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Cavedoni S, Cipresso P, Mancuso V, Bruni F, Pedroli E. Virtual reality for the assessment and rehabilitation of neglect: where are we now? A 6-year review update. VIRTUAL REALITY 2022; 26:1663-1704. [PMID: 35669614 PMCID: PMC9148943 DOI: 10.1007/s10055-022-00648-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/24/2022] [Indexed: 06/13/2023]
Abstract
Unilateral spatial neglect (USN) is a frequent repercussion of a cerebrovascular accident, typically a stroke. USN patients fail to orient their attention to the contralesional side to detect auditory, visual, and somatosensory stimuli, as well as to collect and purposely use this information. Traditional methods for USN assessment and rehabilitation include paper-and-pencil procedures, which address cognitive functions as isolated from other aspects of patients' functioning within a real-life context. This might compromise the ecological validity of these procedures and limit their generalizability; moreover, USN evaluation and treatment currently lacks a gold standard. The field of technology has provided several promising tools that have been integrated within the clinical practice; over the years, a "first wave" has promoted computerized methods, which cannot provide an ecological and realistic environment and tasks. Thus, a "second wave" has fostered the implementation of virtual reality (VR) devices that, with different degrees of immersiveness, induce a sense of presence and allow patients to actively interact within the life-like setting. The present paper provides an updated, comprehensive picture of VR devices in the assessment and rehabilitation of USN, building on the review of Pedroli et al. (2015). The present paper analyzes the methodological and technological aspects of the studies selected, considering the issue of usability and ecological validity of virtual environments and tasks. Despite the technological advancement, the studies in this field lack methodological rigor as well as a proper evaluation of VR usability and should improve the ecological validity of VR-based assessment and rehabilitation of USN.
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Affiliation(s)
- S. Cavedoni
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - P. Cipresso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, University of Turin, Via Verdi, 10, 10124 Turin, TO Italy
| | - V. Mancuso
- Faculty of Psychology, eCampus University, Novedrate, Italy
| | - F. Bruni
- Faculty of Psychology, eCampus University, Novedrate, Italy
| | - E. Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Faculty of Psychology, eCampus University, Novedrate, Italy
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Prominent gamma band activity during visual motion perception in early-stage Alzheimer’s disease. PLoS One 2022; 17:e0266693. [PMID: 35436287 PMCID: PMC9015152 DOI: 10.1371/journal.pone.0266693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/24/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Alzheimer’s disease (AD) affects multiple neural pathways and regions, resulting in various visual impairments such as motion perception. Generally, gamma-band activities during visual motion perception have been thought to reflect ongoing cognitive processes. Nevertheless, few studies have specifically examined induced gamma band activity during visual motion perception in AD patients. Therefore, after performing magnetoencephalography (MEG) recording during apparent motion (AM) stimulation for the left hemi-visual field in patients diagnosed as having AD in the early stage, we compared the results with findings of cognitive performance. Methods Seventeen AD patients in the early stage and 17 controls matched for age, sex, and educational attainment participated in this study. For each participant, memory performance was assessed with the Mini-Mental State Examination (MMSE) and the Wechsler Memory Scale-Revised (WMS-R). For MEG analysis, we examined power changes induced in a higher frequency range (20–100 Hz) after AM stimuli. Results The power of induced gamma band activities was significantly higher in AD patients. The power of induced gamma band activities was associated with higher performance on both MMSE and WMS-R tests for attention and concentration in AD patients. Conclusions Given that neuronal dysfunction in AD is associated with excitotoxic neurodegeneration, and given that subsequent development of compensatory inhibitory mechanisms also contributes to pathology in AD patients, elevated gamma band oscillations might reflect an imbalance of inhibitory and excitatory activity in AD patients. Moreover, positive correlation between induced gamma activity and cognitive performance might signify a compensating mechanism of inhibitory neurons which preserve the pyramidal neuron from excitotoxicity in a posterior association area.
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Carr DB, Grover P. The Role of Eye Tracking Technology in Assessing Older Driver Safety. Geriatrics (Basel) 2020; 5:E36. [PMID: 32517336 PMCID: PMC7345272 DOI: 10.3390/geriatrics5020036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022] Open
Abstract
A growing body of literature is focused on the use of eye tracking (ET) technology to understand the association between objective visual parameters and higher order brain processes such as cognition. One of the settings where this principle has found practical utility is in the area of driving safety. METHODS We reviewed the literature to identify the changes in ET parameters with older adults and neurodegenerative disease. RESULTS This narrative review provides a brief overview of oculomotor system anatomy and physiology, defines common eye movements and tracking variables that are typically studied, explains the most common methods of eye tracking measurements during driving in simulation and in naturalistic settings, and examines the association of impairment in ET parameters with advanced age and neurodegenerative disease. CONCLUSION ET technology is becoming less expensive, more portable, easier to use, and readily applicable in a variety of clinical settings. Older adults and especially those with neurodegenerative disease may have impairments in visual search parameters, placing them at risk for motor vehicle crashes. Advanced driver assessment systems are becoming more ubiquitous in newer cars and may significantly reduce crashes related to impaired visual search, distraction, and/or fatigue.
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Affiliation(s)
- David B. Carr
- Department of Medicine and Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Prateek Grover
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA;
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Coubard OA. What do we know about eye movements in Alzheimer's disease? The past 37 years and future directions. Biomark Med 2016; 10:677-80. [DOI: 10.2217/bmm-2016-0095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Olivier A Coubard
- The Neuropsychological Laboratory, CNS-Fed, 14 rue du Regard, 75006 Paris, France
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Nakamagoe K, Fujimiya S, Koganezawa T, Kadono K, Shimizu K, Fujizuka N, Takiguchi S, Ueno T, Monzen T, Tamaoka A. Vestibular Function Impairment in Alzheimer's Disease. J Alzheimers Dis 2016; 47:185-96. [PMID: 26402767 DOI: 10.3233/jad-142646] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Falls and fractures due to impaired balance in patients with Alzheimer's disease (AD) have an adverse effect on the clinical course of the disease. OBJECTIVE To evaluate balance impairment in AD from the viewpoint of vestibular functional impairment. METHODS The subjects were 12 patients with AD, 12 dementia-free elderly adults, and 12 younger adults. Vestibular function was assessed using a stepping test, caloric nystagmus, and a visual suppression (VS) test. RESULTS The stepping test was abnormal in 9 of the 12 patients in the AD group. An abnormal stepping test was not associated with self-reported dizziness or tendency to fall. Significant VS abnormalities were present in the AD group. The suppression rate of VS was lower in AD patients with either a tendency to fall or constructional apraxia than in AD patients without either. The velocity of the rapid phase of caloric nystagmus before the VS test was similar in the AD group and the elderly control group. Significant abnormalities of both caloric nystagmus and VS were not present in either the elderly or the younger control groups. CONCLUSION AD could involve impairments in the vestibular control of balance. The VS test is useful for assessing the tendency to fall in AD. Impairment of VS in AD might arise from cerebral vestibular cortex impairment rather than comorbid peripheral vestibular disorders.
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Affiliation(s)
- Kiyotaka Nakamagoe
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Suguru Fujimiya
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tadachika Koganezawa
- Department of Physiology, Division of Biomedical Science, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kotarou Kadono
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kotone Shimizu
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Natsu Fujizuka
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shino Takiguchi
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomoyuki Ueno
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tatsuya Monzen
- Department of Neurology, Fuji Heavy Industries Health Insurance Society Ota Memorial Hospital, Gunma, Japan
| | - Akira Tamaoka
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Kim JH, Lee BH, Go SM, Seo SW, Heilman KM, Na DL. Improvement of hemispatial neglect by a see-through head-mounted display: a preliminary study. J Neuroeng Rehabil 2015; 12:114. [PMID: 26666223 PMCID: PMC4678567 DOI: 10.1186/s12984-015-0094-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/01/2015] [Indexed: 11/28/2022] Open
Abstract
Background Patients with right hemisphere damage are often unaware of, inattentive to and fail to interact with stimuli on their left side. This disorder, called hemispatial neglect, is a major source of disability. Inducing leftward ocular pursuit by optokinetic stimulation (OKS) relieves some of the signs of unilateral neglect. However, it is difficult to provide patients with a continuously moving background that is required for OKS. We studied whether OKS projected onto a see-through head-mounted display (HMD) would help treat neglect. Methods 14 patients with neglect after cerebral infarction performed line bisections on a computer screen, both with and without OKS that was either delivered by the HMD or on the same screen that was displaying the lines that were to be bisected. Results The line bisection performances were significantly different in the four conditions (P < 0.001). The post hoc analyses indicated that the rightward deviation observed in the control conditions on the line bisection tasks without OKS, improved significantly with the use OKS in both the HMD and screen conditions (α < 0.05). The results between the screen and HMD conditions were also different (α < 0.05). The OKS in the HMD condition corrected patients’ rightward deviation more toward the actual midline than did the OKS provided during the screen condition. Conclusions OKS projected onto the see-through HMD improved hemispatial neglect. The development of a portable device may aid in the treatment of neglect.
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Affiliation(s)
- Jong Hun Kim
- Department of Neurology, Dementia Center, Ilsan hospital, National Health Insurance Service, Goyang, South Korea.
| | - Byung Hwa Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea. .,Neuroscience Center, Samsung Medical Center, Seoul, South Korea.
| | - Seok Min Go
- Dr. Hwang's Neurology clinic, Suncheon, South Korea.
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea. .,Neuroscience Center, Samsung Medical Center, Seoul, South Korea. .,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
| | - Kenneth M Heilman
- Department of Neurology, University of Florida and Veterans Affairs Medical Center, Gainesville, FL, USA.
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea. .,Neuroscience Center, Samsung Medical Center, Seoul, South Korea. .,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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Yang Q, Wang T, Su N, Xiao S, Kapoula Z. Specific saccade deficits in patients with Alzheimer's disease at mild to moderate stage and in patients with amnestic mild cognitive impairment. AGE (DORDRECHT, NETHERLANDS) 2013; 35:1287-98. [PMID: 22576337 PMCID: PMC3705110 DOI: 10.1007/s11357-012-9420-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 04/24/2012] [Indexed: 05/05/2023]
Abstract
Saccadic impairment in Alzheimer's disease (AD) was found in horizontal saccades. The present study extends investigation to vertical saccades in a large number of subjects, including AD and amnestic mild cognitive impairment (aMCI). We examined both horizontal and vertical saccades in 30 healthy elderly, 18 aMCI, and 25 AD. Two tasks were used: gap (fixation target extinguishes prior to target onset) and overlap (fixation stays on after target onset). Eye movements were recorded with the Eyeseecam system. (1) Robust gap effect (shorter latencies in gap than in overlap) exists for AD and aMCI patients as for healthy elderly; (2) abnormal long latency of saccades in gap and overlap tasks for AD relative to healthy elderly and aMCI patients; (3) longer latency for aMCI patients than for healthy elderly for the overlap task; (4) significant correlation between scores of Mini-Mental State Examination (MMSE) and latencies of saccades considering the AD group only; (5) higher coefficient of variation in latency for AD patients than for healthy elderly and for aMCI patients; (6) variability of accuracy and speed is abnormally higher in AD patients than in aMCI and healthy elderly. Abnormalities of latency and latency-accuracy-speed variability reflect deficits of cerebral areas involved in the triggering and execution of saccades; latency of saccades can be used as follow-up test for aMCI and AD patients with its significant correlation with the changes of MMSE scores.
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Affiliation(s)
- Qing Yang
- />IRIS group, UMR 8194, CNRS, Hôpital Européen Georges Pompidou, University Paris V, 20 rue Leblanc, 75015 Paris, France
| | - Tao Wang
- />Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine; Alzheimer’s Disease and Related Disorders Center,, Shanghai Jiaotong University, 600 Wan Ping Nan Road, 200030 Shanghai, China
| | - Ning Su
- />Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine; Alzheimer’s Disease and Related Disorders Center,, Shanghai Jiaotong University, 600 Wan Ping Nan Road, 200030 Shanghai, China
| | - Shifu Xiao
- />Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine; Alzheimer’s Disease and Related Disorders Center,, Shanghai Jiaotong University, 600 Wan Ping Nan Road, 200030 Shanghai, China
| | - Zoi Kapoula
- />IRIS group, UMR 8194, CNRS, Hôpital Européen Georges Pompidou, University Paris V, 20 rue Leblanc, 75015 Paris, France
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Rothman SM, Mattson MP. Sleep disturbances in Alzheimer's and Parkinson's diseases. Neuromolecular Med 2012; 14:194-204. [PMID: 22552887 PMCID: PMC4544709 DOI: 10.1007/s12017-012-8181-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 04/10/2012] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) and Parkinson's disease (PD) are the two most common neurodegenerative disorders and exact a burden on our society greater than cardiovascular disease and cancer combined. While cognitive and motor symptoms are used to define AD and PD, respectively, patients with both disorders exhibit sleep disturbances including insomnia, hypersomnia and excessive daytime napping. The molecular basis of perturbed sleep in AD and PD may involve damage to hypothalamic and brainstem nuclei that control sleep-wake cycles. Perturbations in neurotransmitter and hormone signaling (e.g., serotonin, norepinephrine and melatonin) and the neurotrophic factor BDNF likely contribute to the disease process. Abnormal accumulations of neurotoxic forms of amyloid β-peptide, tau and α-synuclein occur in brain regions involved in the regulation of sleep in AD and PD patients, and are sufficient to cause sleep disturbances in animal models of these neurodegenerative disorders. Disturbed regulation of sleep often occurs early in the course of AD and PD, and may contribute to the cognitive and motor symptoms. Treatments that target signaling pathways that control sleep have been shown to retard the disease process in animal models of AD and PD, suggesting a potential for such interventions in humans at risk for or in the early stages of these disorders.
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Affiliation(s)
- Sarah M Rothman
- Laboratory of Neurosciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21224, USA.
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Yang Q, Wang T, Su N, Liu Y, Xiao S, Kapoula Z. Long latency and high variability in accuracy-speed of prosaccades in Alzheimer's disease at mild to moderate stage. Dement Geriatr Cogn Dis Extra 2011; 1:318-29. [PMID: 22203824 PMCID: PMC3246280 DOI: 10.1159/000333080] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studying saccades is a useful tool to investigate brain function. There is still controversy regarding deficits in prosaccades in Alzheimer's disease (AD), and a study of saccades in subjects with mild cognitive impairment (MCI) has not been published to date. METHODS We examined horizontal saccades in 10 healthy elderly, and 9 MCI and 9 AD patients. Two tasks were used: gap (fixation target extinguishes prior to target onset) and overlap (fixation stays on after target onset). Eye movements were recorded with the Skalar IRIS system. RESULTS (1) Latencies were shorter in the gap than in the overlap task (a gap effect) in all three groups of subjects: healthy elderly, MCI and AD; (2) for both tasks, latency of saccades was longer for AD patients than for healthy and MCI subjects, and (3) accuracy and mean velocity were normal in MCI and AD subjects, however, variability in accuracy-speed was higher for AD patients than for healthy and MCI subjects in the overlap task. CONCLUSIONS Abnormalities in reaction time and accuracy-speed variability reflect deficits in cerebral areas involved in the triggering and execution of saccades; a saccade test can be useful to follow up the evolution of MCI subjects as some of them may develop AD disease.
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Affiliation(s)
- Qing Yang
- IRIS Group, UMR 8194, CNRS, Hôpital Européen Georges Pompidou, Paris, France
| | - Tao Wang
- Geriatric Psychiatry Department, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ning Su
- Geriatric Psychiatry Department, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuanyuan Liu
- Geriatric Psychiatry Department, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shifu Xiao
- Geriatric Psychiatry Department, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zoi Kapoula
- IRIS Group, UMR 8194, CNRS, Hôpital Européen Georges Pompidou, Paris, France
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Behavioural symptoms in patients with Alzheimer's disease and their association with cognitive impairment. BMC Neurol 2010; 10:87. [PMID: 20920205 PMCID: PMC2955564 DOI: 10.1186/1471-2377-10-87] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 09/28/2010] [Indexed: 12/19/2022] Open
Abstract
Background Behavioural and psychological symptoms of dementia (BPSD) are non-cognitive symptoms commonly associated to Alzheimer's disease (AD). The characterization of the clinical profile of AD patients might help to better understand disease evolution and to improve diagnosis and treatment. Thus, the aim of the present study is to describe the clinical profile of AD patients, and to correlate the presence of BPSD with the severity of the disease. Methods A cross-sectional, observational and multicenter study was conducted at 115 centres in Spain. Patients suffering from AD with higher and lower BPSD scores (ADAS-Noncog score 26-50 and ≤25, respectively) were included. Demographic and clinical data were collected, and dementia severity was assessed by the Mini Mental State Examination (MMSE) [mild 27-21, moderate 20-11, severe ≤10]. The use of ADAS-Noncog in clinical practice was also explored. Results A total of 1014 patients (463 with higher and 551 with lower BPSD scores) were included (mean age 77 ± 7 years, 65% women). Almost all patients (90%) had BPSD at inclusion, 17% of which reported psychotic outbreaks. The most prevalent symptoms were lack of concentration (56%), tremors (56%), depression (44%), lack of cooperation (36%), and delusions (32%). Patients with higher BPSD scores showed a significantly higher prevalence of psychotic symptoms (delusions, hallucinations, and delirium) and tremors, while emotional symptoms (tearfulness and apathy) predominated in patients with lower BPSD scores. MMSE and ADAS-Noncog scores were negatively associated (p = 0.0284), suggesting a correlation between cognitive impairment and BPSD. Lack of concentration and appetite change significantly correlated with MMSE (p = 0.0472 and p = 0.0346, respectively). Rivastigmine and donepezil were the first choice therapies in mild to moderate dementia. ADAS-Noncog was generally considered better or similar to other scales (82%), and 68% of the investigators were willing to use it in the future. Conclusions Our study shows that patients with AD have a high prevalence of noncognitive symptoms, and that cognitive impairment and BPSD are correlated. Therefore, ADAS-Noncog is a useful evaluation tool.
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