Design and Application of a Novel Virtual Reality Navigational Technology (VRNChair)

CyPVICS: A framework to prevent or minimise cybersickness in immersive virtual clinical simulation

Cybersickness is a global issue affecting users of immersive virtual reality. However, there is no agreement on the exact cause of cybersickness. Taking into consideration how it can differ greatly from one person to another, it makes it even more difficult to determine the exact cause or find a solution. Because cybersickness excludes so many prospective users, including healthcare professionals, from using immersive virtual reality as a learning tool, this research sought to find solutions in existing literature and construct a framework that can be used to prevent or minimise cybersickness during immersive virtual clinical simulation (CyPVICS). The Bestfit Framework by Carrol and authors were used to construct the CyPVICS framework. The process started by conducting two separate literature searchers using the BeHEMoTh (for models, theories, and frameworks) and SPIDER (for primary research articles) search techniques. Once the literature searches were completed the models, theories and framework were used to construct a priori framework. The models' theories and frameworks were analysed to determine aspects relevant to causes, reducing, eliminating, and detecting cybersickness. The priori framework was expanded by, first coding the findings of the primary research study into the existing aspects of the priori framework. Once coded the aspects that could not be coded were added in the relevant category, for example causes. After reviewing 1567 abstracts and titles as part of the BeHEMoTh search string,19 full text articles, a total of 15 papers containing models, theories, and frameworks, were used to construct the initial CyPVICS framework. Once the initial CyPVICS was created, a total 904 primary research studies (SPIDER) were evaluated, based on their titles and abstracts, of which 100 were reviewed in full text. In total, 67 articles were accepted and coded to expand the initial CyPVICS framework. This paper presents the CyPVICS framework for use, not only in health professions' education, but also in other disciplines, since the incorporated models, theories, frameworks, and primary research studies were not specific to virtual clinical simulation.

iVR-fNIRS: studying brain functions in a fully immersive virtual environment

Immersive virtual reality (iVR) employs head-mounted displays or cave-like environments to create a sensory-rich virtual experience that simulates the physical presence of a user in a digital space. The technology holds immense promise in neuroscience research and therapy. In particular, virtual reality (VR) technologies facilitate the development of diverse tasks and scenarios closely mirroring real-life situations to stimulate the brain within a controlled and secure setting. It also offers a cost-effective solution in providing a similar sense of interaction to users when conventional stimulation methods are limited or unfeasible. Although combining iVR with traditional brain imaging techniques may be difficult due to signal interference or instrumental issues, recent work has proposed the use of functional near infrared spectroscopy (fNIRS) in conjunction with iVR for versatile brain stimulation paradigms and flexible examination of brain responses. We present a comprehensive review of current research studies employing an iVR-fNIRS setup, covering device types, stimulation approaches, data analysis methods, and major scientific findings. The literature demonstrates a high potential for iVR-fNIRS to explore various types of cognitive, behavioral, and motor functions in a fully immersive VR (iVR) environment. Such studies should set a foundation for adaptive iVR programs for both training (e.g., in novel environments) and clinical therapeutics (e.g., pain, motor and sensory disorders and other psychiatric conditions).

The Effect of Transcranial Alternating Current Stimulation With Cognitive Training on Executive Brain Function in Individuals With Dementia: Protocol for a Crossover Randomized Controlled Trial

BACKGROUND

Although memory and cognitive declines are associated with normal brain aging, they may also be precursors to dementia.

OBJECTIVE

We aim to offer a novel approach to prevent or slow the progress of neurodegenerative dementia, or plausibly, improve the cognitive functions of individuals with dementia.

METHODS

We will recruit and enroll 75 participants (older than 50 years old with either mild cognitive impairment or probable early or moderate dementia) for this double-blind randomized controlled study to estimate the efficacy of active transcranial alternating current stimulation with cognitive treatment (in comparison with sham transcranial alternating current stimulation). This will be a crossover study; a cycle consists of sham or active treatment for a period of 4 weeks (5 days per week, in two 30-minute sessions with a half-hour break in between), and participants are randomized into 2 groups, with stratification by age, sex, and cognitive level (measured with the Montreal Cognitive Assessment). Outcomes will be assessed before and after each treatment cycle. The primary outcomes are changes in Wechsler Memory Scale Older Adult Battery and Alzheimer Disease Assessment Scale scores. Secondary outcomes are changes in performance on tests of frontal lobe functioning (verbal fluency), neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire), mood changes (Montgomery-Åsberg Depression Rating Scale), and short-term recall (visual 1-back task). Exploratory outcome measures will also be assessed: static and dynamic vestibular response using electrovestibulography, neuronal changes using functional near-infrared spectroscopy, and change in spatial orientation using virtual reality navigation.

RESULTS

As of February 10, 2022, the study is ongoing: 7 patients have been screened, and all were deemed eligible for and enrolled in the study; 4 participants have completed baseline assessments.

CONCLUSIONS

We anticipate that transcranial alternating current stimulation will be a well-tolerated treatment, with no serious side effects and with considerable short- and long-term cognitive improvements.

TRIAL REGISTRATION

Clinicaltrials.gov NCT05203523; https://clinicaltrials.gov/show/NCT05203523.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/37282.

Egocentric spatial orientation differences between Alzheimer's disease at early stages and mild cognitive impairment: a diagnostic aid

Alzheimer's disease (AD) is a growing global crisis. Egocentric spatial orientation deteriorates with age and more significantly with AD. A simple and quick virtual reality (VR) localization and target finding technique is presented as a diagnostic aid to screen mild cognitive impairment (MCI) from AD. Spatial orientation data from 93 individuals (65 AD at a mild stage, 20 MCI, and 8 other dementia types) based on VR localization of a target on a landmark-less cubic 3-story building were analyzed. We hypothesize AD and MCI groups' performances are significantly different. AD and MCI spatial performances were statistically significantly (p < 0.001) different. These results plus the longitudinal tracking of three patients who developed AD over a period of 5 years suggest the proposed spatial tests may be used as a quick and simple clinical diagnostic aid to separate AD at early to mild stages from MCI.

Using a 360° Virtual Reality or 2D Video to Learn History Taking and Physical Examination Skills for Undergraduate Medical Students: Pilot Randomized Controlled Trial

BACKGROUND

Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills.

OBJECTIVE

The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills.

METHODS

This pilot system-design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01.

RESULTS

All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ≥3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ≥3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ≥3.6 seconds was not related to a Milestone level of ≥3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ≥1.43 seemed to be inversely associated with a hedonic stimulation score of ≥2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious.

CONCLUSIONS

Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners' needs and prompted learning through the different video modules.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641.

A Scoping Review of Cognitive Training in Neurodegenerative Diseases via Computerized and Virtual Reality Tools: What We Know So Far

Most prevalent neurodegenerative diseases such as Alzheimer's disease, frontotemporal dementia, Parkinson's disease and multiple sclerosis are heterogeneous in their clinical profiles and underlying pathophysiology, although they typically share the presence of cognitive impairment that worsens significantly during the course of the disease. Viable pharmacological options for cognitive symptoms in these clinical conditions are currently lacking. In recent years, several studies have started to apply Computerized Cognitive Training (CCT) and Virtual Reality (VR) tools to try and contrast patients' cognitive decay over time. However, no in-depth literature review of the contribution of these promising therapeutic options across main neurodegenerative diseases has been conducted yet. The present paper reports the state-of-the-art of CCT and VR studies targeting cognitive impairment in most common neurodegenerative conditions. Our twofold aim is to point out the scientific evidence available so far and to support health professionals to consider these promising therapeutic tools when planning rehabilitative interventions, especially when the access to regular and frequent hospital consultations is not easy to be provided.

A Novel Program to Improve Cognitive Function in Individuals With Dementia Using Transcranial Alternating Current Stimulation (tACS) and Tutored Cognitive Exercises

The effects of cognitive exercises on the healthy aging population is controversial. Transcranial alternating current stimulation (tACS) is considered a promising tool for modulating brain oscillation. Research is lacking on its long-lasting cognitive/therapeutic effect. This is the first pilot study to explore the effect of a regimen of cognitive exercises with and without tACS on older adults with dementia. The study groups were 28 individuals (age 56–83 years) enrolled into two groups: Exr Group, who received cognitive exercises only and the Exr + tACS Group who received tACS at 40 Hz simultaneously with cognitive exercises for a period of 4 consecutive weeks, 5 days/week, two 30 min-sessions/day; all the training sessions were tutored. The cognitive exercises were applied using the MindTriggers app. They were assessed at pre and post intervention and also one month after the end of trial (follow-up) with an independent assessment (WMS-IV) as the primary outcome measure. The results show significant cognitive improvement at post-intervention in both groups, while the Exr + tACS protocol lead to superior cognitive improvement at follow-up session. The most important outcomes of this study are: 1) The tutored repeated practice of the MindTriggers app exercises does significantly improve the cognitive functions of older adults with dementia and that that improvement lasts for at least one month after the end of the intervention, and 2) The application of tACS increases the positive effects of cognitive exercises with the positive effect lasting an even longer period of time than exercises alone; in other words we speculate that it may lead to long-term potentiation.

Does Practicing with a Virtual Reality Driving Simulator Improve Spatial Cognition in Older Adults? A Pilot Study

Memory, cognition, executive functioning, and spatial cognition loss are prevalent in the normal aging process, but these impairments are observed more extensively in individuals with dementia, specifically Alzheimer’s disease. To improve the impaired functions, serious games targeting the lost functions are commonly developed and used in training programs. In this study, we designed a virtual reality driving simulator (VRDS) as a serious game with different difficulty levels for improving the spatial cognition; we evaluated it on 11 participants with different levels of dementia for two weeks, every day except weekends (10 sessions of practice in total) and 30 min/day. We assessed the participants’ spatial cognition before and after the intervention by an independent assessment (the VR replica of Morris Water test) and also by their performance playing the VRDS during the intervention. We also assessed the participants’ mood by a standard depression scale as well as their plausible experience of simulation sickness. The results showed significant improvement in Morris water test. The participants’ normalized correct trajectory (to find the target) was improved significantly by 44.4% at post-intervention with respect to baseline. Furthermore, on average, the participants progressed to higher (more challenging) levels of the game, and their spatial learning score increased throughout the sessions. Their mood also showed improvement with respect to baseline. Overall, the results hold promise for the designed VRDS as a mood-lifting and enhancing spatial skills serious game for older adults if it is played regularly.

Trial Registry name: Investigating the Effect of Training with a Virtual Reality Driving Simulator

URL: https://clinicaltrials.gov/ct2/show/NCT04074655

Clinical Trials.gov ID: NCT04074655

Older Adults Show Less Flexible Spatial Cue Use When Navigating in a Virtual Reality Environment Compared With Younger Adults

Daily life requires accurate navigation, and thus better understanding of aging on navigational abilities is critical. Importantly, the use of spatial properties by older and younger adults remains unclear. During this study, younger and older human adults were presented with a virtual environment in which they had to navigate a series of hallways. The hallways provided 2 general types of spatial information: geometric, which included distance and directional turns along a learned route, and featural, which included landmarks situated along the route. To investigate how participants used these different cue types, geometric and/or landmark information was manipulated during testing trials. Data from 40 younger (20 women) and 40 older (20 women) adults were analyzed. Our findings suggest that (1) both younger and older adults relied mostly on landmarks to find their way, and (2) younger adults were better able to adapt to spatial changes to the environment compared with older adults.

Effects of virtual reality technology locomotive multi-sensory motion stimuli on a user simulator sickness and controller intuitiveness during a navigation task

Simulator sickness of users and intuitiveness of controllers contribute to a user's acceptance or rejection of a virtual reality (VR) experiment. However, few studies investigated the effects of different VR locomotive controllers and potential gender effects. Hence, we investigated the effects of different motion stimuli combinations and a user's range of neck motion via two experiments in a gender balanced group. Thus, through separate sessions, young adult participants utilized four common VR locomotive controllers (TiltChair, omni-directional treadmill, VRNChair and joystick) with a head-mounted display to execute the same VR navigation task as we measured simulator sickness by the simulator sickness questionnaire and postural sway. Also, we measured intuitiveness through total traversed distance and execution times. As expected, simulator sickness severity increased with VR exposure time. However, participants had significantly shorter traversed distances and execution times when they utilized the TiltChair and joystick respectively; while, participants had significantly longer execution times when they utilized the omni-directional treadmill. Additionally, female participants easily utilized the TiltChair and omni-directional treadmill because they traversed shorter distances than male participants. Therefore, a VR locomotive controller selection should be based on a target population's characteristics to reduce user simulator sickness and to increase controller intuitiveness. Graphical Abstract The current study investigates the use different virtual reality locomotive controllers to minimize user simulator sickness and maximize controller intuitiveness.

Differential diagnosis of schizophrenia and schizoaffective disorder from normal subjects using virtual reality

Dysfunction of allocentric and egocentric memories is one of the core features of psychiatric disorders. There are a few navigational studies on these memories in schizophrenia and bipolar disorders, but studies in schizoaffective disorder are lacking. Here, we aim to explore allocentric and egocentric navigation deficits in these subjects using our advanced recently developed virtual reality navigation task (VRNT). Twenty patients with schizophrenia and 20 with schizoaffective disorder were compared with 20 normal volunteer subjects on VRNTs consisting of a virtual neighbourhood (allocentric memory) and a virtual maze (egocentric memory). Compared with schizoaffective disorder and control subjects, patients with schizophrenia had the worst performance on both virtual neighbourhood and virtual maze tasks. The allocentric memory in both patients with schizophrenia and those with schizoaffective disorder was more impaired than the egocentric memory (p ˂ 0.001). However, the patients with schizoaffective disorder performed better in egocentric memory than those with schizophrenia, as they had fewer errors in the virtual maze. It was concluded that allocentric memory is more impaired than egocentric in both schizoaffective disorder and schizophrenia patients, whereas patients with schizoaffective disorder performed better in egocentric memory than patients with schizophrenia. It was also concluded that allocentric memory deficits can help differentiate patients with schizophrenia and schizoaffective disorder from healthy participants, whereas egocentric memory deficits can be used to distinguish them from each other.

Investigating the Reliability and Validity of Three Novel Virtual Reality Environments With Different Approaches to Simulate Wheelchair Maneuvers

Wheelchair manoeuvring has received little attention in the literature despite its importance in mobility and performing activities of daily living and its role in developing secondary injuries for wheelchair users. The focus in this paper was technology development with iterative and proof-of-concept testing. Three versions of a wheelchair simulator that were designed and developed for simulating curvilinear wheelchair propulsion in virtual reality were tested for their validity and reliability. The wheelchair simulators comprise a sophisticated wheelchair ergometer in an immersive virtual reality environment and are developed for manual wheelchair propulsion. These simulators all replicate inertia in translation, in addition to taking three approaches for simulating turning. The three systems were then tested and compared with the real world to see how reliable and valid they are; 15 healthy participants were recruited to perform the Illinois Agility Test (IAT) in two sessions that were at least one week apart. The intraclass correlation coefficient and the Pearson correlation coefficient were found for 16 variables to find the test-retest reliability and convergent construct validity of the systems, respectively. Overall, the three systems showed good validity and reliability with the VR_system 2 (mechanical compensation for rotational inertia) having the best scores and the VR_system 3 (software compensation for rotational inertia) having the lowest scores. Also, it was observed that performing IAT in the real world needed fewer pushes and often accompanied more negative pushes. Participants also used longer strokes in the real world compared to virtual reality environment.

The Clinical Utility of Virtual Reality in Neurorehabilitation: A Systematic Review

Background:

Virtual reality (VR) experiences (through games and virtual environments) are increasingly being used in physical, cognitive, and psychological interventions. However, the impact of VR as an approach to rehabilitation is not fully understood, and its advantages over traditional rehabilitation techniques are yet to be established.

Method:

We present a systematic review which was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). During February and March of 2018, we conducted searches on PubMed (Medline), Virtual Health Library Search Portal databases (BVS), Web of Science (WOS), and Embase for all VR-related publications in the past 4 years (2015, 2016, 2017, and 2018). The keywords used in the search were “neurorehabilitation” AND “Virtual Reality” AND “devices.”

Results:

We summarize the literature which highlights that a range of effective VR approaches are available. Studies identified were conducted with poststroke patients, patients with cerebral palsy, spinal cord injuries, and other pathologies. Healthy populations have been used in the development and testing of VR approaches meant to be used in the future by people with neurological disorders. A range of benefits were associated with VR interventions, including improvement in motor functions, greater community participation, and improved psychological and cognitive function.

Conclusions:

The results from this review provide support for the use of VR as part of a neurorehabilitation program in maximizing recovery.

Virtual reality body motion induced navigational controllers and their effects on simulator sickness and pathfinding

Virtual reality (VR) navigation is usually constrained by plausible simulator sickness (SS) and intuitive user interaction. The paper reports on the use of four different degrees of body motion induced navigational VR controllers, a TiltChair, omni-directional treadmill, a manual wheelchair joystick (VRNChair), and a joystick in relation to a participant's SS occurrence and a controller's intuitive utilization. Twenty young adult participants utilized all controllers to navigate through the same VR task environment in separate sessions. Throughout the sessions, SS occurrence was measured from a severity score by a standard SS questionnaire and from body sway by a center of pressure path length with eyes opened and closed. SS occurrence did not significantly differ among the controllers. However, time spent in VR significantly contributed to SS occurrence; hence, a few breaks to minimize SS should be interjected throughout a VR task. For all task trials, we recorded the participant's travel trajectories to investigate each controller's intuitive utilization from a computed traversed distance. Shorter traversed distances indicated that participants intuitively utilized the TiltChair with a slower speed; while longer traversed distances indicated participants struggled to utilize the omni-directional treadmill with a unnaturalistic stimulation of gait. Therefore, VR navigation should use technologies best suited for the intended age group that minimizes SS, and produces intuitive interactions for the participants.

Development of Three Versions of a Wheelchair Ergometer for Curvilinear Manual Wheelchair Propulsion Using Virtual Reality

Although wheelchair ergometers provide a safe and controlled environment for studying or training wheelchair users, until recently they had a major disadvantage in only being capable of simulating straight-line wheelchair propulsion. Virtual reality has helped overcome this problem and broaden the usability of wheelchair ergometers. However, for a wheelchair ergometer to be validly used in research studies, it needs to be able to simulate the biomechanics of real world wheelchair propulsion. In this paper, three versions of a wheelchair simulator were developed. They provide a sophisticated wheelchair ergometer in an immersive virtual reality environment. They are intended for manual wheelchair propulsion and all are able to simulate simple translational inertia. In addition, each of the systems reported uses a different approach to simulate wheelchair rotation and accommodate rotational inertial effects. The first system does not provide extra resistance against rotation and relies on merely linear inertia, hypothesizing that it can provide acceptable replication of biomechanics of wheelchair maneuvers. The second and third systems, however, are designed to simulate rotational inertia. System II uses mechanical compensation, and System III uses visual compensation simulating the influence that rotational inertia has on the visual perception of wheelchair movement in response to rotation at different speeds.

Effect of viewing mode on pathfinding in immersive Virtual Reality

The use of Head Mounted Displays (HMDs) to view Virtual Reality Environments (VREs) has received much attention recently. This paper reports on the difference between actual humans' navigation in a VRE viewed through an HMD compared to that in the same VRE viewed on a laptop PC display. A novel Virtual Reality (VR) Navigation input device (VRNChair), designed by our team, was paired with an Oculus Rift DK2 Head-Mounted Display (HMD). People used the VRNChair to navigate a VRE, and we analyzed their navigational trajectories with and without the HMD to investigate plausible differences in performance due to the display device. It was found that people's navigational trajectories were more accurate while wearing the HMD compared to viewing an LCD monitor; however, the duration to complete a navigation task remained the same. This implies that increased immersion in VR results in an improvement in pathfinding. In addition, motion sickness caused by using an HMD can be reduced if one uses an input device such as our VRNChair. The VRNChair paired with an HMD provides vestibular stimulation as one moves in the VRE, because movements in the VRE are synchronized with movements in the real environment.

Orientation in Virtual Reality Does Not Fully Measure Up to the Real-World

Adult participants learned to reorient to a specific corner inside either a real or virtual rectangular room containing a distinct featural object in each corner. Participants in the virtual-reality (VR) condition experienced an immersive virtual version of the physical room using a head-mounted display (HMD) and customized manual wheelchair to provide self-movement. Following a disorientation procedure, people could reorient by using either the geometry of the room and/or the distinct features in the corners. Test trials in which the different spatial cues were manipulated revealed participants encoded features and geometry in both the real and VR rooms. However, participants in the VR room showed less facility with using geometry. Our results suggest caution must be taken when interpreting the nuances of spatial cue use in virtual environments. Reduced reliability of geometric cues in VR environments may result in greater reliance on feature cues than would normally be expected under similar real-world conditions.

Neurocognitive Treatment for a Patient with Alzheimer's Disease Using a Virtual Reality Navigational Environment

In this case study, a man at the onset of Alzheimer’s disease (AD) was enrolled in a cognitive treatment program based upon spatial navigation in a virtual reality (VR) environment. We trained him to navigate to targets in a symmetric, landmark-less virtual building. Our research goals were to determine whether an individual with AD could learn to navigate in a simple VR navigation (VRN) environment and whether that training could also bring real-life cognitive benefits. The results show that our participant learned to perfectly navigate to desired targets in the VRN environment over the course of the training program. Furthermore, subjective feedback from his primary caregiver (his wife) indicated that his skill at navigating while driving improved noticeably and that he enjoyed cognitive improvement in his daily life at home. These results suggest that VRN treatments might benefit other people with AD.

Introducing a new age-and-cognition-sensitive measurement for assessing spatial orientation using a landmark-less virtual reality navigational task

Age-related impairments during spatial navigation have been widely reported in egocentric and allocentric paradigms. However, the effect of age on more specific navigational components such as the ability to drive or update directional information has not received enough attention. In this study we investigated the effect of age on spatial updating of a visual target after a series of whole-body rotations and transitions using a novel landmark-less virtual reality (VR) environment. Moreover, a significant number of previous studies focused on measures susceptible to a general decline in motor skills such as the spent time navigating, the distance traversed. The current paper proposes a new compound spatial measure to assess navigational performance, examines its reliability and compares its power with those of the measures of duration and traversed distance in predicting participants' age and cognitive groups assessed by Montreal Cognitive Assessment (MoCA) scores. Using data from 319 adults (20-83 years), our results confirm the reliability, the age sensitivity, and the cognitive validity of the designed spatial measure as well as its superiority to the measures of duration and traversed distance in predicting age and MoCA score. In addition, the results show the significant effect of age cognitive status on spatial updating.