1
|
Kang JM, Kim N, Yun SK, Seo HE, Bae JN, Kim WH, Na KS, Cho SE, Ryu SH, Noh Y, Youn JH, Kang SG, Lee JY, Cho SJ. Exploring transfer effects on memory and its neural mechanisms through a computerized cognitive training in mild cognitive impairment: randomized controlled trial. Psychogeriatrics 2024; 24:1075-1086. [PMID: 39014538 DOI: 10.1111/psyg.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Computerized cognitive training (CCT) has been proposed as a potential therapy for cognitive decline. One of the benefits of CCT is a transfer effect, but its mechanism on the memory domain is unclear. This study aimed to investigate the transfer effect of non-memory multidomain CCT on the memory domain and its neural basis in patients with mild cognitive impairment (MCI) through a randomized controlled trial. METHODS Patients with MCI recruited from memory clinics were randomly assigned to either the CCT or the control group. The CCT group received multidomain CCT training excluding memory training, while the control group read educational books with learning-based quizzes twice a week for 8 weeks. Participants underwent memory tests yielding a composite score, other cognitive domain tests, non-cognitive scales, and resting-state functional magnetic resonance imaging (rsfMRI), at baseline and after intervention. Within- and between-group comparisons, group × time interactions, and seed-to-voxel analyses in memory-involving brain networks were performed. RESULTS The CCT group showed improvement over the control group in memory domain (Group × time, F = 5.87, P = 0.03, η2 = 0.31), which was related with the increased connectivity in the hippocampal-frontal and fusiform-occipital network. No other cognitive and non-cognitive symptoms differed between groups after adjusting for covariates. CONCLUSION Eight weeks of multidomain CCT without memory training improved memory function and restored functional network in the hippocampal and medial temporal region in MCI patients. These results can provide evidence for the transferring ability of CCT on memory functioning with its neural basis.
Collapse
Affiliation(s)
- Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Nambeom Kim
- Department of Big Data & AI Master Business Administration, Sejong University, Seoul, Republic of Korea
| | - Seon Kyung Yun
- Department of Nursing, Saekyung University, Yeongwol, Republic of Korea
| | - Ha-Eun Seo
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea
| | - Jae Nam Bae
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Won-Hyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seo-Eun Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Young Noh
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jung-Hae Youn
- Department of Counselling Psychology, Cha University, Seongnam, Republic of Korea
| | - Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| |
Collapse
|
2
|
Porras-Garcia B, Rojas-Rincón J, Adams A, Garolera M, Chang R. Immersive Virtual Reality Cognitive Training for Improving Cognition and Depressive Symptoms Among Older Adults. Current Evidence and Future Recommendations. A Systematic Review. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2024. [PMID: 39180434 DOI: 10.1089/cyber.2024.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2024]
Abstract
Older adults, particularly impacted by the pandemic, are anticipated to face considerable challenges to their cognitive and psychological health. Various cognitive training methods have been proposed to improve their cognitive decline through regular practice. Immersive virtual reality (IVR) offers a promising avenue to bolster cognitive and mental health care accessibility for older adults and has shown potential in augmenting traditional cognitive training methods. This systematic review aims to assess the efficacy of IVR-based cognitive training on improving cognitive impairments and depressive symptoms among older adults, irrespective of their level of cognitive decline. Systematic searches were conducted across MEDLINE-PubMed, EMBASE, and Web of Science databases from inception to December 2022. Only peer-reviewed articles reporting results from randomized controlled trials and pilot studies, focusing on the effects of VR-based cognitive training on adults aged 55 or older, were deemed eligible. Using the Cochrane Handbook for Systematic Reviews of Interventions, the risk of bias was appraised for each selected study. Out of 3,835 studies identified, 9 met the inclusion criteria. The qualitative analyses concluded that IVR cognitive training interventions enhanced certain cognitive functions and well-being among older adults, notably those with mild cognitive impairments. These interventions were particularly effective in boosting memory, visuospatial abilities, and measures related to depressive symptoms and overall well-being. However, enhancements were less pronounced for executive functions, attention, and global cognition. Based on these findings, we propose a set of tailored, inclusive, and evidence-based recommendations to adapt emerging technologies to better accommodate the needs of older adults.
Collapse
Affiliation(s)
- Bruno Porras-Garcia
- Department of Psychology, BrainXRLab, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
- Brain, Cognition and Behavior Research Group, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
| | - Juliana Rojas-Rincón
- Department of Psychology, BrainXRLab, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
| | - Annalisa Adams
- Health Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Maite Garolera
- Department of Psychology, BrainXRLab, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
- Brain, Cognition and Behavior Research Group, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
- Neuropsychology Unit, Consorci Sanitari de Terrassa (CST), Terrassa, Spain
| | - Rocio Chang
- Department of Psychiatry, University of Connecticut, West Hartford, Connecticut, USA
| |
Collapse
|
3
|
Li Y, Muschalla B. Virtual Reality Mental Health Interventions in Geriatric Care for Functional or Well-being Enhancement - A Scoping Review. DIE REHABILITATION 2024; 63:209-219. [PMID: 38885655 PMCID: PMC11309805 DOI: 10.1055/a-2316-6541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
PURPOSE It has become common to use Virtual Reality (VR) for mental health interventions; however, its use in care of the elederly is limited, especially regarding mood and well-being. In this review, we summarize the results of current VR-based mental health interventions for this population. METHODS Peer-reviewed journal articles on immersive VR mental health intervention in seniors, published until 2022, were included. RESULTS There were 2697 results found in the database search, of which 40 articles met the inclusion criteria and were included in the final analysis. Most studies did not use an experimental design with randomized controlled trials and follow-up sessions. Function-oriented and entertainment-oriented intervention studies were categorized. VR-based geriatric mental interventions have grown rapidly since 2018, especially the number of interventions that promote wellbeing. The function-oriented interventions used active interactions with varied devices. Entertainment-oriented interaction was primarily passive, seldomly using hand controllers for moving activities. Generally, VR interventions improved the mental health of older adults. CONCLUSION Geriatric rehabilitation can benefit from this innovative technology to maintain cognitive functions and to improve the well-being of seniors. They have potential for use in aging care and in retirement homes. Future VR interventions may also involve promoting social interaction to combat loneliness among seniors.
Collapse
Affiliation(s)
- Yijun Li
- Psychotherapy and Diagnostics, Technische Universität, Braunschweig, Germany
| | | |
Collapse
|
4
|
Park H, Ha J. Effect of digital technology interventions for cognitive function improvement in mild cognitive impairment and dementia: A systematic review and meta-analysis. Res Nurs Health 2024; 47:409-422. [PMID: 38567389 DOI: 10.1002/nur.22383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/14/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
The development and commercialization of digital therapeutics are increasing. The aim of this study was to determine the effects of digital technology interventions on cognitive function, thereby providing evidence for the development and practical application of interventions to manage cognitive function in patients with mild cognitive impairment and dementia. We conducted a systematic review and meta-analysis of randomized controlled trials according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Randomized controlled trials on digital technology interventions published until April 2023 were searched in PubMed, Embase, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases without a period limit. Articles that identified the effects of digital technology interventions on cognitive function improvement in dementia and mild cognitive impairment were integrated and analyzed. RevMan software 5.4 was used for quality assessment and meta-analysis. Twelve out of 708 studies were included in the review and meta-analysis. Digital technology interventions had significant effects on global cognitive function (standardized mean difference [SMD] = 0.31; 95% confidence interval [CI] = 0.04-0.57; p = 0.02; I² = 60%). In addition, these interventions had significant effects on neuropsychological characteristics, including attention (SMD = 1.17; 95% CI = 0.36-1.97; p = 0.004; I² = 84%), visuospatial perception (SMD = 0.68; 95% CI = 0.19-1.17; p = 0.006; I² = 57%), and memory (SMD = 0.45; 95% CI = 0.19-0.71; p = 0.0007; I² = 22%). The results suggest that digital technology interventions help improve cognitive function in patients with dementia and mild cognitive impairment.
Collapse
Affiliation(s)
- Hyojin Park
- College of Nursing, Pusan National University, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Juyoung Ha
- College of Nursing, Pusan National University, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| |
Collapse
|
5
|
Stavropoulou I, Sakellari E, Barbouni A, Notara V. Community-Based Virtual Reality Interventions in Older Adults with Dementia and/or Cognitive Impairment: A Systematic Review. Exp Aging Res 2024:1-28. [PMID: 38972047 DOI: 10.1080/0361073x.2024.2377438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 06/05/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Virtual reality devices have been widely used for the rehabilitation among older people with cognitive impairments. They enable the user to navigate in three-dimensional environments, which are constructed by a computer. Recent studies have been focused on the cognitive benefits of virtual reality for people with cognitive deficits. The current study aimed to investigate the overall impact of community-based virtual reality interventions in older adults with dementia and/or cognitive impairment. METHODS A systematic review of the literature was conducted according to the PRISMA guidelines. Google Scholar, PubMed, Science Direct and Scopus databases were searched for the years 2010-2022. RESULTS Of the 245 articles 20 met the inclusion criteria. The results of the current systematic review indicated that virtual reality improved older adults' cognitive and motor skills and increased their positive emotions while minimizing less positive ones. However, there is insufficient data of its impact on their overall quality of life. CONCLUSION There is a need to implement and evaluate interventions that examine its impact not only on cognitive functioning, but also on other aspects of older people with cognitive deficits.
Collapse
Affiliation(s)
- Iliana Stavropoulou
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | - Evanthia Sakellari
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | - Anastasia Barbouni
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | - Venetia Notara
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| |
Collapse
|
6
|
Hayashi H, Sone T, Iokawa K, Sumigawa K, Fujita T, Kawamata H, Asao A, Kawasaki I, Ogasawara M, Kawakatsu S. Effects of computerized cognitive training on biomarker responses in older adults with mild cognitive impairment: A scoping review. Health Sci Rep 2024; 7:e2175. [PMID: 38895550 PMCID: PMC11182779 DOI: 10.1002/hsr2.2175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/08/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024] Open
Abstract
Background and Aims Mild cognitive impairment (MCI) is a widespread condition in older individuals, posing significant risk of dementia. However, limited research has been conducted to explore effective interventions and clarify their impact at the neural level. Therefore, this study aimed to investigate the effects of computerized cognitive training (CCT) and explore the associated neural mechanisms in preventing dementia in older individuals with MCI, with a view to inform future intervention efforts. Methods We reviewed the effects of CCT on biomarker outcomes in older adults with MCI. The search was conducted for studies published between 2010 and May 10, 2023, using three search engines: PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature. The inclusion criteria were as follows: studies that involved participants diagnosed with MCI, included CCT, included quantitative assessment of biomarker results, and conducted randomized controlled trials. Results Sixteen studies that used biomarkers, including magnetic resonance imaging, electroencephalography (EEG), functional near-infrared spectroscopy (fNIRS), and blood or salivary biomarkers, were extracted. The results showed that CCT caused changes in structure and function within the main brain network, including the default mode network, and decreased both theta rhythm activity on EEG and prefrontal activity on fNIRS, with improvement in cognitive function. Furthermore, CCT combined with physical exercise showed more significant structural and functional changes in extensive brain regions compared with CCT alone. Virtual reality-based cognitive training improved not only executive function but also instrumental activities of daily living. Conclusion CCT causes functional and structural changes in extensive brain regions and improves cognitive function in older adults with MCI. Our findings highlight the potential of individualized intervention methods and biomarker assessment according to the specific causes of MCI. Future research should aim to optimize these personalized therapeutic strategies to maximize the benefits of CCT in older adults with MCI.
Collapse
Affiliation(s)
- Hiroshi Hayashi
- Department of Occupational TherapyFukushima Medical University School of Health SciencesFukushimaJapan
| | - Toshimasa Sone
- Department of Occupational TherapyFukushima Medical University School of Health SciencesFukushimaJapan
| | - Kazuaki Iokawa
- Department of Occupational TherapyFukushima Medical University School of Health SciencesFukushimaJapan
| | - Koshi Sumigawa
- Department of Occupational TherapyFukushima Medical University School of Health SciencesFukushimaJapan
| | - Takaaki Fujita
- Department of Occupational TherapyFukushima Medical University School of Health SciencesFukushimaJapan
| | - Hironori Kawamata
- Department of Occupational TherapyFukushima Medical University School of Health SciencesFukushimaJapan
| | - Akihiko Asao
- Department of Occupational TherapyFukushima Medical University School of Health SciencesFukushimaJapan
| | - Iori Kawasaki
- Department of Occupational TherapyFukushima Medical University School of Health SciencesFukushimaJapan
| | - Maki Ogasawara
- Department of Occupational TherapyFukushima Medical University School of Health SciencesFukushimaJapan
| | - Shinobu Kawakatsu
- Department of Neuropsychiatry, Aizu Medical CenterFukushima Medical UniversityAizuwakamatsuJapan
| |
Collapse
|
7
|
Szczepocka E, Mokros Ł, Kaźmierski J, Nowakowska K, Łucka A, Antoszczyk A, Oltra-Cucarella J, Werzowa W, Hellevik M, Skouras S, Bagger K. Virtual reality-based training may improve visual memory and some aspects of sustained attention among healthy older adults - preliminary results of a randomized controlled study. BMC Psychiatry 2024; 24:347. [PMID: 38720251 PMCID: PMC11080129 DOI: 10.1186/s12888-024-05811-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND/AIMS Older age and cognitive inactivity have been associated with cognitive impairment, which in turn is linked to economic and societal burdens due to the high costs of care, especially for care homes and informal care. Emerging non-pharmacological interventions using new technologies, such as virtual reality (VR) delivered on a head-mounted display (HMD), might offer an alternative to maintain or improve cognition. The study aimed to evaluate the efficacy and safety of a VR-based Digital Therapeutics application for improving cognitive functions among healthy older adults. METHODS Seventy-two healthy seniors (experimental group N = 35, control group N = 37), aged 65-85 years, were recruited by the Medical University of Lodz (Poland). Participants were randomly allocated to the experimental group (a VR-based cognitive training which consists of a warm-up module and three tasks, including one-back and dual-N-back) or to the control group (a regular VR headset app only showing nature videos). The exercises are performed in different 360-degree natural environments while listening to a preferred music genre and delivered on a head-mounted display (HMD). The 12-week intervention of 12 min was delivered at least three times per week (36 sessions). Compliance and performance were followed through a web-based application. Primary outcomes included attention and working memory (CNS-Vital Signs computerized cognitive battery). Secondary outcomes comprised other cognitive domains. Mixed linear models were constructed to elucidate the difference in pre- and post-intervention measures between the experimental and control groups. RESULTS The users performed, on average, 39.8 sessions (range 1-100), and 60% performed more than 36 sessions. The experimental group achieved higher scores in the visual memory module (B = 7.767, p = 0.011) and in the one-back continuous performance test (in terms of correct responses: B = 2.057, p = 0.003 and omission errors: B = -1.950, p = 0.007) than the control group in the post-test assessment. The results were independent of participants' sex, age, and years of education. The differences in CNS Vital Signs' global score, working memory, executive function, reaction time, processing speed, simple and complex attention, verbal memory, cognitive flexibility, motor speed, and psychomotor speed were not statistically significant. CONCLUSIONS VR-based cognitive training may prove to be a valuable, efficacious, and well-received tool in terms of improving visual memory and some aspect of sustainability of attention among healthy older adults. This is a preliminary analysis based on part of the obtained results to that point. Final conclusions will be drawn after the analysis of the target sample size. TRIAL REGISTRATION Clinicaltrials.gov ID NCT05369897.
Collapse
Affiliation(s)
- Ewa Szczepocka
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, Lodz, 92-216, Poland.
| | - Łukasz Mokros
- Department of Clinical Pharmacology, Medical University of Lodz, Lodz, Poland
| | - Jakub Kaźmierski
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, Lodz, 92-216, Poland
| | - Karina Nowakowska
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, Lodz, 92-216, Poland
| | - Anna Łucka
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, Lodz, 92-216, Poland
| | - Anna Antoszczyk
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, Lodz, 92-216, Poland
| | - Javier Oltra-Cucarella
- Senopi AG, Zurich, Switzerland
- Department of Health Psychology, University Miguel Hernández de Elche, Elche, Spain
| | | | | | - Stavros Skouras
- Senopi AG, Zurich, Switzerland
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | | |
Collapse
|
8
|
Khalid UB, Naeem M, Stasolla F, Syed MH, Abbas M, Coronato A. Impact of AI-Powered Solutions in Rehabilitation Process: Recent Improvements and Future Trends. Int J Gen Med 2024; 17:943-969. [PMID: 38495919 PMCID: PMC10944308 DOI: 10.2147/ijgm.s453903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Rehabilitation is an important and necessary part of local and global healthcare services along with treatment and palliative care, prevention of disease, and promotion of good health. The rehabilitation process helps older and young adults even children to become as independent as possible in activities of daily life and enables participation in useful living activities, recreation, work, and education. The technology of Artificial Intelligence (AI) has evolved significantly in recent years. Many activities related to rehabilitation have been getting benefits from using AI techniques. The objective of this review study is to explore the advantages of AI for rehabilitation and how AI is impacting the rehabilitation process. This study aims at the most critical aspects of the rehabilitation process that could potentially take advantage of AI techniques including personalized rehabilitation apps, rehabilitation through assistance, rehabilitation for neurological disorders, rehabilitation for developmental disorders, virtual reality rehabilitation, rehabilitation of neurodegenerative diseases and Telerehabilitation of Cardiovascular. We presented a survey on the newest empirical studies available in the literature including the AI-based technology helpful in the Rehabilitation process. The novelty feature included but was not limited to an overview of the technological solutions useful in rehabilitation. Seven different categories were identified. Illustrative examples of practical applications were detailed. Implications of the findings for both research and practice were critically discussed. Most of the AI applications in these rehabilitation types are in their infancy and continue to grow while exploring new opportunities. Therefore, we investigate the role of AI technology in rehabilitation processes. In addition, we do statistical analysis of the selected studies to highlight the significance of this review work. In the end, we also present a discussion on some challenges, and future research directions.
Collapse
Affiliation(s)
- Umamah bint Khalid
- Department of Electronics, Quaid-I-Azam University, Islamabad, 44000, Pakistan
| | - Muddasar Naeem
- Research Center on ICT Technologies for Healthcare and Wellbeing, Università Telematica “Giustino Fortunato”, Benevento, 82100, Italy
| | - Fabrizio Stasolla
- Research Center on ICT Technologies for Healthcare and Wellbeing, Università Telematica “Giustino Fortunato”, Benevento, 82100, Italy
| | - Madiha Haider Syed
- Department of Electronics, Quaid-I-Azam University, Islamabad, 44000, Pakistan
- Institute of Information Technology, Quaid-i-Azam University, Islamabad, 44000, Pakistan
| | - Musarat Abbas
- Department of Electronics, Quaid-I-Azam University, Islamabad, 44000, Pakistan
| | - Antonio Coronato
- Research Center on ICT Technologies for Healthcare and Wellbeing, Università Telematica “Giustino Fortunato”, Benevento, 82100, Italy
| |
Collapse
|
9
|
Ren Y, Wang Q, Liu H, Wang G, Lu A. Effects of immersive and non-immersive virtual reality-based rehabilitation training on cognition, motor function, and daily functioning in patients with mild cognitive impairment or dementia: A systematic review and meta-analysis. Clin Rehabil 2024; 38:305-321. [PMID: 38289618 DOI: 10.1177/02692155231213476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE To examine the effectiveness of virtual reality (VR)-based rehabilitation training in improving cognition, motor function, and daily functioning in patients with mild cognitive impairment and dementia. DATA SOURCES A systematic review of published literature was conducted using PubMed, Web of Science, Elsevier, Embase, Cochrane, CNKI, Networked Digital Library of Theses and Dissertations. METHODS The search period was from inception to 7 October 2023. Eligible studies were randomized controlled trials evaluating the efficacy of VR-based rehabilitation training in patients with mild cognitive impairment or dementia versus control subjects. Methodologic quality was assessed with the Cochrane risk of bias tool, and outcomes were calculated as the standard mean difference between participant groups with 95% confidence interval. RESULTS A total of 21 randomized controlled trials with 1138 patients were included. The meta-analysis showed that VR-based rehabilitation training had significant effects on Montreal Cognitive Assessment (SMD: 0.50; 95%CI: 0.05 to 0.95; P = 0.030), Trail-making test A (SMD: -0.38; 95%CI: -0.61 to -0.14; P = 0.002), and Berg Balance Scale scores (SMD: 0.79; 95%CI: 0.13 to 1.45; P = 0.020). A subgroup analysis revealed that the type of VR, and duration and frequency of interventions had statistically significant effects on cognition and motor function. CONCLUSION VR-based rehabilitation training is a beneficial nonpharmacologic approach for managing mild cognitive impairment or dementia. Immersive VR-based training had greater effects on cognition and motor function than non-immersive VR-based training, but non-immersive VR-based training was more convenient for patients with limitations imposed by their disease. Also, an intervention lasting 5-8 weeks and for >30 min at a frequency of ≥3 times/week achieved the best results. It indicated that a longer intervention cycle may not achieve the best intervention effect and training duration and schedule should be carefully considered when managing patients.
Collapse
Affiliation(s)
- Yuanyuan Ren
- Physical Education and Sport Science, Soochow University, Suzhou, Jiangsu Province, China
| | - Qingjie Wang
- Physical Education and Sport Science, Soochow University, Suzhou, Jiangsu Province, China
| | - Houyu Liu
- Physical Education and Sport Science, Soochow University, Suzhou, Jiangsu Province, China
| | - Guodong Wang
- Physical Education and Sport Science, Soochow University, Suzhou, Jiangsu Province, China
| | - Aming Lu
- Physical Education and Sport Science, Soochow University, Suzhou, Jiangsu Province, China
| |
Collapse
|
10
|
Moulaei K, Sharifi H, Bahaadinbeigy K, Dinari F. Efficacy of virtual reality-based training programs and games on the improvement of cognitive disorders in patients: a systematic review and meta-analysis. BMC Psychiatry 2024; 24:116. [PMID: 38342912 PMCID: PMC10860230 DOI: 10.1186/s12888-024-05563-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/28/2024] [Indexed: 02/13/2024] Open
Abstract
INTRODUCTION Cognitive impairments present challenges for patients, impacting memory, attention, and problem-solving abilities. Virtual reality (VR) offers innovative ways to enhance cognitive function and well-being. This study explores the effects of VR-based training programs and games on improving cognitive disorders. METHODS PubMed, Scopus, and Web of Science were systematically searched until May 20, 2023. Two researchers selected and extracted data based on inclusion and exclusion criteria, resolving disagreements through consultation with two other authors. Inclusion criteria required studies of individuals with any cognitive disorder engaged in at least one VR-based training session, reporting cognitive impairment data via scales like the MMSE. Only English-published RCTs were considered, while exclusion criteria included materials not primarily focused on the intersection of VR and cognitive disorders. The risk of bias in the included studies was assessed using the MMAT tool. Publication bias was assessed using funnel plots and Egger's test. The collected data were utilized to calculate the standardized mean differences (Hedges's g) between the treatment and control groups. The heterogeneity variance was estimated using the Q test and I2 statistic. The analysis was conducted using Stata version 17.0. RESULTS Ten studies were included in the analysis out of a total of 3,157 retrieved articles. VR had a statistically significant improvement in cognitive impairments among patients (Hedges's g = 0.42, 95% CI: 0.15, 0.68; p_value = 0.05). games (Hedges's g = 0.61, 95% CI: 0.30, 0.39; p_value = 0.20) had a more significant impact on cognitive impairment improvement compared to cognitive training programs (Hedges's g = 0.29, 95% CI: -0.11, 0.69; p_value = 0.24). The type of VR intervention was a significant moderator of the heterogeneity between studies. CONCLUSION VR-based interventions have demonstrated promise in enhancing cognitive function and addressing cognitive impairment, highlighting their potential as valuable tools in improving care for individuals with cognitive disorders. The findings underscore the relevance of incorporating virtual reality into therapeutic approaches for cognitive disorders.
Collapse
Affiliation(s)
- Khadijeh Moulaei
- Department of Health Information Technology, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Dinari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| |
Collapse
|
11
|
Ramalho A, Duarte-Mendes P, Paulo R, Serrano J, Petrica J. Crossing the digital frontier: are older adults ready for virtual reality workouts? Front Public Health 2024; 12:1324004. [PMID: 38389949 PMCID: PMC10881650 DOI: 10.3389/fpubh.2024.1324004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
In the dynamic web of our digital age, virtual reality (VR) is crystallizing as a promising medium for promoting physical activity in older adults, overcoming age-old barriers. This perspective article explores the intricate synergy between VR and physical activity in older adults and highlights the many challenges of aging within a virtual environment. While VR heralds the potential for multisensory interaction and cognitive enhancement, a thorough assessment of its impact is paramount. The reach of VR goes beyond immediate applications and permeates the emotional and psychological realms of the human journey. Such an exploration requires a comprehensive perspective that goes beyond a purely technical assessment. The aim of this article is not to present clear-cut solutions, but to encourage reflection on the diverse impact of VR on our aging population. We argue for a future in which technology complements, rather than eclipses, the depth of human experience.
Collapse
Affiliation(s)
- André Ramalho
- Sport, Health & Exercise Research Unit (SHERU), Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
- Sport Physical Activity and Health Research & INnovation CenTer, SPRINT, Santarém, Portugal
| | - Pedro Duarte-Mendes
- Sport, Health & Exercise Research Unit (SHERU), Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
- Sport Physical Activity and Health Research & INnovation CenTer, SPRINT, Santarém, Portugal
| | - Rui Paulo
- Sport, Health & Exercise Research Unit (SHERU), Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
- Sport Physical Activity and Health Research & INnovation CenTer, SPRINT, Santarém, Portugal
| | - João Serrano
- Sport, Health & Exercise Research Unit (SHERU), Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
- Sport Physical Activity and Health Research & INnovation CenTer, SPRINT, Santarém, Portugal
| | - João Petrica
- Sport, Health & Exercise Research Unit (SHERU), Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
- Sport Physical Activity and Health Research & INnovation CenTer, SPRINT, Santarém, Portugal
| |
Collapse
|
12
|
Yu J, Wu J, Liu B, Zheng K, Ren Z. Efficacy of virtual reality technology interventions for cognitive and mental outcomes in older people with cognitive disorders: An umbrella review comprising meta-analyses of randomized controlled trials. Ageing Res Rev 2024; 94:102179. [PMID: 38163517 DOI: 10.1016/j.arr.2023.102179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/25/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
We conducted an umbrella review of virtual reality (VR) technology interventions and cognitive improvement in older adults with cognitive disorders to establish a hierarchy of evidence. We systematically searched PubMed, Web of Science, Scopus, and PsycINFO databases from database creation to February 2023. We included meta-analyses relevant to our study objectives for the overall review. We assessed the methodological quality according to AMSTAR2, and we used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) method to assess the credibility of the evidence. This overall review was registered with the International Prospective Register of Systematic Reviews (CRD42023423063). We identified six meta-analyses that included 12 cognitive outcomes, but only memory (Standardized Mean Difference(SMD) = 0.27, 95% confidence interval (CI): 0.04 to 0.49), depression (SMD = -1.26, 95% CI: -1.8 to -0.72), and global cognition (SMD = 0.42, 95% CI: 0.18 to 0.66) improved through the VR technology intervention. Using the 95% prediction interval (PI) results, we found that VR technology did not significantly affect the cognitive abilities of people with cognitive decline despite increasing the subject size. We conclude that the VR technology intervention improved only specific cognitive abilities.
Collapse
Affiliation(s)
- Jingxuan Yu
- College of Physical Education, Shenzhen University, Shenzhen 518060, China
| | - Jinlong Wu
- College of Physical Education, Southwest University, Chongqing 400715, China
| | - Bowen Liu
- College of Physical Education, Shenzhen University, Shenzhen 518060, China
| | - Kangyong Zheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 999077, Hong Kong, China
| | - Zhanbing Ren
- College of Physical Education, Shenzhen University, Shenzhen 518060, China.
| |
Collapse
|
13
|
Chan ATC, Ip RTF, Tran JYS, Chan JYC, Tsoi KKF. Computerized cognitive training for memory functions in mild cognitive impairment or dementia: a systematic review and meta-analysis. NPJ Digit Med 2024; 7:1. [PMID: 38172429 PMCID: PMC10764827 DOI: 10.1038/s41746-023-00987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Dementia is a common medical condition in the ageing population, and cognitive intervention is a non-pharmacologic strategy to improve cognitive functions. This meta-analysis evaluated the benefits of computerized cognitive training (CCT) on memory functions in individuals with MCI or dementia. The study was registered prospectively with PROSPERO under CRD42022363715 and received no funding. The search was conducted on MEDLINE, Embase, and PsycINFO on Sept 19, 2022, and Google Scholar on May 9, 2023, to identify randomized controlled trials that examined the effects of CCT on memory outcomes in individuals with MCI or dementia. Mean differences and standard deviations of neuropsychological assessment scores were extracted to derive standardized mean differences. Our search identified 10,678 studies, of which 35 studies were included. Among 1489 participants with MCI, CCT showed improvements in verbal memory (SMD (95%CI) = 0.55 (0.35-0.74)), visual memory (0.36 (0.12-0.60)), and working memory (0.37 (0.10-0.64)). Supervised CCT showed improvements in verbal memory (0.72 (0.45-0.98)), visual memory (0.51 (0.22-0.79)), and working memory (0.33 (0.01-0.66)). Unsupervised CCT showed improvement in verbal memory (0.21 (0.04-0.38)) only. Among 371 participants with dementia, CCT showed improvement in verbal memory (0.64 (0.02-1.27)) only. Inconsistency due to heterogeneity (as indicated by I2 values) is observed, which reduces our confidence in MCI outcomes to a moderate level and dementia outcomes to a low level. The results suggest that CCT is efficacious on various memory domains in individuals with MCI. Although the supervised approach showed greater effects, the unsupervised approach can improve verbal memory while allowing users to receive CCT at home without engaging as many healthcare resources.
Collapse
Affiliation(s)
- Aaron T C Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Roy T F Ip
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Joshua Y S Tran
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce Y C Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin K F Tsoi
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, China.
| |
Collapse
|
14
|
Li Z, He H, Chen Y, Guan Q. Effects of engagement, persistence and adherence on cognitive training outcomes in older adults with and without cognitive impairment: a systematic review and meta-analysis of randomised controlled trials. Age Ageing 2024; 53:afad247. [PMID: 38266127 DOI: 10.1093/ageing/afad247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Limited understanding exists regarding the influences of engagement, persistence and adherence on the efficacy of cognitive training for age-related cognitive decline and neurodegenerative cognitive impairment. METHODS This study conducted a meta-analysis of randomised controlled trials (RCTs). We systematically searched MEDLINE, PubMed, Web of Science, Embase and CINAHL databases from 1 January 2012 to 13 June 2023, and included RCTs assessing the effects of cognitive training in older adults, both with and without cognitive impairment. Hedges' g with a 95% confidence interval (CI) was used to synthesise cognitive training effect sizes on various neuropsychological tests. Subgroup analyses were conducted based on variables including engagement, persistence, adherence and cognitive conditions of normal cognition, mild cognitive impairment (MCI) or neurodegenerative dementia. RESULTS This meta-analysis included 55 RCTs with 4,455 participants with cognitive conditions spanning normal cognition, MCI and neurodegenerative dementia. The mean age of participants was 73.9 (range: 65.7-84.5) years. Overall, cognitive training showed a significant cross-domain effect (Hedges' g = 0.286, 95% CI: 0.224-0.348). Training effects are significant when engagement or persistence rates exceed 60% or when adherence rates exceed 80%. Higher levels of persistence are required to achieve significant training effects in memory, visuospatial ability and reasoning than in executive function and attention and language. Higher persistence is also required for older adults with normal cognition to achieve significant training gains compared to those with cognitive impairment. CONCLUSIONS This systematic review highlights the critical roles of engagement, persistence and adherence in augmenting the efficacy of cognitive training.
Collapse
Affiliation(s)
- Zhen Li
- School of Psychology, Shenzhen University, Shenzhen 518060, China
| | - Hao He
- School of Psychology, Shenzhen University, Shenzhen 518060, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China
| | - Yiqi Chen
- School of Psychology, Shenzhen University, Shenzhen 518060, China
- Department of Psychology, University of Mannheim, Mannheim 68131, Germany
| | - Qing Guan
- School of Psychology, Shenzhen University, Shenzhen 518060, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China
| |
Collapse
|
15
|
Buele J, Varela-Aldás JL, Palacios-Navarro G. Virtual reality applications based on instrumental activities of daily living (iADLs) for cognitive intervention in older adults: a systematic review. J Neuroeng Rehabil 2023; 20:168. [PMID: 38110970 PMCID: PMC10729470 DOI: 10.1186/s12984-023-01292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND In recent years, the use of virtual reality (VR) as a complementary intervention in treating cognitive impairment has significantly increased. VR applications based on instrumental activities of daily living (iADL-VR) could offer a promising approach with greater ecological validity for intervention in groups with cognitive impairments. However, the effectiveness of this approach is still debated. OBJECTIVE This systematic review aims to synthesize the effects of iADL-VR interventions to rehabilitate, train, or stimulate cognitive functions in healthy adults and people with mild cognitive impairment (MCI) and different types of dementia. METHODS A systematic search was performed in the Scopus, PubMed, IEEE Xplore, Web of Science, and APA PsycNet databases until September 2022 and repeated in April 2023. The selected studies met the search terms, were peer-reviewed, included an iADL-VR intervention, and were written in English. Descriptive, qualitative studies, reviews, cognitive assessment, non-intervention studies, those unrelated to VR or iADL, those focused on motor aspects, and non-degenerative disorders were excluded. The PEDro scale was used to assess the methodological quality of the controlled studies. To present and synthesize the results, we organized the extracted data into three tables, including PEDro scores, participant characteristics, and study characteristics. RESULTS Nineteen studies that met the inclusion and exclusion criteria were included. The total sample reached 590 participants, mostly women (72.67%). Approximately 30% were diagnosed with Alzheimer's disease or dementia, and 20% had mild cognitive impairment. Variables such as authors and year of publication, study design, type of intervention and VR applied, duration of the intervention, main findings, and conclusions were extracted. Regarding demographic characteristics, the sample size, age, sex, years of education, neurological diagnosis, dropouts, and the city and country where the intervention took place were recorded. Almost all studies showed improvements in some or all the outcomes after the intervention, generally greater in the iADL-VR group than in the control group. CONCLUSION iADL-VR interventions could be beneficial in improving the performance of cognitive functions in older adults and people with MCI and different types of dementia. The ecological component of these tasks makes them very suitable for transferring what has been learned to the real world. However, such transfer needs to be confirmed by further studies with larger and more homogeneous samples and longer follow-up periods. This review had no primary funding source and was registered with PROSPERO under registration ID: 375166.
Collapse
Affiliation(s)
- Jorge Buele
- SISAu Research Group, Facultad de Ingeniería, Industria y Producción, Universidad Indoamérica, Ambato, Ecuador
- Department of Electronic Engineering and Communications, University of Zaragoza, Teruel, Spain
| | - José Luis Varela-Aldás
- Centro de Investigaciones de Ciencias Humanas y de la Educación (CICHE), Universidad Indoamérica, Ambato, Ecuador
| | | |
Collapse
|
16
|
Drazich BF, McPherson R, Gorman EF, Chan T, Teleb J, Galik E, Resnick B. In too deep? A systematic literature review of fully-immersive virtual reality and cybersickness among older adults. J Am Geriatr Soc 2023; 71:3906-3915. [PMID: 37560978 DOI: 10.1111/jgs.18553] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Virtual reality technology holds great promise in improving the health and well-being of older adults; however, this technology is associated with potential risks that may outweigh the benefits. The purpose of this systematic review is to synthesize and critique the existing literature on fully-immersive virtual reality interventions for older adults and the associated risk of cybersickness. METHODS We searched eight databases for studies that utilized fully-immersive virtual reality, stated the population as older adults, provided outcomes related to cybersickness, and were written or translated into the English language. Our search generated 332 articles, 39 of which were selected for inclusion in this systematic synthesis and appraisal. RESULTS We found that the majority of studies utilized a one-time session. The studies generally had weak sample generalizability and methodological design, but strong data collection and participant retention. The studies nearly all used the Simulator Sickness Questionnaire to measure cybersickness, but the scoring for the Simulator Sickness Questionnaire varied or was not mentioned. Most included studies reported only minor cybersickness among older adult participants. CONCLUSION Researchers might conclude that the benefits of virtual reality interventions outweigh the risk of cybersickness in this population. Going forward, researchers should concentrate on the efficacy of virtual reality interventions among older adults, using larger samples and randomized controlled study design, along with measuring dosage effects.
Collapse
Affiliation(s)
- Brittany F Drazich
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Rachel McPherson
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Emily F Gorman
- Health Sciences and Human Services Library, University of Maryland, Baltimore, Maryland, USA
| | - Thomas Chan
- Health Equity Research and Education Center & Autonomy Research Center for STEAHM, California State University Northridge, Northridge, California, USA
| | - Jejomar Teleb
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Barbara Resnick
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| |
Collapse
|
17
|
Kim DR, Moon E, Shin MJ, Yang YA, Park JH. Effect of Individual Virtual Reality Cognitive Training Programs on Cognitive Function and Depression in Middle-Aged Women: Randomized Controlled Trial. JMIR Ment Health 2023; 10:e48912. [PMID: 37878378 PMCID: PMC10632914 DOI: 10.2196/48912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Given the increasing incidence of early-onset Alzheimer disease, strategies for early diagnosis and swift treatment interventions are crucial for mitigating cognitive problems in women and middle-aged individuals who face a high risk of cognitive impairment. OBJECTIVE This study aimed to assess the effectiveness of individual cognitive training programs based on virtual reality (VR), a nonpharmacological intervention, on cognitive function and depression in middle-aged women at risk of cognitive impairment. It used VR technology, which has recently been recognized as a promising tool. METHODS We administered a VR-based cognitive training program for 30 minutes daily, twice a week, for 12 weeks (24 sessions). This study included middle-aged women residing in older adults' welfare facilities in G-gu, Busan, from May to August 2021. A total of 60 participants were randomly divided into the training (n=30) and control (n=30) groups. Cognitive and depressive functions were assessed using the Korean versions of the Montreal Cognitive Assessment (K-MoCA), Digit Span Test (DST), Korean-Color Word Stroop Test (K-CWST), and Short Form of the Geriatric Depression Scale (SGDS-K) before the intervention. The training group underwent a VR-based cognitive training program, whereas the control group was educated to maintain regular daily activities. The same assessments were performed 12 weeks after treatment. RESULTS A comparison of the mean scores before and after K-MoCA in the training group revealed a significant increase from 24.87 (SD 2.62) to 27.50 (SD 1.70; P<.01), indicating substantial cognitive improvement. Similarly, the mean DST forward scores increased significantly from 6.97 (SD 1.10) to 7.90 (SD 1.18; P<.01), suggesting enhanced short-term auditory memory and attention. The mean DST backward scores also showed a significant improvement from 4.10 (SD 0.71) to 4.77 (SD 1.2; P=.01). Notably, the mean SGDS-K scores decreased significantly from 3.97 (SD 2.51) to 2.13 (SD 1.87; P<.01), indicating a reduction in depression within the training group. CONCLUSIONS The VR-based cognitive training programs significantly enhanced cognitive function and reduced depression in middle-aged women. Consequently, these programs are considered beneficial nonpharmacological cognitive training interventions for middle-aged women at high risk of cognitive impairment. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000049752; https://tinyurl.com/z5du989z.
Collapse
Affiliation(s)
- Du-Ri Kim
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Rehabilitation Science, Graduate School, Inje University, Gimhae, Republic of Korea
| | - EunSoo Moon
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Psychiatry, Pusan National University Hospital, Busan, Republic of Korea
| | - Myung-Jun Shin
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Yeong-Ae Yang
- Department of Occupational Therapy, College of Biomedical Science and Engineering, Inje University, Gimhae, Republic of Korea
- Institute of Aged Life Redesign, Inje University, Gimhae, Republic of Korea
| | - Jong-Hwan Park
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| |
Collapse
|
18
|
Munro CE, Boyle R, Chen X, Coughlan G, Gonzalez C, Jutten RJ, Martinez J, Orlovsky I, Robinson T, Weizenbaum E, Pluim CF, Quiroz YT, Gatchel JR, Vannini P, Amariglio R. Recent contributions to the field of subjective cognitive decline in aging: A literature review. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12475. [PMID: 37869044 PMCID: PMC10585124 DOI: 10.1002/dad2.12475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/23/2023] [Accepted: 08/04/2023] [Indexed: 10/24/2023]
Abstract
Subjective cognitive decline (SCD) is defined as self-experienced, persistent concerns of decline in cognitive capacity in the context of normal performance on objective cognitive measures. Although SCD was initially thought to represent the "worried well," these concerns can be linked to subtle brain changes prior to changes in objective cognitive performance and, therefore, in some individuals, SCD may represent the early stages of an underlying neurodegenerative disease process (e.g., Alzheimer's disease). The field of SCD research has expanded rapidly over the years, and this review aims to provide an update on new advances in, and contributions to, the field of SCD in key areas and themes identified by researchers in this field as particularly important and impactful. First, we highlight recent studies examining sociodemographic and genetic risk factors for SCD, including explorations of SCD across racial and ethnic minoritized groups, and examinations of sex and gender considerations. Next, we review new findings on relationships between SCD and in vivo markers of pathophysiology, utilizing neuroimaging and biofluid data, as well as associations between SCD and objective cognitive tests and neuropsychiatric measures. Finally, we summarize recent work on interventions for SCD and areas of future growth in the field of SCD.
Collapse
Affiliation(s)
| | - Rory Boyle
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Xi Chen
- Helen Wills Neuroscience InstituteUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - Gillian Coughlan
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Christopher Gonzalez
- Department of PsychologyIllinois Institute of TechnologyChicagoIllinoisUSA
- Department of PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Roos J. Jutten
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Jairo Martinez
- Department of PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
| | - Irina Orlovsky
- Department of Psychological and Brain SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| | | | - Emma Weizenbaum
- Department of PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Celina F. Pluim
- Brigham and Women's HospitalBostonMassachusettsUSA
- Department of PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
| | - Yakeel T. Quiroz
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Department of PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Jennifer R. Gatchel
- Department of PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Patrizia Vannini
- Brigham and Women's HospitalBostonMassachusettsUSA
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | | |
Collapse
|
19
|
Gómez-Cáceres B, Cano-López I, Aliño M, Puig-Perez S. Effectiveness of virtual reality-based neuropsychological interventions in improving cognitive functioning in patients with mild cognitive impairment: A systematic review and meta-analysis. Clin Neuropsychol 2023; 37:1337-1370. [PMID: 36416175 DOI: 10.1080/13854046.2022.2148283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
Objective: Increased prevalence of mild cognitive impairment (MCI) has led to a need for new neuropsychological intervention tools in this population. This meta-analysis aimed to learn about the efficacy of virtual reality (VR)-based neuropsychological interventions in improving cognitive functioning in patients with MCI. Method: This review followed the recommendations of the PRISMA statement, and it was registered in PROSPERO. The studies examined were collected from the PsycINFO, Web of Science, Pubmed/MEDLINE, Embase, Scopus, and Cochrane Library databases. Results: The systematic search yielded 258 articles, of which 13 randomized controlled trials were selected. VR-based neuropsychological interventions had moderate effects on global cognition (g = 0.30; 95% CI = 0.05, 0.56; p = 0.02), small effects on attention (g = 0.27; 95% CI = 0.04, 0.49; p = 0.02), and large effects on executive function (g = 0.60; 95% CI = 0.38, 0.81; p < 0.0001), but non-significant effects on working memory, episodic memory, language, or visuoconstruction. When the length of the intervention was considered, VR-based interventions of 15 or more hours had moderate effects on working memory (g = 0.55; 95% CI = 0.11, 0.99; p = 0.01), and large effects on language (g = 0.60; 95% CI = 0.01, 1.20; p = 0.05) and visuoconstruction (g = 1.13; 95% CI = 0.58, 1.67; p < 0.0001). Conclusions: Results suggest that VR-based interventions are beneficial for improving cognitive functioning in patients with MCI, and allow us to make recommendations that could have implications for clinical decision-making in this population.
Collapse
Affiliation(s)
| | - Irene Cano-López
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- VIU-NED Chair of Global Neuroscience and Social Change, Valencian International University, Valencia, Spain
- Research Group in Psychology and Quality of Life (PsiCal), Valencian International University, Valencia, Spain
| | - Marta Aliño
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- VIU-NED Chair of Global Neuroscience and Social Change, Valencian International University, Valencia, Spain
- Research Group in Psychology and Quality of Life (PsiCal), Valencian International University, Valencia, Spain
| | - Sara Puig-Perez
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- VIU-NED Chair of Global Neuroscience and Social Change, Valencian International University, Valencia, Spain
- Research Group in Psychology and Quality of Life (PsiCal), Valencian International University, Valencia, Spain
| |
Collapse
|
20
|
Yue J, Han S, Li A, Wei Z, Cao D, Gao S, Li X, Yang G, Zhang Q. Multimodal magnetic resonance imaging on brain structure and function changes in subjective cognitive decline: a mini-review. Front Aging Neurosci 2023; 15:1259190. [PMID: 37790282 PMCID: PMC10543888 DOI: 10.3389/fnagi.2023.1259190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/28/2023] [Indexed: 10/05/2023] Open
Abstract
Subjective cognitive decline (SCD) is the initial stage of Alzheimer's disease (AD). Early identification of SCD and its risk factors is of great importance for targeted interventions and for delaying the onset of AD. We reviewed the relevant literature on structural magnetic resonance imaging (sMRI), diffusion tensor imaging (DTI), functional magnetic resonance imaging (fMRI), and other techniques regarding SCD research in recent years. This study applied sMRI and fMRI techniques to explore abnormal brain structures and functions, which may help provide a basis for SCD diagnosis.
Collapse
Affiliation(s)
- Jinhuan Yue
- Shenzhen Frontiers in Chinese Medicine Research Co., Ltd., Shenzhen, China
- Department of Acupuncture and Moxibustion, Vitality University, Hayward, CA, United States
| | - Shengwang Han
- Third Ward of Rehabilitation Department, Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Ang Li
- Servier (Beijing) Pharmaceutical Research & Development CO., Ltd., Beijing, China
| | - Zeyi Wei
- Graduate School of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Danna Cao
- Division of CT and MRI, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Shenglan Gao
- Graduate School of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiaoling Li
- Division of CT and MRI, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Guanhu Yang
- Department of Specialty Medicine, Ohio University, Athens, OH, United States
| | - Qinhong Zhang
- Shenzhen Frontiers in Chinese Medicine Research Co., Ltd., Shenzhen, China
- Heilongjiang University of Chinese Medicine, Harbin, China
| |
Collapse
|
21
|
Liu X, Wang G, Cao Y. Association of nonpharmacological interventions for cognitive function in older adults with mild cognitive impairment: a systematic review and network meta-analysis. Aging Clin Exp Res 2023; 35:463-478. [PMID: 36607554 DOI: 10.1007/s40520-022-02333-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Understanding the effectiveness of nonpharmacological interventions to improve cognitive function in older adults with MCI and identifying the best intervention may help inform ideas for future RCT studies and clinical decision-making. AIM The main focus of this study was to assess the comparative effectiveness of nonpharmacological interventions on cognitive function in older adults with MCI and to rank the interventions. METHODS RCT studies until September 2022 were searched from six databases, including PubMed, the Cochrane Library, Embase, Web of Science, PsycINFO and CINAHL. The risk of bias in eligible trials was evaluated using the Cochrane Risk of Bias tool. Both pairwise and network meta-analyses were used, and pooled effect sizes were reported using SMD and the corresponding 95% confidence intervals. RESULTS A total of 28 RCT studies were included in this study, pooling 18 categories of nonpharmacological interventions. MBE (mind-body exercise) (SMD (standard mean difference): 0.24, 95% CI: 0.08-0.41, P = 0.004), DTE (dual-task exercise) (SMD: 0.61, 95% CI: 0.09-1.13, P = 0.02), PE (physical exercise) (SMD: 0.58, 95% CI: 0.04-1.12, P = 0.03) may be effective in improving cognitive function in older adults with MCI. Acupressure + CT (cognitive training) was the top-ranked intervention among all interventions. No greater benefits of MA (mindful awareness) on cognitive function were found. CONCLUSIONS Overall, nonpharmacological interventions significantly improved cognitive function in older adults with MCI. Acupressure + CT(cognitive training) was the most effective intervention for managing cognitive impairment. Future studies with high quality and large sample size RCT studies are needed to confirm our results.
Collapse
Affiliation(s)
- Xueyan Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Lixia District, Jinan, Shandong Province, China
| | - Guangpeng Wang
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan Province, China
| | - Yingjuan Cao
- Department of Nursing, Qilu Hospital, Shandong University, 107 Wenhuaxi Road, Lixia District, Jinan, Shandong Province, China.
| |
Collapse
|
22
|
Lee KN, Kim HJ, Choe K, Cho A, Kim B, Seo J, Myung W, Park JY, Oh KJ. Effects of Fetal Images Produced in Virtual Reality on Maternal-Fetal Attachment: Randomized Controlled Trial. J Med Internet Res 2023; 25:e43634. [PMID: 36826976 PMCID: PMC10007014 DOI: 10.2196/43634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/07/2022] [Accepted: 01/19/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Maternal-fetal attachment (MFA) has been reported to be associated with the postpartum mother-infant relationship. Seeing the fetus through ultrasound might influence MFA, and the effect could be increased by more realistic images, such as those generated in virtual reality (VR). OBJECTIVE The aim was to determine the effect of fetal images generated in VR on MFA and depressive symptoms through a prenatal-coaching mobile app. METHODS This 2-arm parallel randomized controlled trial involved a total of 80 pregnant women. Eligible women were randomly assigned to either a mobile app-only group (n=40) or an app plus VR group (n=40). The VR group experienced their own baby's images generated in VR based on images obtained from fetal ultrasonography. The prenatal-coaching mobile app recommended health behavior for the pregnant women according to gestational age, provided feedback on entered data for maternal weight, blood pressure, and glucose levels, and included a private diary service for fetal ultrasound images. Both groups received the same app, but the VR group also viewed fetal images produced in VR; these images were stored in the app. All participants filled out questionnaires to assess MFA, depressive symptoms, and other basic medical information. The questionnaires were filled out again after the interventions. RESULTS Basic demographic data were comparable between the 2 groups. Most of the assessments showed comparable results for the 2 groups, but the mean score to assess interaction with the fetus was significantly higher for the VR group than the control group (0.4 vs 0.1, P=.004). The proportion of participants with an increased score for this category after the intervention was significantly higher in the VR group than the control group (43% vs 13%, P=.005). The feedback questionnaire revealed that scores for the degree of perception of fetal appearance all increased after the intervention in the VR group. CONCLUSIONS The use of a mobile app with fetal images in VR significantly increased maternal interaction with the fetus. TRIAL REGISTRATION ClinicalTrials.gov NCT04942197; https://clinicaltrials.gov/ct2/show/NCT04942197.
Collapse
Affiliation(s)
- Kyong-No Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hyeon Ji Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kiroong Choe
- Department of Computer Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Aeri Cho
- Department of Computer Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Bohyoung Kim
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Gyeonggi-do, Republic of Korea
| | - Jinwook Seo
- Department of Computer Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| |
Collapse
|
23
|
Gómez-Soria I, Cuenca-Zaldívar JN, Rodriguez-Roca B, Subirón-Valera AB, Salavera C, Marcén-Román Y, Andrade-Gómez E, Calatayud E. Cognitive Effects of a Cognitive Stimulation Programme on Trained Domains in Older Adults with Subjective Memory Complaints: Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3636. [PMID: 36834329 PMCID: PMC9967658 DOI: 10.3390/ijerph20043636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Age-related subjective memory complaints (SMC) are a common concern among older adults. However, little is known about the effects of cognitive stimulation (CS) interventions on subjective memory complaints. The aim of this study was to analyse the effectiveness of a CS programme on global cognition and cognitive functions of older adults with SMC. A randomised clinical trial was conducted on older adults with SMC, including 308 participants ≥65 years of age assessed 6 and 12 months after the intervention. The assessment instrument was the Spanish version of the Mini-Mental State Examination (MEC-35), and all domains of the instrument were assessed. For statistical analysis, the data were analysed using robust ANOVA with means truncated at 20% utilising a two-way repeated measures model, with between (groups) and within (measurements) factors. In post hoc tests, a Wilcoxon signed-rank test of exact permutations between groups and Bonferroni correction were applied. In post hoc between-group tests, significant differences were found: (1) post-treatment in MEC-35, temporal orientation, short-term memory (STM), global language and praxis, and language and praxis (p ≤ 0.005); (2) at 6 months in MEC-35, global orientation, temporal orientation, and STM (p = 0.005); (3) at 12 months in MEC-35, global orientation, temporal orientation, STM, global language and praxis, and language (p = 0.005). This study shows benefits in global cognition and orientation, temporal orientation, STM, and language in older adults with SMC.
Collapse
Affiliation(s)
- Isabel Gómez-Soria
- Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
- Health Research Institute of Aragon, 50009 Zaragoza, Spain
| | - Juan Nicolás Cuenca-Zaldívar
- Grupo de Investigación en Fisioterapia y Dolor, Departamento de Enfermería y Fisioterapia, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28801 Alcalá de Henares, Spain
- Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute-Segovia de Arana (IDIPHISA), 28222 Majadahonda, Spain
- Physical Therapy Unit, Primary Health Care Center “El Abajón”, Las Rozas de Madrid, 28231 Madrid, Spain
| | | | | | - Carlos Salavera
- Department of Psychology and Sociology, Education Faculty, University of Zaragoza, 50009 Zaragoza, Spain
| | - Yolanda Marcén-Román
- Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
- Health Research Institute of Aragon, 50009 Zaragoza, Spain
| | - Elena Andrade-Gómez
- Department of Nursing, University of La Rioja, La Rioja, 26004 Logroño, Spain
| | - Estela Calatayud
- Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
- Health Research Institute of Aragon, 50009 Zaragoza, Spain
| |
Collapse
|
24
|
Doménech S, Santos PM, Porta X, Albino-Pires N, Benali A, Nebot O, Mugica F, Nebot À. [Reminiscence program supported by artificial intelligence and based on intangible cultural heritage aimed at the elderly: A pilot study]. Rev Esp Geriatr Gerontol 2023; 58:89-95. [PMID: 36804953 DOI: 10.1016/j.regg.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/22/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Technological applications are an innovative way of providing reminiscence therapy and must meet the users' needs. Intangible cultural heritage as a basis for such therapy has not been explored yet. We evaluated the applicability of a new technological application supported by artificial intelligence for reminiscence therapy based on intangible cultural heritage aimed at older people. MATERIAL AND METHODS A prospective observational study was carried out with people aged 65 or over, without cognitive impairment and with mild and moderate cognitive impairment who attended six centers for older people in Spain and Portugal. Participants tested the first prototype of the individualized LONG-REMI program in four consecutive weekly sessions. The usability and satisfaction of the experience were evaluated using the VAS scale at the end of the intervention. Emotions were evaluated using the PANAS scale before and at the end of the intervention. RESULTS Data from 56 participants were analysed. For all participants, usability and satisfaction were highly perceived, with scores of 7.75±1.88 and 8.38±1.57, respectively. The positive affect subscale PANAS showed significant changes (28.86±8.88 before the intervention versus 36.70±9.43 post intervention, Z = -4.18, P = 0.000). There were no significant changes in the PANAS negative affect subscale. CONCLUSIONS The first prototype of the LONG-REMI technological application can be used by older people both with and without cognitive impairment. This has the potential to be an instrument for future cognitive therapies with stimulating activities and benefits for emotions.
Collapse
Affiliation(s)
- Sara Doménech
- Fundación Salud y Envejecimiento, Universitat Autònoma de Barcelona, España.
| | - Pedro M Santos
- CINTESIS-Centro de Investigación en Tecnologías y Servicios de Salud, Universidad de Lusófona Humanidades e Tecnologias, Lisboa, Portugal
| | - Xènia Porta
- Fundación Salud y Envejecimiento, Universitat Autònoma de Barcelona, España
| | - Natália Albino-Pires
- Escuela Superior de Educación, Instituto Politécnico de Coimbra, Coimbra, Portugal
| | - Anass Benali
- Grupo de Investigación de Soft Computing en el Centro de Investigación de Inteligencia Artificial, Universitat Politènica de Catalunya, Barcelona, España
| | - Oriol Nebot
- UX/UI Departamento de Diseño, Universitat Oberta de Catalunya, Barcelona, España
| | - Francisco Mugica
- Grupo de Investigación de Soft Computing en el Centro de Investigación de Inteligencia Artificial, Universitat Politènica de Catalunya, Barcelona, España
| | - Àngela Nebot
- Grupo de Investigación de Soft Computing en el Centro de Investigación de Inteligencia Artificial, Universitat Politènica de Catalunya, Barcelona, España
| |
Collapse
|
25
|
Wang L, Zhan X, Jiang L, Xu G, Bao Y, Wang J, Qv S, Yang J, Huang D. Association between plasma trimethylamine-N-oxide and cognitive impairment in patients with transient ischemic attack. Neurol Res 2023; 45:634-645. [PMID: 36789535 DOI: 10.1080/01616412.2023.2176632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND There is increasing evidence for the association of trimethylamine-N-oxide (TMAO) with cognitive impairment after minor stroke or transient ischemic attack (TIA). However, how TMAO affects cognitive function in TIA patients has seldom been studied. METHODS A total of 310 TIA participants were retrospectively collected from our stroke register between January 2020 and July 2021. Plasma TMAO was measured by liquid chromatography‒mass spectrometry at baseline. Cognitive performance was assessed by neuropsychological evaluation at 3 months after TIA onset. RESULTS A total of 310 patients were included (mean age, 74 years; male, 160 [51.6%]; mean ABCD2 score, 2.6). TMAO was positively associated with cognitive impairment after TIA (aOR, 1.423; 95% CI, 1.125-2.561). The highest quartile of TMAO was related to an almost 2-fold increased risk of cognitive decline compared to the lowest quartile. Furthermore, executive and memory function were more susceptible to impairment after TIA in groups with higher levels of TMAO. Mediation analysis revealed that the overall mediated effect was-0.347 (p < 0.001), and the intermediary effect of CRP was-0.108. CONCLUSION Plasma TMAO at baseline was independently associated with cognitive impairment at the 3-month follow-up after TIA. In addition, the inflammatory marker CRP may serve as an important mediator in this relationship. Our study may provide some insights into anti-inflammatory therapy to improve the cognitive trajectory of TIA patients with high TMAO levels.
Collapse
Affiliation(s)
- Lufeng Wang
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaopeng Zhan
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Li Jiang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guangyu Xu
- Second school of Clinical medicine, Wenzhou Medical University, Wenzhou, China
| | - Yiwen Bao
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junlang Wang
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shaohua Qv
- Department of Gastrointestinal Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jie Yang
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dongya Huang
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
26
|
Perra A, Riccardo CL, De Lorenzo V, De Marco E, Di Natale L, Kurotschka PK, Preti A, Carta MG. Fully Immersive Virtual Reality-Based Cognitive Remediation for Adults with Psychosocial Disabilities: A Systematic Scoping Review of Methods Intervention Gaps and Meta-Analysis of Published Effectiveness Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1527. [PMID: 36674283 PMCID: PMC9864668 DOI: 10.3390/ijerph20021527] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Cognitive Remediation (CR) programs are effective for the treatment of mental diseases; in recent years, Virtual Reality (VR) rehabilitation tools are increasingly used. This study aimed to systematically review and meta-analyze the published randomized controlled trials that used fully immersive VR tools for CR programs in psychiatric rehabilitation. We also wanted to map currently published CR/VR interventions, their methods components, and their evidence base, including the framework of the development intervention of CR in fully immersive VR. METHODS Level 1 of evidence. This study followed the PRISMA extension for Scoping Reviews and Systematic Review. Three electronic databases (Pubmed, Cochrane Library, Embase) were systematically searched, and studies were included if they met the eligibility criteria: only randomized clinical trials, only studies with fully immersive VR, and only CR for the adult population with mental disorders. RESULTS We found 4905 (database) plus 7 (manual/citation searching articles) eligible studies. According to inclusion criteria, 11 studies were finally reviewed. Of these, nine included patients with mild cognitive impairment, one with schizophrenia, and one with mild dementia. Most studies used an ecological scenario, with improvement across all cognitive domains. Although eight studies showed significant efficacy of CR/VR, the interventions' development was poorly described, and few details were given on the interventions' components. CONCLUSIONS Although CR/VR seems to be effective in clinical and feasibility outcomes, the interventions and their components are not clearly described. This limits the understanding of the effectiveness and undermines their real-world implementation and the establishment of a gold standard for fully immersive VR/CR.
Collapse
Affiliation(s)
- Alessandra Perra
- International PhD in Innovation Sciences and Technologies, Department of Mechanical Chemistry and Materials Engineering, University of Cagliari, 09042 Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
| | - Chiara Laura Riccardo
- Department of Clinical and Biological Sciences, University of Turin, 10126 Turin, Italy
| | | | - Erika De Marco
- Azienda Sociosanitaria Ligure 2, Dipartimento di Salute Mentale e delle Dipendenze, 17100 Savona, Italy
| | | | | | - Antonio Preti
- Department of Neuroscience, University of Turin, 10126 Turin, Italy
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
| |
Collapse
|
27
|
Wiebe A, Kannen K, Selaskowski B, Mehren A, Thöne AK, Pramme L, Blumenthal N, Li M, Asché L, Jonas S, Bey K, Schulze M, Steffens M, Pensel MC, Guth M, Rohlfsen F, Ekhlas M, Lügering H, Fileccia H, Pakos J, Lux S, Philipsen A, Braun N. Virtual reality in the diagnostic and therapy for mental disorders: A systematic review. Clin Psychol Rev 2022; 98:102213. [PMID: 36356351 DOI: 10.1016/j.cpr.2022.102213] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/21/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders. OBJECTIVE To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders. DATA SOURCE Systematic literature searches via PubMed (last literature update: 9th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders. ELIGIBILITY CRITERIA To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology. STUDY EVALUATION For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria. RESULTS Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder. CONCLUSION While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application. REVIEW REGISTRATION PROSPERO register CRD42020188436. FUNDING The review was funded by budgets from the University of Bonn. No third party funding was involved.
Collapse
Affiliation(s)
- Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Aylin Mehren
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Ann-Kathrin Thöne
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Pramme
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Nike Blumenthal
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mengtong Li
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Asché
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Stephan Jonas
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Maria Steffens
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Max Christian Pensel
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Matthias Guth
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Felicia Rohlfsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mogda Ekhlas
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Lügering
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Fileccia
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Julian Pakos
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
| |
Collapse
|
28
|
Kim H, Jung J, Lee S. Therapeutic Application of Virtual Reality in the Rehabilitation of Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. VISION (BASEL, SWITZERLAND) 2022; 6:vision6040068. [PMID: 36412649 PMCID: PMC9680273 DOI: 10.3390/vision6040068] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022]
Abstract
This review aimed to quantify the effect of therapeutic application of virtual reality (VR) on cognitive function in individuals with mild cognitive impairment (MCI). We searched for randomized controlled trials involving VR in the interventions provided to individuals with MCI. After searching four international electronic databases, we analyzed six studies involving 279 individuals with MCI. RevMan 5.4 was used for quality assessment and quantitative analysis. Therapeutic application of VR in individuals with MCI resulted in a significant improvement in cognitive function (mean difference = -1.46; 95% confidence interval: -2.53 to -0.39; heterogeneity: χ2 = 970.56, df = 18, I2 = 98%; and overall effect: Z = 2.67, p = 0.008). However, there was no significant improvement in the subcategories such as global cognition, working memory, executive function, memory function, and attention. In conclusion, feedback stimulation through VR has a potential value in improving cognitive function in individuals with MCI. However, on the basis of the results of the subcategories, a personalized VR program is required for the individual subcategories of cognitive function.
Collapse
Affiliation(s)
- Hyunjoong Kim
- Seogwangju Chung Yeon Rehabilitation Hospital, Gwangju 72070, Republic of Korea
- Department of Physical Therapy, Gwangju Health University, Gwangju 62287, Republic of Korea
| | - Jihye Jung
- Institute of SMART Rehabilitation, Sahmyook University, Seoul 01795, Republic of Korea
| | - Seungwon Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea
- Correspondence:
| |
Collapse
|
29
|
Schaefer SY, Hooyman A, Haikalis NK, Essikpe R, Lohse KR, Duff K, Wang P. Efficacy of Corsi Block Tapping Task training for improving visuospatial skills: a non-randomized two-group study. Exp Brain Res 2022; 240:3023-3032. [PMID: 36227343 PMCID: PMC9558013 DOI: 10.1007/s00221-022-06478-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/30/2022] [Indexed: 11/04/2022]
Abstract
Even though impaired visuospatial abilities can negatively affect daily functioning, there are very few training programs that attempt to improve visuospatial abilities. The purpose of this study was to examine if a single training session with a computerized version of the Corsi Block Tapping Task could improve mental rotation skills. Fifty-three young adults were assigned to one of two groups: (1) control group (mean age = 21.4; 10 females), who had 20 min of rest after their baseline assessment, or (2) training group (mean age = 21.5; 17 females), who had 20 min of training on the Corsi Block Tapping Task after their baseline assessment. The primary outcome was reaction time on a computer-based mental rotation task, and it was assessed both before and after the rest or training. There was a significant interaction between time (pre vs. post) and group (control vs. training) on mental rotation performance (p = 0.04), with the training group performing on average 124 ms faster on accurate trials than the control group at post-test. This preliminary study suggested that improving mental rotation may be feasible through targeted cognitive training. Future studies will consider multiple sessions of Corsi Block Tapping Task training to maximize training benefits (i.e., dose-response), as well as longer term retention in cognitively intact and impaired individuals.
Collapse
Affiliation(s)
- Sydney Y Schaefer
- School of Biological and Health Systems Engineering, Arizona State University, 501 E. Tyler Mall, MC 9709, Tempe, AZ, 85287-9709, USA.
| | - Andrew Hooyman
- School of Biological and Health Systems Engineering, Arizona State University, 501 E. Tyler Mall, MC 9709, Tempe, AZ, 85287-9709, USA
| | - Nicole K Haikalis
- School of Biological and Health Systems Engineering, Arizona State University, 501 E. Tyler Mall, MC 9709, Tempe, AZ, 85287-9709, USA
| | - Randy Essikpe
- School of Biological and Health Systems Engineering, Arizona State University, 501 E. Tyler Mall, MC 9709, Tempe, AZ, 85287-9709, USA
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Kevin Duff
- Center for Alzheimer's Care, Imaging and Research, University of Utah, Salt Lake City, UT, USA
| | - Peiyuan Wang
- School of Biological and Health Systems Engineering, Arizona State University, 501 E. Tyler Mall, MC 9709, Tempe, AZ, 85287-9709, USA
| |
Collapse
|
30
|
Kim Y, Hong S, Choi M. Effects of Serious Games on Depression in Older Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2022; 24:e37753. [PMID: 36066964 PMCID: PMC9490522 DOI: 10.2196/37753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/11/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression is a severe psychological concern that negatively affects health in older adults. Serious games applied in various fields are considered appropriate interventions, especially in mental health care. However, there is a lack of evidence regarding the effects of serious games on depression in older adults. OBJECTIVE This study aimed to investigate the characteristics and effectiveness of serious games for depression in older adults. METHODS A systematic review and meta-analysis of randomized controlled trials were conducted. In total, 5 electronic databases (PubMed, CINAHL, Embase, PsycINFO, and Cochrane Library) were searched to identify relevant studies published until July 6, 2021. A total of 2 reviewers independently conducted study selection, data extraction, and quality appraisals. The risk of bias in the included studies was assessed using the JBI Critical Appraisal Checklist. For the meta-analysis, the effect size was calculated as the standardized mean difference (SMD) by using a random effects model. RESULTS A total of 17 studies with 1280 older adults were included in the systematic review, and 15 studies were included in the meta-analysis. Serious game interventions were classified into 3 types: physical activity (PA), cognitive function, and both PA and cognitive function. The meta-analysis demonstrated that serious games reduced depression in older adults (SMD -0.54, 95% CI -0.79 to -0.29; P<.001). Serious games had a more significant effect size in community or home settings (SMD -0.61, 95% CI -0.95 to -0.26; P<.001) than in hospital settings (SMD -0.46, 95% CI -0.85 to -0.08; P=.02); however, the difference between groups was not significant. Among the types of games, games for PA (SMD -0.60, 95% CI -0.95 to -0.25; P<.001) and games for both (SMD -0.73, 95% CI -1.29 to -0.17; P=.01) had a significant effect on reducing depression in older adults. However, no significant correlations were observed between the duration or number of serious games and depression. CONCLUSIONS Serious games were beneficial in reducing depression in older adults. Regardless of the study setting, serious games appeared to reduce depression. Particularly, serious games including PA had a significant impact on reducing depression. Furthermore, high-quality randomized controlled trials are needed to establish substantial evidence for the effectiveness of serious games on depression in older adults. TRIAL REGISTRATION PROSPERO CRD42021242573; https://tinyurl.com/26xf7ym5.
Collapse
Affiliation(s)
- Yesol Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Soomin Hong
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Mona Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea.,Yonsei Evidence Based Nursing Centre of Korea, A JBI Affiliated Group, Seoul, Republic of Korea
| |
Collapse
|
31
|
Nam S, Jang KM, Kwon M, Lim HK, Jeong J. Electroencephalogram microstates and functional connectivity of cybersickness. Front Hum Neurosci 2022; 16:857768. [PMID: 36072889 PMCID: PMC9441598 DOI: 10.3389/fnhum.2022.857768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Virtual reality (VR) is a rapidly developing technology that simulates the real world. However, for some cybersickness-susceptible people, VR still has an unanswered problem-cybersickness-which becomes the main obstacle for users and content makers. Sensory conflict theory is a widely accepted theory for cybersickness. It proposes that conflict between afferent signals and internal models can cause cybersickness. This study analyzes the brain states that determine cybersickness occurrence and related uncomfortable feelings. Furthermore, we use the electroencephalogram (EEG) microstates and functional connectivity approach based on the sensory conflict theory. The microstate approach is a time-space analysis method that allows signals to be divided into several temporarily stable states, simultaneously allowing for the exploration of short- and long-range signals. These temporal dynamics can show the disturbances in mental processes associated with neurological and psychiatric conditions of cybersickness. Furthermore, the functional connectivity approach gives us in-depth insight and relationships between the sources related to cybersickness. We recruited 40 males (24.1 ± 2.3 years), and they watched a VR video on a curved computer monitor for 10 min to experience cybersickness. We recorded the 5-min resting state EEG (baseline condition) and 10-min EEG while watching the VR video (task condition). Then, we performed a microstate analysis, focusing on two temporal parameters: mean duration and global explained variance (GEV). Finally, we obtained the functional connectivity data using eLoreta and lagged phase synchronization (LPS). We discovered five sets of microstates (A-E), including four widely reported canonical microstates (A-D), during baseline and task conditions. The average duration increased in microstates A and B, which is related to the visual and auditory networks. The GEV and duration decreased in microstate C, whereas those in microstate D increased. Microstate C is related to the default mode network (DMN) and D to the attention network. The temporal dynamics of the microstate parameters are from cybersickness disturbing the sensory, DMN, and attention networks. In the functional connectivity part, the LPS between the left and right parietal operculum (OP) significantly decreased (p < 0.05) compared with the baseline condition. Furthermore, the connectivity between the right OP and V5 significantly decreased (p < 0.05). These results also support the disturbance of the sensory network because a conflict between the visual (V5) and vestibular system (OP) causes cybersickness. Changes in the microstates and functional connectivity support the sensory conflict theory. These results may provide additional information in understanding brain dynamics during cybersickness.
Collapse
Affiliation(s)
- Sungu Nam
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Kyoung-Mi Jang
- Korea Research Institute of Standards and Science, Daejeon, South Korea
| | - Moonyoung Kwon
- Korea Research Institute of Standards and Science, Daejeon, South Korea
| | - Hyun Kyoon Lim
- Korea Research Institute of Standards and Science, Daejeon, South Korea
| | - Jaeseung Jeong
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| |
Collapse
|
32
|
Ho KY, Cheung PM, Cheng TW, Suen WY, Ho HY, Cheung DSK. Virtual Reality Intervention for Managing Apathy in People With Cognitive Impairment: Systematic Review. JMIR Aging 2022; 5:e35224. [PMID: 35544317 PMCID: PMC9133981 DOI: 10.2196/35224] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background Apathy is common in people with cognitive impairment. It leads to different consequences, such as more severe cognitive deficits, rapid functional decline, and decreased quality of life. Virtual reality (VR) interventions are increasingly being used to manage apathy in individuals with cognitive impairment. However, reports of VR interventions are scattered across studies, which has hindered the development and use of the interventions. Objective This study aimed to systematically review existing evidence on the use of VR interventions for managing apathy in people with cognitive impairment with regard to the effectiveness, contents, and implementation of the interventions. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. The PubMed, Embase, CINAHL, and PsycINFO databases were systematically searched for experimental studies published up to March 13, 2022, that reported the effects of VR interventions on apathy in older adults with cognitive impairment. Hand searching and citation chasing were conducted. The results of the included studies were synthesized by using a narrative synthesis. Their quality was appraised by using the Effective Public Health Practice Project quality assessment tool. However, because the VR interventions varied in duration, content, and implementation across studies, a meta-analysis was not conducted. Results A total of 22 studies were identified from the databases, of which 6 (27%) met the inclusion criteria. Of these 6 studies, 2 (33%) were randomized controlled trials, 1 (17%) was a controlled clinical trial, and 3 (50%) were quasi-experimental studies. Individual studies showed significant improvement in apathy and yielded within-group medium to large effect sizes. The level of immersion ranged from low to high. Minor adverse effects were reported. The VR content mostly included natural scenes, followed by city views and game-based activities. A background soundtrack was often used with natural scenes. Most (5/6, 83%) of the studies were conducted in a residential care setting and were implemented by health care professionals or researchers. Safety precautions were taken in most (5/6, 83%) of the studies. Conclusions Although preliminary evidence shows that VR interventions may be effective and feasible for alleviating apathy in people with cognitive impairment, the methodological limitations in the included studies make it difficult to reach a firm conclusion on these points. The implementation of the interventions was highlighted and discussed. More rigorous studies are encouraged. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021268289; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268289
Collapse
Affiliation(s)
- Ka Ying Ho
- School of Nursing, The Hong Kong Polytechinc University, Hong Kong, Hong Kong
| | - Po Mang Cheung
- School of Nursing, The Hong Kong Polytechinc University, Hong Kong, Hong Kong
| | - Tap Wing Cheng
- School of Nursing, The Hong Kong Polytechinc University, Hong Kong, Hong Kong
| | - Wing Yin Suen
- School of Nursing, The Hong Kong Polytechinc University, Hong Kong, Hong Kong
| | - Hiu Ying Ho
- School of Nursing, The Hong Kong Polytechinc University, Hong Kong, Hong Kong
| | | |
Collapse
|
33
|
Cheng TC, Huang SF, Wu SY, Lin FG, Lin WS, Tsai PY. Integration of Virtual Reality into Transcranial Magnetic Stimulation Improves Cognitive Function in Patients with Parkinson's Disease with Cognitive Impairment: A Proof-of-Concept Study. JOURNAL OF PARKINSON'S DISEASE 2022; 12:723-736. [PMID: 34897103 DOI: 10.3233/jpd-212978] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Emerging evidence has indicated the positive effects of repetitive transcranial magnetic stimulation (rTMS) on patients with Parkinson's disease (PD) for the treatment of mild cognitive impairment (MCI). OBJECTIVE Investigating whether combining virtual reality (VR) training with rTMS can further enhance cognitive improvement induced by rTMS treatment. METHODS We randomly assigned 40 patients with PD and MCI into three groups, namely the rTMS-VR group (n = 13), rTMS group (n = 11), and sham rTMS group (n = 16). rTMS was administered as 10 consecutive sessions of intermittent theta burst stimulation (iTBS) over the left dorsolateral prefrontal cortex. In the rTMS-VR group, VR training was administered immediately after each rTMS session. Cognitive function was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Montreal Cognitive Assessment (MoCA) at baseline, immediately after intervention, and at 3-month follow-up. RESULTS Compared with the rTMS group, the rTMS-VR group exhibited significantly more improvements in total and delayed memory scores of the RBANS and the visuospatial/executive function score of the MoCA after intervention (p = 0.000∼0.046) and the delayed memory score of the RBANS at 3-month follow-up (p = 0.028). CONCLUSION The integrated rTMS-VR protocol achieved a superior outcome in global cognitive function, more effectively enhancing working memory and visuospatial executive function than did the rTMS protocol alone. The combination of VR and rTMS can be an effective regimen for improving the cognitive function of patients with PD.
Collapse
Affiliation(s)
- Tsai-Chin Cheng
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Fong Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shang-Yu Wu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Gong Lin
- Department of Optometry, University of Kang Ning, Taipei, Taiwan
| | - Wang-Sheng Lin
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan
| | - Po-Yi Tsai
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming Chiao-Tung University, School of Medicine, Taipei, Taiwan
| |
Collapse
|
34
|
Zhong D, Chen L, Feng Y, Song R, Huang L, Liu J, Zhang L. Effects of virtual reality cognitive training in individuals with mild cognitive impairment: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:1829-1847. [PMID: 34318524 DOI: 10.1002/gps.5603] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/04/2021] [Accepted: 07/12/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Virtual reality (VR) is used to improve specific health needs by combining multiple technologies; it is increasingly being used in the medical field, showing satisfactory effects, especially in the management of chronic disease. The aim of this study was to assess the effects of VR cognitive training for individuals with mild cognitive impairment (MCI). METHODS Peer-reviewed articles were searched from the PubMed, Embase, Web of Science, the Cochrane Library, Science Direct, and EBSCOhost databases, as well as CNKI, Sinomed, Vip. and Wan Fang, through 23 May 2021. We only included randomized controlled trials (RCTs) enrolling participants with MCI. RESULTS Seventeen RCTs were included, with a total of 744 participants. Evidence of moderate quality showed that VR cognitive training significantly enhanced MCI patients' global cognitive function, as measured by the Montreal Cognitive Assessment (standardized mean difference [SMD] = 0.42; 95% confidence interval [CI], 0.04-0.79; p = 0.03) and executive function, as measured by trail making test A (SMD = -0.58; 95% CI, -0.80 to -0.35; p < 0.001). The meta-analysis indicated that the effects of VR cognitive training on delayed memory, immediate memory, attention and instrumental activities of daily living were not statistically significant (p > 0.05). CONCLUSION The available data showed that VR cognitive training might be beneficial for improving global cognitive function and executive function in individuals with MCI, although the effects were short term.
Collapse
Affiliation(s)
- Dongmei Zhong
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Liangying Chen
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yongshen Feng
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Rui Song
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Likui Huang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Liu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lifeng Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|