Disentangling the Contribution of Spatial Reference Frames to Executive Functioning in Healthy and Pathological Aging: An Experimental Study with Virtual Reality

Two Immersive Virtual Reality Tasks for the Assessment of Spatial Orientation in Older Adults with and Without Cognitive Impairment: Concurrent Validity, Group Comparison, and Accuracy Results

OBJECTIVE

Spatial disorientation is common in Alzheimer's disease (AD), Mild Cognitive Impairment (MCI), and preclinical individuals with AD biomarkers. However, traditional neuropsychological tests lack ecological validity for the assessment of spatial orientation and to date, there is still no gold standard. The current study aimed to determine the validity and accuracy of two virtual reality tasks for the assessment of spatial orientation.

METHODS

We adapted two spatial orientation tasks to immersive virtual environments: a "survey to route" task in which participants had to transfer information from a map to their body position within a maze [Spatial Orientation in Immersive Virtual Environment Test (SOIVET) Maze], and an allocentric-type, route learning task, with well-established topographic landmarks (SOIVET Route). A total of 19 MCI patients and 29 cognitively healthy older adults aged 61-92 participated in this study. Regular neuropsychological assessments were used for correlation analysis and participant performances were compared between groups. Receiver Operating Characteristic (ROC) curve analysis was performed for accuracy.

RESULTS

The SOIVET Maze correlated with measures of visuoperception, mental rotation, and planning, and was not related to age, educational level, or technology use profile. The SOIVET Route immediate correlated with measures of mental rotation, memory, and visuoconstruction, and was influenced only by education. Both tasks significantly differentiated MCI and control groups, and demonstrated moderate accuracy for the MCI diagnosis.

CONCLUSION

Traditional neuropsychological assessment presents limitations and immersive environments allow for the reproduction of complex cognitive processes. The two immersive virtual reality tasks are valid tools for the assessment of spatial orientation and should be considered for cognitive assessments of older adults.

Technological Solutions for Diagnosis, Management and Treatment of Alzheimer's Disease-Related Symptoms: A Structured Review of the Recent Scientific Literature

In people with Alzheimer's disease (PwAD), there is a need for specific tools for the timely diagnosis, management, and treatment of symptoms. New technological solutions, including digital devices, application programs (apps), sensors and virtual reality, represent promising possibilities for objective and reliable assessment, monitoring and intervention strategies in this field. Our structured review presents an up-to-date summary of the technological solutions for the (i) diagnosis, (ii) management and (iii) treatment of AD-related symptoms. To this end, we searched electronic databases (i.e., PubMed, Web of Science, and Cochrane Library) for studies published over the last 10 years. Two authors of the review extracted data of interest. A total of eight manuscripts were included. In the last decade, a series of technological solutions across AD stages have been proposed. These include: (i) innovative strategies for the early detection of deficits in finger dexterity, visuo-spatial abilities (including spatial navigation), divided attention and instrumental autonomy; (ii) tools to activate the patient's responsiveness in terms of alertness and mood improvement; and (iii) useful interventions for retrieving memories, increasing body movements and improving spatial cognition. Methodological limitations, mainly pertaining to the paucity of randomized controlled trials and comprehensive assessments, were observed. Advances in technology currently provide the potential for designing innovative methods for evaluating, controlling and handling AD-related symptoms. The co-creation of technological solutions with all stakeholders represents the best way to design effective strategies for PwAD.

Virtual reality and mental health in older adults: a systematic review

IMPORTANCE

Virtual reality (VR) is a promising tool with the potential to enhance care of cognitive and affective disorders in the aging population. VR has been implemented in clinical settings with adolescents and children; however, it has been less studied in the geriatric population.

OBJECTIVE

The objective of this study is to determine the existing levels of evidence for VR use in clinical settings and identify areas where more evidence may guide translation of existing VR interventions for older adults.

DESIGN AND MEASUREMENTS

We conducted a systematic review in PubMed and Web of Science in November 2019 for peer-reviewed journal articles on VR technology and its applications in older adults. We reviewed article content and extracted the number of study participants, study population, goal of the investigation, the level of evidence, and categorized articles based on the indication of the VR technology and the study population.

RESULTS

The database search yielded 1554 total results, and 55 articles were included in the final synthesis. The most represented study design was cross-sectional, and the most common study population was subjects with cognitive impairment. Articles fell into three categories for VR Indication: Testing, Training, and Screening. There was a wide variety of VR environments used across studies.

CONCLUSIONS

Existing evidence offers support for VR as a screening and training tool for cognitive impairment in older adults. VR-based tasks demonstrated validity comparable to some paper-based assessments of cognition, though more work is needed to refine diagnostic specificity. The variety of VR environments used shows a need for standardization before comparisons can be made across VR simulations. Future studies should address key issues such as usability, data privacy, and confidentiality. Since most literature was generated from high-income countries (HICs), it remains unclear how this may be translated to other parts of the world.

Study of virtual reality for mild cognitive impairment: A bibliometric analysis using CiteSpace

Objectives

Non-invasive and low-cost virtual reality (VR) technology is important for early evaluation and intervention in mild cognitive impairment (MCI). This study aimed to demonstrate the current status of overseas and domestic research as well as the focus and frontier of VR technology among individuals with MCI through a bibliometric analysis.

Methods

Studies from the core collection of Web of Science™ between 1995 and 2020 were used; furthermore, CiteSpace 5.7 R3 was utilized to analyse information on authors/cited authors, keywords, burst words, and cited references.

Results

In total, 230 publications were identified. Most studies were published in the USA (45 publications) and Italy (41 publications), where Guiseppe Riva ranks first (14 publications), and Tarnanas I is the author with the highest centrality (0.44). The hot topics in VR applications in the MCI population are ‘physical activity,’ ‘people,’ ‘single-blind,’ ‘disease,’ ‘walking,’ ‘technology,’ ‘working memory,’ and ‘risk’ in recent years. The keyword ‘mild cognitive impairment’ has attracted extensive attention since 2012, showing the strongest citation outbreak (8.28). The clustering results of the literature show the research types and emerging trends, including ‘exergame,’ ‘serious games,’ ‘spatial navigation,’ ‘activities of daily living,’ ‘exercise,’ ‘enriched environment’ and ‘wayfinding.‘

Conclusions

Cognitive assessment and nonpharmacological intervention research on patients with MCI have become the focus of dementia prevention in recent years. Virtual technology, combined with traditional methods such as exercise therapy, provides new ideas for innovative cognitive evaluation and cognitive intervention.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Reframing spatial frames of reference: What can aging tell us about egocentric and allocentric navigation?

Representations of space in mind are crucial for navigation, facilitating processes such as remembering landmark locations, understanding spatial relationships between objects, and integrating routes. A significant problem, however, is the lack of consensus on how these representations are encoded and stored in memory. Specifically, the nature of egocentric and allocentric frames of reference in human memory is widely debated. Yet, in recent investigations of the spatial domain across the lifespan, these distinctions in mnemonic spatial frames of reference have identified age-related impairments. In this review, we survey the ways in which different terms related to spatial representations in memory have been operationalized in past aging research and suggest a taxonomy to provide a common language for future investigations and theoretical discussion. This article is categorized under: Psychology > Memory Neuroscience > Cognition Psychology > Development and Aging.

Age-related differences in the elderly in a spatial recognition task

Spatial memory is a cognitive ability which declines with ageing thus showing changes in some process such as the use of allocentric strategies. These age-related changes in spatial orientation suggest that this skill could be an adequate marker of cognitive decline. Many tasks used in investigation to assess spatial memory demand a participant's active role, which involves that the navigational experience is different for everyone. In this study, the Almeria Spatial Memory Recognition Test (ASMRT), a test based on a recognition paradigm, was used to offer the same experience with the environment. The aim of this research was to determine if the ASMRT is suitable to be applied in the elderly and detect spatial memory differences as one age. The ASMRT and other neuropsychological tests were applied in a sample aged between 50and 79 years. Results revealed a decrease in the ASMRT performance by the older group. No gender differences were found. Performance in attention and visuospatial working memory tests revealed some correlations with the ASMRT performance. In conclusion, this study demonstrates that 70-79-year-old participants clearly show age-related changes in spatial memory. Thanks to its simplicity the ASMRT could be used as a screening test in medical practice.

Directional Force Feedback: Mechanical Force Concentration for Immersive Experience in Virtual Reality

In recent years, consumer-level virtual-reality (VR) devices and content have become widely available. Notably, establishing a sense of presence is a key objective of VR and an immersive interface with haptic feedback for VR applications has long been in development. Despite the state-of-the-art force feedback research being conducted, a study on directional feedback, based on force concentration, has not yet been reported. Therefore, we developed directional force feedback (DFF), a device that generates directional sensations for virtual-reality (VR) applications via mechanical force concentrations. DFF uses the rotation of motors to concentrate force and deliver directional sensations to the user. To achieve this, we developed a novel method of force concentration for directional sensation; by considering both rotational rebound and gravity, the optimum rotational motor speeds and rotation angles were identified. Additionally, we validated the impact of DFF in a virtual environment, showing that the users’ presence and immersion within VR were higher with DFF than without. The result of the user studies demonstrated that the device significantly improves immersivity of virtual applications.