ESAS) were applied pre- and post-intervention.

RESULTS

Data showed very strong evidence of a reduction in negative affect for the intervention group (p < 0.001) and moderate evidence for the control group (p = 0.034). There was also a significant reduction in the intervention group for pain (p < 0.001), tiredness (p = 0.002), sadness (p < 0.001), anxiety (p < 0.001), and appetite (p = 0.001). The Beauty video had the best performance, while the Tranquility video showed no significant improvement in any of the symptoms evaluated. These findings suggest that images of nature may be a valuable tool to help control clinical and psychological symptoms in cancer patients undergoing chemotherapy.

Restorative Effects of Observing Natural and Urban Scenery after Working Memory Depletion

According to attention restoration theory observing nature has restorative effects on cognitive components, such as working memory, after a cognitive depleting task. Additionally, urban environments are thought to have no effect or even a negative effect on cognitive restoration. Previous research has confirmed that observing actual, as well as digitally presented nature sceneries leads to more restoration of working memory capacity (WMC) than observing (digital) urban sceneries. To further investigate these findings, we conducted an experiment with 72 university students as participants. After a WMC depleting task, participants observed either digitally presented nature scenery, urban scenery or no scenery, and subsequently performed a digit span test, which was used to measure restoration of WMC. Results indicated significant higher performance on the digit span test for those who observed nature scenery in comparison to those who observed urban scenery or no scenery, thereby replicating results from previous research. Observing urban scenery was neither harmful nor helpful in terms of cognitive restoration compared to observing no scenery. These findings provide a foundation for implementing a brief intervention of observing nature in academic settings to facilitate the restoration of WMC.

A Virtual Reality Intervention to Reduce Dementia-Related Agitation Using Single-Case Design

OBJECTIVES

The primary objective of this study was to use a single-case design to evaluate the utility of a VR intervention to reduce agitation behaviors in two female participants with a diagnosis of dementia.

METHODS

A single-case research design with an ideographic approach was selected given the novelty of this intervention. A blended single case experimental design was used combining the Multiple-baseline design across individuals with a reversal design to examine the effects of VR nature scenes on agitation. Visual analysis was used to determine changes in mean, level, and latency of the behaviors.

RESULTS

For both participants, a significant decrease in their respective agitation behaviors was observed during intervention phases.

CONCLUSIONS

This study provides preliminary evidence of the utility of VR as a brief and effective intervention to decrease agitation in individuals with dementia.

CLINICAL IMPLICATIONS

These initial, promising results may help caregivers improve the quality of life for dementia patients. Further, the brevity of the intervention makes this a practical tool for care providers working in clinical settings. The primary objective of this study was to use a single-case design to evaluate the utility of a VR intervention to reduce agitation behaviors in two female participants with a diagnosis of dementia.

Comparing Auditory and Visual Distractions for Reducing Pain Severity and Pain Anxiety in Older Outpatients with Burn: A Randomized Controlled Trial

Pain and anxiety are major issues among older patients with burn injuries. Complementary medicine and non-pharmacological methods can relieve pain and anxiety in older people, but comparison of the effects of these methods needs further research. This study aimed to compare the effects of auditory and visual distractions on pain severity and pain anxiety in older outpatients referred to a burn clinic for dressing change. In this randomized controlled clinical trial, older men were randomly assigned to three groups as auditory distraction, visual distraction, and control (n = 45 in each group). The Visual Analogue Scale (VAS) and the Burn Specific Pain Anxiety Scale (BSPAS) were used to asses pain severity and pain anxiety before and immediately after the interventions, and after wound dressing. Reduction in pain severity and pain anxiety after visual distraction was reported. Auditory distraction only reduced pain anxiety. Therefore, visual distraction had a better effect on alleviating pain anxiety compared with auditory distraction. Visual distraction is suggested to be used during dressing changes for older outpatients with burn injuries in outpatient clinics in order to reduce their burn-related suffering and improve their collaboration with the therapeutic regimen.

Virtual reality cognitive intervention for heart failure: CORE study protocol

Introduction

Heart failure (HF) is a prevalent, serious chronic illness that affects 6.5 million adults in the United States. Among patients with HF, the prevalence of attention impairment is reported to range from 15% to 27%. Although attention is fundamental to human activities including HF self-care, cognitive interventions for patients with HF that target improvement in attention are scarce. The COgnitive intervention to Restore attention using nature Environment (CORE) study aims to test the preliminary efficacy of the newly developed Nature-VR, a virtual reality-based cognitive intervention that is based on the restorative effects of nature. Nature-VR development was guided by Attention Restoration Theory. The target outcomes are attention, HF self-care, and health-related quality of life (HRQoL). Our exploratory aims examine the associations between attention and several putative/established HF biomarkers (eg, oxygen saturation, brain-derived neurotrophic factor, apolipoprotein E, dopamine receptor, and dopamine transporter genes) as well as the effect of Nature-VR on cognitive performance in other domains (ie, global cognition, memory, visuospatial, executive function, and language), cardiac and neurological events, and mortality.

Methods

This single-blinded, two-group randomized-controlled pilot study will enroll 74 participants with HF. The Nature-VR intervention group will view three-dimensional nature pictures using a virtual reality headset for 10 minutes per day, 5 days per week for 4 weeks (a total of 200 minutes). The active comparison group, Urban-VR, will view three-dimensional urban pictures using a virtual reality headset to match the Nature-VR intervention in intervention dose and delivery mode, but not in content. After baseline interviews, four follow-up interviews will be conducted to assess sustained effects of Nature-VR at 4, 8, 26, and 52 weeks.

Discussion

The importance and novelty of this study consists of using a first-of-its kind, immersive virtual reality technology to target attention and in investigating the health outcomes of the Nature-VR cognitive intervention among patients with HF.

Utilizing the "One Health" Model to Study Human Aging in Urban Environments

The "One Health" concept has resulted in a rich research literature that integrates human and animal systems, with a focus on zoonotic diseases; however, this narrow focus is at the expense of one of the leading causes of global human mortality: non-infectious, chronic diseases. Here, we provide a viewpoint that applying the integrated One Health framework to public health issues such as the impact of stressful urban environments on the process of human aging has the potential to elucidate potential causal mechanisms that have previously gone unnoticed. Given the success of the One Health paradigm in studying human health in rural areas, we posit that this model would be a useful tool for studying human, animal, and environmental interactions in urban settings.

What's Playing in Your Waiting Room? Patient and Provider Stress and the Impact of Waiting Room Media

Patients enter the healthcare space shouldering a lot of personal stress. Concurrently, health care providers and staff are managing their own personalstressors as well as workplace stressors. As stress can negatively affect the patient-provider experience and cognitive function of both individuals, it is imperative to try to uplift the health care environment for all. Part of the healthcare environmental psychology strategy to reduce stress often includes televisions in waiting rooms, cafeterias, and elsewhere, with the intent to distract the viewer and make waiting easier. Although well-intentioned, many select programming which can induce stress (eg, news). In contrast, as positive media can induce desirable changes in mood, it is possible to use it to decrease stress and uplift viewers, including staff. Positive media includes both nature media, which can relax and calm viewers and kindness media, which uplifts viewers, induces calm, and promotes interpersonal connection and generosity. Careful consideration of waiting room media can affect the patient-provider experience.

Validating Visual Stimuli of Nature Images and Identifying the Representative Characteristics

This study fills a void in the literature by both validating images of nature for use in future research experiments and examining which characteristics of these visual stimuli are found to be most representative of nature. We utilized a convenience sample of university students to assess 129 different nature images on which best represented nature. Participants (n = 40) viewed one image per question (n = 129) and were asked to rate images using a 5-point Likert scale, with the anchors “best represents nature” (5) and “least represents nature” (1). Average ratings across participants were calculated for each image. Canopies, mountains, bodies of water, and unnatural elements were identified as semantic categories of interest, as well as atmospheric perspectives and close-range views. We conducted the ordinary least squares (OLS) regression and the ordered logistic regression analyses to identify semantic categories highly representative of nature, controlling for the presence/absence of other semantic categories. The results showed that canopies, bodies of water, and mountains were found to be highly representative of nature, whereas unnatural elements and close-range views were inversely related. Understanding semantic categories most representative of nature is useful in developing nature-centered interventions in behavioral performance research and other neuroimaging modalities. All images are housed in an online repository and we welcome the use of the final 10 highly representative nature images by other researchers, which will hopefully prompt and expedite future examinations of nature across multiple research formats.

Breaking Beyond the Borders of the Brain: Self-Control as a Situated Ability

“I just couldn’t control myself” are the infamous last words of a person that did something that they knew they should not have done. Consistent self-control is difficult to achieve, but it is also instrumental in achieving ambitious goals. Traditionally, the key to self-control has been assumed to reside in the brain. Recently, an alternative has come to light through the emergence of situated theories of self-control, which emphasize the causal role of specific situated factors in producing successful self-control. Some clinical interventions for motivational or impulse control disorders also incorporate certain situated factors in therapeutic practices. Despite remaining a minority, situated views and practices based on these theories have planted the seeds of a paradigm shift in the self-control literature, moving away from the idea that self-control is an ability limited to the borders of the brain. The goal of this paper is to further motivate this paradigm shift by arguing that certain situated factors show strong promise as genuine causes of successful self-control, but this potential role is too often neglected by theorists and empirical researchers. I will present empirical evidence which suggests that three specific situated factors – clenched muscles, calming or anxiety-inducing environmental cues, and social trust – exhibit a specialized effect of increasing the likelihood of successful self-control. Adopting this situated view of the ability to regulate oneself works to reinforce and emphasize the emerging trend to design therapies based on situated cognition, makes self-control more accessible and less overwhelming for laypeople and those who struggle with impulse control disorders, and opens a new avenue of empirical investigation.

Implicit Associations With Nature and Urban Environments: Effects of Lower-Level Processed Image Properties

Nature experiences usually lead to restorative effects, such as positive affective states and reduced stress. Even watching nature compared to urban images, which are known to differ in several image properties that are processed at early stages, can lead to such effects. One potential pathway explaining how the visual input alone evokes restoration is that image properties processed at early stages in the visual system evoke positive associations. To study these automatic bottom-up processes and the role of lower-level visual processing involved in the restoring effects of nature, we conducted two studies. First, we analyzed nature and urban stimuli for a comprehensive set of image properties. Second, we investigated implicit associations in a dichotomous set of nature and urban images in three domains, namely, valence, mood, and stress restoration. To examine the role of lower-level processing in these associations, we also used stimuli that lacked the spatial information but retained certain image properties of the original photographs (i.e., phase-scrambled images). While original nature images were associated with “good,” “positive mood,” and “restoration,” urban images were associated with “bad” and “stress.” The results also showed that image properties differ between our nature and urban images and that they contribute to the implicit associations with valence, although spatial information and therefore recognition of the environment remained necessary for positive associations. Moreover, lower-level processed image properties seem to play no or only minor roles for associations with mood and stress restoration.

Age Differences in the Subcomponents of Executive Functioning

OBJECTIVES

Across the life span, deficits in executive functioning (EF) are associated with poor behavioral control and failure to achieve goals. Though EF is often discussed as one broad construct, a prominent model of EF suggests that it is composed of three subdomains: inhibition, set shifting, and updating. These subdomains are seen in both younger (YA) and older adults (OA), with performance deficits across subdomains in OA. Therefore, our goal was to investigate whether subdomains of EF might be differentially affected by age, and how these differences may relate to broader global age differences in EF.

METHODS

To assess these age differences, we conducted a meta-analysis at multiple levels, including task level, subdomain level, and of global EF. Based on previous work, we hypothesized that there would be overall differences in EF in OA.

RESULTS

Using 1,268 effect sizes from 401 articles, we found overall differences in EF with age. Results suggested that differences in performance are not uniform, such that variability in age effects emerged at the task level, and updating was not as affected by age as other subdomains.

DISCUSSION

These findings advance our understanding of age differences in EF, and stand to inform early detection of EF decline.

What Affects Older Adults' Viewing Behaviors in Neighborhood Open Space: A Study in Hong Kong

Research on older adults' behaviors, living environments, and their quality of life (QoL) has grown rapidly. Viewing behaviors, although broadly acknowledged as critical for older adults' QoL, have not been systematically examined in situ. What affects the viewing behaviors of older adults in neighborhood open space (NOS) is still unclear. This study conducted unobtrusive continuous observations in NOS of two residential estates in Hong Kong. With spatio-temporal analyses with ArcGIS Pro and statistical analyses with SPSS, principal influential factors to viewing behaviors of older adults in NOS were identified, including distances for viewing, landscape attractiveness, body supporting elements, as well as moving and interactive behaviors. How these factors would affect older adults' well-being and QoL is discussed from the perspectives of supportive landscape design, sense of control, prospect and refuge, and social support, etc. Corresponding design implications are proposed to enrich existing NOS design knowledge for older adults' quality of life.

Effects of exposure to immersive videos and photo slideshows of forest and urban environments

A large number of studies have demonstrated the benefits of natural environments on people's health and well-being. For people who have limited access to nature (e.g., elderly in nursing homes, hospital patients, or jail inmates), virtual representations may provide an alternative to benefit from the illusion of a natural environment. For this purpose and in most previous studies, conventional photos of nature have been used. Immersive virtual reality (VR) environments, however, can induce a higher sense of presence compared to conventional photos. Whether this higher sense of presence leads to increased positive impacts of virtual nature exposure is the main research question of this study. Therefore, we compared exposure to a forest and an urban virtual environment in terms of their respective impact on mood, stress, physiological reactions, and cognition. The environments were presented via a head-mounted display as (1) conventional photo slideshows or (2) 360[Formula: see text] videos. The results show that the forest environment had a positive effect on cognition and the urban environment disturbed mood regardless of the mode of presentation. In addition, photos of either urban or forest environment were both more effective in reducing physiological arousal compared to immersive 360[Formula: see text] videos.

Natural Is Not Always Better: The Varied Effects of a Natural Environment and Exercise on Affect and Cognition

The Attention Restoration Theory (ART) has been widely cited to account for beneficial effects of natural environments on affect and attention. However, the effects of environment and exercise are not consistent. In a within-subjects design, participants completed affective and cognitive measures that varied in attentional demands (memory, working memory, and executive function) both before and after exercise in a natural and indoor environment. Contrary to the hypotheses, a natural environment resulted in lower positive affect and no difference in negative affect compared to an indoor environment. A natural environment resulted in the most improvement for cognitive tasks that required moderate attentional demand: Trail Making Test A and Digit Span Forwards. As predicted, exercise resulted in improved affect and improved executive function (Trail Making Test B). There were no interactions between environment and exercise. These results suggest that ART cannot fully explain the influence of environment on affect and cognition.

Restore or Get Restored: The Effect of Control on Stress Reduction and Restoration in Virtual Nature Settings

Virtual nature experiences can improve physiological and psychological well-being. Although there is ample research on the positive effects of nature, both in virtual and physical settings, we know little about potential moderators of restoration effects in virtual reality settings. According to theories of needs and control beliefs, it is plausible to assume that control over one’s actions affects how people respond to nature experiences. In this virtual reality (VR) experiment, 64 participants either actively navigated through a VR landscape or they were navigated by the experimenter. We measured their perceived stress, mood, and vitality before and after the VR experience as well as the subjective restoration outcome and the perceived restorativeness of the landscape afterwards. Results revealed that participants’ positive affective states increased after the VR experience, regardless of control. There was a main effect such that participants reported lower stress after the VR experience; however, this was qualified by an interaction showing that this result was only the case in the no control condition. These results unexpectedly suggest that active VR experiences may be more stressful than passive ones, opening pathways for future research on how handling of and navigating in VR can attenuate the effects of virtual nature.

Focusing on Emotional and Social Intelligence Stimulation of People With Dementia by Playing a Serious Game—Proof of Concept Study

Context: Dementia is one of the top five chronic diseases, which has an overwhelming impact on patients' life quality, family, and caregivers. Currently, research relating to people with dementia (PwD) focuses on the deterioration of cognitive abilities. A more innovative approach, and the one taken by this paper, is focusing on methods to maintain and improve functionality, communication and quality of life of PwD by building on remaining capacities in the yet unexplored domain of emotional and social intelligence (ESI). The use of serious games for PwD (SG4D) aimed at building social and emotional capacity is a budding field of research.

Objectives: Proof of concept that the, low cost, easy to deploy SG4D, called “My Brain Works” (MBW), co-designed with PwD, enhances ESI, based on the Bar-On ESI model.

Methods: 27 PwD, clients at MELABEV dementia day center, participated in a mixed methods 12 weeks pilot, proof of concept study using a tablet SG4D co-designed with PwD. Quantitative performance data was collected automatically by the tablet during game sessions. In this paper we focus on the analysis of the qualitative and quantitative data related to ESI, observed by 10 different researchers, during each game session.

Results: Quantitative data revealed: both the PwD with high and low MoCA scores had similar average ESI scores. Qualitative analysis revealed that the PwD demonstrated 9 sub-components of the Bar-On ESI Model.

Conclusion: While there is no drug to stop cognitive decline associated with dementia, interventions related to ESI, on the other hand, may improve functioning and quality of life. Despite declines in cognitive abilities, our study shows that a tablet based SG4D can stimulate their ESI and evoke responses in self-awareness, empathy, social and communication capacities. Using SG4D to exercise and maintain social skills is an area that may be promising in the future and may help counter the negative effects of social isolation and loneliness. Such games, while not focusing on cognitive improvement, may also impact on cognitive functioning and help bridge the gap between caregiver and PwD. More research is needed with larger sample sizes.

Immediate Attention Enhancement and Restoration From Interactive and Immersive Technologies: A Scoping Review

Interactive and immersive technologies such as video games, exergames, and virtual reality are typically regarded as entertainment mediums. They also offer a multitude of health and well-being benefits. They have the capacity to incorporate established well-being techniques (e.g., mindfulness, exercise, and play) and expose users to beneficial environment settings with greater ease, improved access, and a broader appeal. The authors conducted a scoping review to explore whether these technologies could be used to benefit attention in healthy adults, that is, in a regulatory sense such as during periods of cognitive fatigue or attention-critical tasks. Research efforts have typically focused on long-term practice methods for attention enhancement with these technologies. Instead, this review provides the first attempt to unify a broad range of investigations concerned with their immediate impact on attention through state-change mechanisms. This applies the concept of attention state training and a growing evidence base, which suggests that meditative practices, exercise bouts, and nature exposures can provide short-term improvements in attentional performance following brief interactions. A systematic search of MEDLINE, Embase, and PsycINFO databases resulted in 11 peer-reviewed articles (13 experimental trials) each including at least one objective measure of attention directly following the use of an interactive or immersive technology. Most studies involved interactive technologies (i.e., video games and exergames), whereas there were three immersive interventions in the form of virtual reality. The comparisons between baseline and postintervention showed mostly no effect on attention, although there were five cases of improved attention. There were no instances of negative effects on attention. The results are significant considering mounting concerns that technology use could be detrimental for cognitive functioning. The positive effects reported here indicate a need to specify the type of technology in question and bring attention to positive vs. negative technology interactions. Implications for the literature concerning attention state training are discussed considering promising effects of technology exposures geared toward flow state induction. Significant gaps in the literature are identified regarding the implementation of traditional attention state training practices.

Can Simulated Nature Support Mental Health? Comparing Short, Single-Doses of 360-Degree Nature Videos in Virtual Reality With the Outdoors

Nature exposure in virtual reality (VR) can provide emotional well-being benefits for people who cannot access the outdoors. Little is known about how these simulated experiences compare with real outdoor experiences. We conduct an experiment with healthy undergraduate students that tests the effects of 6 min of outdoor nature exposure with 6 min of exposure to a 360-degree VR nature video, which is recorded at the outdoor nature exposure location. Skin conductivity, restorativeness, and mood before and after exposure are measured. We find that both types of nature exposure increase physiological arousal, benefit positive mood levels, and are restorative compared to an indoor setting without nature; however, for outdoor exposure, positive mood levels increase and for virtual nature, they stay the same. The nature-based experience shows benefits above and beyond the variance explained by participants' preferences, nature and VR experiences, and demographic characteristics. Settings where people have limited access to nature might consider using VR nature experiences to promote mental health.

Perception and Performance on a Virtual Reality Cognitive Stimulation for Use in the Intensive Care Unit: A Non-randomized Trial in Critically Ill Patients

Background: Newly acquired long-term cognitive impairments are common among survivors of critical illness. They have been linked to the stressful situation that patients experience in the intensive care unit (ICU). In this paper we use virtual reality (VR) technology to comfort critically ill patients and reduce stress during their ICU stay. We investigate the acceptance, comfort, recollection, and visual perception of VR stimulation and how it affects physiological parameters.

Methods: A VR head-mounted display was used to present immersive nature scenes to 33 critically ill cardiac surgery patients [mean age 63 years (range 32–83)]. Data was collected with an eye tracker fitted inside the VR head-mounted display to measure eye movements (250 Hz) and sensors to record physiological parameters (240 Hz). Patients received VR stimulation (for 5 min.) prior to ICU admission, during ICU stay, and 3 months after discharge. Acceptance, recollection and comfort were assessed with validated questionnaires.

Results: The number of gazed meaningful objects per minute was significantly lower during the ICU session compared to pre- and follow-up sessions, whereas mean duration of fixation on meaningful moving objects did not differ between the sessions. While respiratory rate decreased significantly during VR stimulation, heart rate and blood pressure remained constant. Post-ICU rating of VR acceptance during ICU stay was moderate to high and discomfort low. Recollection of VR was high [28/33 patients (84.8%)], while recollection of ICU stay was low [10/33 patients (30.3%)].

Conclusion: Eye movements indicate that patients were able to perceive and process cognitive stimulation during their ICU stay. VR was recalled better than the rest of the ICU stay and well accepted. Decreased respiratory rate during stimulation indicate a relaxing effect of VR.

Comparing the Relaxing Effects of Different Virtual Reality Environments in the Intensive Care Unit: Observational Study

Background

After a prolonged intensive care unit (ICU) stay, approximately 50%-75% of all critically ill patients suffer from neurocognitive late effects and a reduction of health-related quality of life. It is assumed that the noisy and stressful ICU environment leads to sensory overload and deprivation and potentially to long-term cognitive impairment.

Objective

In this study, we investigated three different virtual reality environments and their potentially restorative and relaxing effects for reducing sensory overload and deprivation in the ICU.

Methods

A total of 45 healthy subjects were exposed to three different environments, each 10 minutes in length (dynamic, virtual, natural, and urban environments presented inside the head-mounted display, and a neutral video on an ICU TV screen). During the study, data was collected by validated questionnaires (ie, restoration and sickness) and sensors to record physiological parameters (240 hertz).

Results

The results showed that the natural environment had the highest positive and restorative effect on the physiological and psychological state of healthy subjects, followed by the urban environment and the ICU TV screen.

Conclusions

Overall, virtual reality stimulation with head-mounted display using a dynamic, virtual and natural environment has the potential, if directly used in the ICU, to reduce sensory overload and deprivation in critically ill patients and thus to prevent neurocognitive late effects.

Nature as nurture: Rural older women's perspectives on the natural environment

Rural older women are surrounded by nature, a dynamic context for human development. Informed by place attachment and attention restoration theory, and guided by a life course perspective, this qualitative study focused on the perceived influence of nature in the lives of 34 rural older women. Using grounded theory techniques to analyze in-depth interviews, two primary findings emerged: (a) nature was integral to the women's identity; and (b) interactions with nature were motivated by prior positive spiritual and psychological outcomes. Findings revealed the power of the natural environment as a resource for coping with the challenges associated with aging.

Gender and hometown population density interact to predict face recognition ability

Several studies have found that individuals from small hometowns show diminished face recognition ability as compared with individuals from larger hometowns. We further this line of research by relating six measures of face recognition ability to hometown density. We predicted that the three face recognition ability measures which included a learning component would relate to hometown density whereas the three measures which did not include such a learning component would not. Instead, we found that none of the six measures related to hometown density. Interestingly, we found interactions between gender and hometown population density on many of these measures and on a general index of face recognition, with females from small hometowns outperforming males from small hometowns but no such differences in the large hometown group. In a follow-up re-analysis of a previous study, we found a similar interaction in one of two face recognition ability measures. Together, these results reveal a pattern of gender differences modulated by hometown population density. If indeed experience with faces in one's hometown influences face recognition ability, understanding these effects may require more than a quantification of the environment. Men and women growing up in the same environment likely have different experiences, which likely modulates effects on visual abilities.

Changes in Psychological and Cognitive Outcomes after Green versus Suburban Walking: A Pilot Crossover Study

This study investigated the acute effects of repeated walking sessions within green and suburban environments on participants’ psychological (anxiety and mood) and cognitive (directed-attention) outcomes. Twenty-three middle-aged adults (19 female) participated in a non-randomized crossover study comprised of once-weekly 50-min moderate-intensity walking sessions. Participants walked for three weeks in each of two treatment conditions: green and suburban, separated by a two-week washout period. Eleven participants completed green walking first and 12 suburban walking first. For each walk, we used validated psychological questionnaires to measure pre- and post-walk scores for: (1) mood, evaluated via the Positive and Negative Affect Schedule (PANAS); (2) anxiety, assessed by the State-Trait Anxiety Inventory (STAI-S); and (3) directed-attention, measured using the visual Backwards Digit Span test (BDS). Repeated measures linear mixed models assessed pre- to post-walk changes within-treatment conditions and post-walk contrasts between-treatment conditions. Results indicated that anxiety decreased after green walking and increased after suburban walking (−1.8 vs. +1.1 units, respectively; p = 0.001). For mood, positive affect improved after green walking and decreased after suburban walking (+2.3 vs. −0.3 units, respectively; p = 0.004), and negative affect decreased after green walking and remained similar after suburban walking (−0.5 vs. 0 units, respectively; p = 0.06). Directed-attention did not improve from pre- to post-walk for either condition. Our results suggested that green walking may be more effective at reducing state anxiety and increasing positive affect compared to suburban walking.

Association of Environmental Features and the Risk of Alzheimer's Dementia in Older Adults: A Nationwide Longitudinal Case-Control Study

Little is known about the association between environmental features and the risk of Alzheimer’s dementia (AD). This study aims to investigate the association of physical and social environments with the incidence of AD. We identified 12,401 newly diagnosed AD cases aged ≥65 years in 2010, with the same no. of matched controls from National Health Insurance claims in Taiwan. Environmental data were collected from government statistics including three physical environments and three social environments. Multilevel logistic regression was conducted to calculate the odds ratios (OR) of AD in association with environmental features at the township level. Results showed that living in the areas with higher availability of playgrounds and sport venues was associated with a 3% decreased odds of AD (95% CI = 0.96–0.99), while higher density of elderly living alone was associated with a 5% increased odds of AD (95% CI = 1.01–1.11), after controlling for individual and other environmental factors. In further examination by urbanization level, the above relationships were found only in rural areas but not in urban areas. This study provides evidence that specific physical and social environmental features have different impacts on the risk of AD.

Positive Effects of Nature on Cognitive Performance Across Multiple Experiments: Test Order but Not Affect Modulates the Cognitive Effects

Interactions with natural environments and nature-related stimuli have been found to be beneficial to cognitive performance, in particular on executive cognitive tasks with high demands on directed attention processes. However, results vary across different studies. The aim of the present paper was to evaluate the effects of nature vs. urban environments on cognitive performance across all of our published and new/unpublished studies testing the effects of different interactions with nature vs. urban/built control environments, on an executive-functioning test with high demands on directed attention—the backwards digit span (BDS) task. Specific aims in this study were to: (1) evaluate the effect of nature vs. urban environment interactions on BDS across different exposure types (e.g., real-world vs. artificial environments/stimuli); (2) disentangle the effects of testing order (i.e., effects caused by the order in which experimental conditions are administered) from the effects of the environment interactions, and (3) test the (mediating) role of affective changes on BDS performance. To this end, data from 13 experiments are presented, and pooled data-analyses are performed. Results from the pooled data-analyses (N = 528 participants) showed significant time-by-environment interactions with beneficial effects of nature compared to urban environments on BDS performance. There were also clear interactions with the order in which environment conditions were tested. Specifically, there were practice effects across environment conditions in first sessions. Importantly, after parceling out initial practice effects, the positive effects of nature compared to urban interactions on BDS performance were magnified. Changes in positive or negative affect did not mediate the beneficial effects of nature on BDS performance. These results are discussed in relation to the findings of other studies identified in the literature. Uncontrolled and confounding order effects (i.e., effects due to the order of experimental conditions, rather than the treatment conditions) may explain some of the inconsistent findings across studies in the literature on nature effects on cognitive performance. In all, these results highlight the robustness of the effects of natural environments on cognition, particularly when confounding order effects have been considered, and provide a more nuanced account of when a nature intervention will be most effective.

A Review on the Trajectory of Attentional Mechanisms in Aging and the Alzheimer's Disease Continuum through the Attention Network Test

Multiple domains of cognition are known to decline in both normal aging and in the trajectory towards Alzheimer's disease (AD). While declines in episodic memory are most well-known in both normal aging and AD, some of these memory differences might stem from early deteriorations in attention that have consequences for later memory. Further complicating the matter is that attention is a multifaceted construct that might be differentially affected in normal aging and AD. According to cognitive neuroscience models of attention, three types of attention networks exist: alerting, orienting, and executive. Efficiency of these three networks can be captured using the Attention Network Test (ANT). We reviewed the literature investigating differences in attention networks using the ANT as a function of normal aging and the AD trajectory, which included people at risk for AD, preclinical stages of AD, mild cognitive impairment, and those diagnosed with AD. We found that normal aging and the AD trajectory evidenced different patterns of attentional declines. Whereas normal aging was most consistently associated with impairments in alerting, early phases of the AD trajectory were most consistently associated with impairments in executive attention, and later phases of the AD trajectory were mixed. The mixed results with AD are largely attributed to small sample sizes and confounding effects of general slowing. These findings highlight key gaps in the literature linking different phases of AD while also highlighting the usefulness of the ANT to distinguish normal aging from the AD trajectory, especially in the earliest phases of the disease process.

Cognitive Strategies and Natural Environments Interact in Influencing Executive Function

Exposure to natural environments and the adoption of specific cognitive strategies are each claimed to have a direct influence on executive mental functioning. Here we manipulate both factors to help determine whether they draw on common cognitive resources. Three experiments investigated links between environmental effects (nature vs. urban video tours) and strategic effects (active vs. passive instructional approaches to the task). Each experiment used a pretest-posttest design and assessed executive mental functioning using a backward digit span task and Raven's progressive matrices. Experiment 1 manipulated participants' cognitive strategy through explicit instructions in order to establish a link between cognitive strategy and executive mental functioning. Experiment 2 used a pair of 10-min video tours (urban, nature) to examine the relationship between environmental exposure and executive mental function on the same tasks, replicating previous findings with the backward digit span task and extended them to a new task (i.e., Raven's progressive matrices). In Experiment 3, these two manipulations were combined to explore the relations between them. The results showed that the nature video tour attenuated the influence of task instructions relative to the urban video tour. An interaction between environmental video exposure and cognitive strategy was found, in that effects of cognitive strategy on executive function were smaller in the nature video condition than in the urban video condition. This suggests that brief exposure to nature had a direct positive influence on executive mental functioning.

Attention Restoration Theory II: a systematic review to clarify attention processes affected by exposure to natural environments

Attention Restoration Theory (ART) predicts exposure to natural environments may lead to improved cognitive performance through restoration of a limited cognitive resource, directed attention. A recent review by Ohly and colleagues (2016) uncovered substantial ambiguity surrounding details of directed attention and how cognitive restoration was tested. Therefore, an updated systematic review was conducted to identify relevant cognitive domains from which to describe elements of directed attention sensitive to the restoration effect. Forty-two articles that tested natural environments or stimuli against a suitable control, and included an objective measure of cognitive performance, had been published since July 2013. Articles were subjected to screening procedures and quality appraisal. Random effects meta-analyses were performed to calculate pooled effect sizes across 8 cognitive domains using data from 49 individual outcome measures. Results showed that working memory, cognitive flexibility, and to a less-reliable degree, attentional control, are improved after exposure to natural environments, with low to moderate effect sizes. Moderator analyses revealed that actual exposures to real environments may enhance the restoration effect within these three domains, relative to virtual exposures; however, this may also be due to differences in the typical lengths of exposure. The effect of a participants' restoration potential, based upon diagnosis or fatigue-induction, was less clear. A new framework is presented to qualify the involvement of directed attention-related processes, using examples of tasks from the three cognitive domains found to be sensitive to the restoration effect. The review clarifies the description of cognitive processes sensitive to natural environments, using current evidence, while exploring aspects of protocol that appear influential to the strength of the restoration effect.

Visuo-acoustic stimulation that helps you to relax: A virtual reality setup for patients in the intensive care unit

After prolonged stay in an intensive care unit (ICU) patients often complain about cognitive impairments that affect health-related quality of life after discharge. The aim of this proof-of-concept study was to test the feasibility and effects of controlled visual and acoustic stimulation in a virtual reality (VR) setup in the ICU. The VR setup consisted of a head-mounted display in combination with an eye tracker and sensors to assess vital signs. The stimulation consisted of videos featuring natural scenes and was tested in 37 healthy participants in the ICU. The VR stimulation led to a reduction of heart rate (p = 0. 049) and blood pressure (p = 0.044). Fixation/saccade ratio (p < 0.001) was increased when a visual target was presented superimposed on the videos (reduced search activity), reflecting enhanced visual processing. Overall, the VR stimulation had a relaxing effect as shown in vital markers of physical stress and participants explored less when attending the target. Our study indicates that VR stimulation in ICU settings is feasible and beneficial for critically ill patients.

The Built Environment and Cognitive Disorders: Results From the Cognitive Function and Ageing Study II

INTRODUCTION

Built environment features have been related to behavior modification and might stimulate cognitive activity with a potential impact on cognitive health in later life. This study investigated cross-sectional associations between features of land use and cognitive impairment and dementia, and also explored urban and rural differences in these associations.

METHODS

Postcodes of the 7,505 community-based participants (aged ≥65 years) in the Cognitive Function and Ageing Study II (collected in 2008-2011) were linked to environmental data from government statistics. Multilevel logistic regression investigated associations between cognitive impairment (defined as Mini-Mental State Examination score ≤25) and dementia (Geriatric Mental Status and Automatic Geriatric Examination for Computer-Assisted Taxonomy organicity level ≥3) and land use features, including natural environment availability and land use mix, fitting interaction terms with three rural/urban categories. Data were analyzed in 2015.

RESULTS

Associations between features of land use and cognitive impairment were not linear. After adjusting for individual-level factors and area deprivation, living in areas with high land use mix was associated with a nearly 30% decreased odds of cognitive impairment (OR=0.72, 95% CI=0.58, 0.89). This was similar, yet non-significant, for dementia (OR=0.70, 95% CI=0.46, 1.06). In conurbations, living in areas with high natural environment availability was associated with 30% reduced odds of cognitive impairment (OR=0.70, 95% CI=0.50, 0.97).

CONCLUSIONS

Non-linear associations between features of land use and cognitive impairment were confirmed in this new cohort of older people in England. Both lack of and overload of environmental stimulation may be detrimental to cognition in later life.

Complexity As Key to Designing Cognitive-Friendly Environments for Older People

The lived environment is the arena where our cognitive skills, preferences, and attitudes come together to determine our ability to interact with the world. The mechanisms through which lived environments can benefit cognitive health in older age are yet to be fully understood. The existing literature suggests that environments which are perceived as stimulating, usable and aesthetically appealing can improve or facilitate cognitive performance both in young and older age. Importantly, optimal stimulation for cognition seems to depend on experiencing sufficiently stimulating environments while not too challenging. Environmental complexity is an important contributor to determining whether an environment provides such an optimal stimulation. The present paper reviews a selection of studies which have explored complexity in relation to perceptual load, environmental preference and perceived usability to propose a framework which explores direct and indirect environmental influences on cognition, and to understand these influences in relation to aging processes. We identify ways to define complexity at different environmental scales, going from micro low-level perceptual features of scenes, to design qualities of proximal environments (e.g., streets, neighborhoods), to broad geographical areas (i.e., natural vs. urban environments). We propose that studying complexity at these different scales will provide new insight into the design of cognitive-friendly environments.

Environment as 'Brain Training': A review of geographical and physical environmental influences on cognitive ageing

Global ageing demographics coupled with increased urbanisation pose major challenges to the provision of optimal living environments for older persons, particularly in relation to cognitive health. Although animal studies emphasize the benefits of enriched environments for cognition, and brain training interventions have shown that maintaining or improving cognitive vitality in older age is possible, our knowledge of the characteristics of our physical environment which are protective for cognitive ageing is lacking. The present review analyses different environmental characteristics (e.g. urban vs. rural settings, presence of green) in relation to cognitive performance in ageing. Studies of direct and indirect associations between physical environment and cognitive performance are reviewed in order to describe the evidence that our living contexts constitute a measurable factor in determining cognitive ageing.

Effects of viewing a preferred nature image and hearing preferred music on engagement, agitation, and mental status in persons with dementia

Background:

The purpose of the described exploratory study was to test proactive strategies for enhancing engagement and cognitive ability while diminishing dementia-related disordered behaviors of those diagnosed with Alzheimer’s disease and other dementias. Study participants resided in an Memory Care unit of an assisted living community.

Method:

The researchers measured the effects of exposure to music and nature images on engagement using the Individualized Dementia Engagement and Activities Scale tool, on cognitive ability using the Montreal Cognitive Assessment, and on agitation using the Cohen-Mansfield Agitation Inventory.

Result:

The within-subject study design revealed that use of both music and nature images hold promise for reducing undesirable behaviors and improving engagement of residents.

Conclusion:

The authors suggest caregivers for those with Alzheimer’s disease and other dementias can effectively use nature images and music to improve engagement and reduce disordered behaviors, thus potentially enhancing quality of life for the care recipient as well as the caregiver while possibly reducing the costs of medications used to control dementia-related undesirable behaviors.

Natural environments, ancestral diets, and microbial ecology: is there a modern "paleo-deficit disorder"? Part I

Famed microbiologist René J. Dubos (1901-1982) was an early pioneer in the developmental origins of health and disease (DOHaD) construct. In the 1960s, he conducted groundbreaking experimental research concerning the ways in which early-life experience with nutrition, microbiota, stress, and other environmental variables could influence later-life health outcomes. He also wrote extensively on potential health consequences of a progressive loss of contact with natural environments (now referred to as green or blue space), arguing that Paleolithic experiences have created needs, particularly in the mental realm, that might not be met in the context of rapid global urbanization. He posited that humans would certainly adapt to modern urban landscapes and high technology, but there might be a toll to be paid in the form of higher psychological distress (symptoms of anxiety and depression) and diminished quality of life. In particular, there might be an erosion of humanness, exemplified by declines in altruism/empathy. Here in the first of a two-part review, we examine contemporary research related to natural environments and question to what extent Dubos might have been correct in some of his 50-year-old assertions.