Virtual Reality (VR)-Based Environmental Enrichment in Older Adults with Mild Cognitive Impairment (MCI) and Mild Dementia

Background: Despite an alarming rise in the global prevalence of dementia, the available modalities for improving cognition and mental wellbeing of dementia patients remain limited. Environmental enrichment is an experimental paradigm that has shown promising anti-depressive and memory-enhancing effects in pre-clinical studies. However, its clinical utility has remained limited due to the lack of effective implementation strategies. Objective: The primary objective of this study was to evaluate the usability (tolerability and interactivity) of a long-term virtual reality (VR)- based environmental enrichment training program in older adults with mild cognitive impairment (MCI) and mild dementia. A secondary objective was to assess the effect of VR-based environmental enrichment on stabilization of cognitive functioning and improvement of mental wellbeing in older adults with MCI and mild dementia. Methods: A total of seven participants (four patients with MCI and three with mild dementia) received biweekly VR-based environmental enrichment over a course of 6 months. The tolerability and interactivity of the participants in the VR training was serially assessed via virtual reality sickness questionnaire (VRSQ) and recording of input-error ratio. Cognitive functioning was assessed through Montreal cognitive assessment (MoCA) before and after the study. Mental wellbeing was assessed through Warwick-Edinburgh Mental Well Being Scale (WEMWBS). Results: VR-based environmental enrichment was well-tolerated by the patients with significant decrease in VRSQ scores (p < 0.01) and input-error ratio (p < 0.001) overtime. VR training was also effective in stabilization of MoCA scores over the course of therapy (non-significant difference in the MoCA scores before and after the therapy) and was associated with a trend (p < 0.1) towards improvement in WEMWBS scores between the first and the last assessments. Qualitative observations by the care-givers further corroborated a noticeable improvement in mental wellbeing of patients. Conclusions: This pilot study shows that VR can be a feasible, tolerable, and potentially effective tool in long-term support of older adults with MCI and mild dementia.

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Effects of virtual reality-based cognitive training in older adults living without and with mild dementia: a pretest–posttest design pilot study

BMC Research Notes ◽

10.1186/s13104-019-4810-2 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 3

Author(s):

Ludmiła Zając-Lamparska ◽

Monika Wiłkość-Dębczyńska ◽

Adam Wojciechowski ◽

Marta Podhorecka ◽

Anna Polak-Szabela ◽

...

Keyword(s):

Older Adults ◽

Virtual Reality ◽

Cognitive Training ◽

Cognitive Enhancement ◽

Cognitive Ageing ◽

Healthy Older Adults ◽

Mild Dementia ◽

Cognitive Interventions ◽

Before And After ◽

Modern Technologies

Abstract Objective Modern technologies are increasingly used in the development of cognitive interventions for older adults. Research into possible applications of virtual reality in such interventions has begun only recently. The aim of present study was to evaluate the effects of 8 sessions of VR-based cognitive training using the GRADYS game in healthy older adults (n = 72; aged 60–88) and older adults living with mild dementia (n = 27; aged 60–89). Results Older adults with mild dementia demonstrated worse baseline cognitive performance than participants without dementia. Both groups showed progress in training, which was greater in healthy older adults. There were also significant differences in cognitive functioning before and after the training. However, positive changes were revealed almost exclusively in the group of older adults without dementia. Based on the findings, we can recommend the GRADYS game for cognitive enhancement and as a possible counter-measure for cognitive decline experienced in normal cognitive ageing. Our results provide also support for the usefulness of VR technology in cognitive interventions in older adults. The use of the GRADYS game in persons living with dementia, however, would require several of the hardware and software modifications. Trial registration ISRCTN17613444, date of registration: 10.09.2019. Retrospectively registered

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Virtual reality video game improves high-fidelity memory in older adults

Scientific Reports ◽

10.1038/s41598-021-82109-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Peter E. Wais ◽

Melissa Arioli ◽

Roger Anguera-Singla ◽

Adam Gazzaley

Keyword(s):

Older Adults ◽

Virtual Reality ◽

Video Game ◽

Cognitive Abilities ◽

Environmental Enrichment ◽

Cognitive Intervention ◽

Therapeutic Interventions ◽

Placebo Control ◽

Long Term Memory ◽

High Fidelity

AbstractTherapeutic interventions have not yet been shown to demonstrate restorative effects for declining long-term memory (LTM) that affects many healthy older adults. We developed a virtual reality (VR) spatial wayfinding game (Labyrinth-VR) as a cognitive intervention with the hypothesis that it could improve detailed, high-fidelity LTM capability. Spatial navigation tasks have been used as a means to achieve environmental enrichment via exposure to and learning about novel and complex information. Engagement has been shown to enhance learning and has been linked to the vitality of the LTM system in the brain. In the current study, 48 older adults (mean age 68.7 ± 6.4 years) with average cognitive abilities for their age were randomly assigned to 12 h of computer game play over four weeks in either the Labyrinth-VR or placebo control game arms. Promptly before and after each participant’s treatment regimen, high-fidelity LTM outcome measures were tested to assess mnemonic discrimination and other memory measures. The results showed a post-treatment gain in high-fidelity LTM capability for the Labyrinth-VR arm, relative to placebo, which reached the levels attained by younger adults in another experiment. This novel finding demonstrates generalization of benefits from the VR wayfinding game to important, and untrained, LTM capabilities. These cognitive results are discussed in the light of relevant research for hippocampal-dependent memory functions.

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Feasibility and Enjoyment of Exercise Video Games in Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.1838 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 559-559

Author(s):

Sara Freed ◽

Briana Sprague ◽

Lesley Ross

Keyword(s):

Older Adults ◽

Video Games ◽

Game Design ◽

Long Term Effects ◽

Short Term ◽

Qualitative And Quantitative ◽

Before And After ◽

Xbox Kinect ◽

Game Developers

Abstract Interventions using exercise video games, or exergames, have shown short-term cognitive and physical benefits to older adults, though long-term effects are less promising. Enjoyment of exergames may promote exergame use after the intervention period, though little work has examined older adults’ views of exergames before and after gameplay experience. We invited 20 older adults between 65 and 84 years of age (M=73.30, SD=5.95) to play two Xbox Kinect games, Just Dance and Kinect Sports Rivals, for twenty minutes. In our presentation, we will present qualitative and quantitative findings of this pilot study, including findings that older adults reported that they were not likely to play similar exergames in the future and that they did not find the exergames to be more fun compared to other ways of exercising. We will discuss implications for game design and research relevant to game developers, manufacturers, and researchers. Part of a symposium sponsored by Technology and Aging Interest Group.

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Usefulness of Virtual Reality-Based Training to Diagnose Strabismus

10.21203/rs.3.rs-149285/v1 ◽

2021 ◽

Author(s):

Hyun Sik Moon ◽

Hyeon Jeong Yoon ◽

Sang Woo Park ◽

Chae Yeon Kim ◽

Mu Seok Jeong ◽

...

Keyword(s):

Virtual Reality ◽

Ease Of Use ◽

Accuracy Score ◽

Performance Score ◽

Deviation Angle ◽

Short Period ◽

Before And After ◽

Vr Training ◽

And Performance ◽

Real Patients

Abstract Purpose: To study the usefulness of virtual reality (VR) based training for diagnosing strabismusMethods: Fourteen ophthalmology residents performed at least 30 VR training sessions to diagnose esotropia and exotropia. Examinations of real patients with esotropia or exotropia before and after the VR training were video-recorded and presented to a strabismus expert to assess accuracy and performance scores for measuring the deviation angle and diagnosing strabismus with anonymization. A feedback survey regarding the usefulness and ease of use of the VR application was conducted for participants.Results: The mean age of 14 ophthalmology residents, including 10 men and 4 women, was 29.7 years. Before VR training, participants showed a mean accuracy score of 14.50 ± 5.45 and performance score of 9.64 ± 4.67 for measuring the deviation angle and diagnosing strabismus in real patients with strabismus. After VR training, they showed a significantly improved accuracy score of 22.14 ± 4.37 (p = 0.012) and performance score of 15.50 ± 1.99 (p = 0.011). According to the survey, most participants agreed on the usefulness of VR application.Conclusions: This study suggests that VR based training improves ophthalmology residents’ clinical diagnostic skills for strabismus in a short period.

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The Efficacy of a Virtual Reality Exposure Therapy Treatment for Fear of Flying: A Retrospective Study

Frontiers in Psychology ◽

10.3389/fpsyg.2021.641393 ◽

2021 ◽

Vol 12 ◽

Author(s):

Amihai Gottlieb ◽

Glen M. Doniger ◽

Yara Hussein ◽

Shlomo Noy ◽

Meir Plotnik

Keyword(s):

Virtual Reality ◽

Treatment Period ◽

Outcome Measures ◽

Large Scale ◽

Exposure Therapy ◽

Fear Of Flying ◽

Efficacy Outcome ◽

Before And After ◽

Pre Treatment

Background: Fear of flying (FoF) is a phobia with 10–40% prevalence in the industrialized world. FoF is accompanied by severe economic, social, vocational, and emotional consequences. In recent years, virtual reality (VR)-based exposure therapy (VRET) for FoF has been introduced. Positive long-term efficacy of FoF-VRET has been reported by several studies, which, however, were limited by relatively small, non-representative samples and a lack of comparative pre/post functional efficacy outcome measures. Our objective was to evaluate the efficacy of a VRET treatment utilizing a large-scale VR system, experienced by a representative sample of self-referred individuals.Methods: We conducted a retrospective survey. Of 274 individuals who received the treatment (over a period of 3 years), 209 met inclusion/criteria, and 98 agreed to participate. We mainly collected information regarding flight activity before and after treatment relying on evidence such as boarding passes and flight tickets. The primary outcome measures were (1) number of flights per month (FpM) and (2) number of flight hours per month (FHpM). For each participant, these outcomes were computed for the post-treatment period (≥6 months after FoF-VRET) and the corresponding pre-treatment period.Results: FpM (mean ± SD) increased from 0.04 ± 0.06 to 0.16 ± 14 flights (p < 0.0001). FHpM rose from 0.19 ± 0.35 to 0.79 ± 0.87 h per month (p < 0.0001).Conclusion: These results are indicative of FoF-VRET treatment efficacy. Future studies should evaluate long-term maintenance of the treatment effect and thus identify the optimal frequency for delivery of periodic booster treatments.

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Evaluation of FlowVR: a virtual reality game for improvement of depressive mood

10.1101/451245 ◽

2018 ◽

Cited By ~ 1

Author(s):

Lukas Bittner ◽

Fariba Mostajeran ◽

Frank Steinicke ◽

Jürgen Gallinat ◽

Simone Kühn

Keyword(s):

Virtual Reality ◽

Depressive Mood ◽

Time Of Day ◽

The State ◽

Long Term Effects ◽

Positive Affectivity ◽

Head Mounted Display ◽

Before And After ◽

Anxiety Depression

AbstractObjectiveThis study evaluated the efficacy of FlowVR, a virtual reality (VR) game designed to improve mood and reduce feelings of depression. The aim is to contribute to the question of whether and how VR could be used for depression therapy, as research in this area is quite rare.Method18 healthy participants (9 female; Mage = 25.9) underwent three conditions, playing FlowVR in VR with a head-mounted display, playing FlowVR on a tablet or reading a text on a tablet. For each condition, they were tested on a separate day at the same time of day within a two-week period. Before and after every condition participants completed the Becks Depression Inventory II (BDI-II), the state part of the State-Trait-Anxiety-Depression-Inventory (STADI(S)) and the Positive Affect Negative Affect Schedule-Expanded Form (PANAS-X).ResultsWhile the participants showed only a reduction in acute anxiety in the control and the tablet conditions, they showed improved affectivity in all variables measured in the VR condition. In addition, VR had significantly better results than the control condition in improving positive affectivity, negative affectivity and acute feelings of depression. Using a less conservative statistical approach, these significant differences could also be found between the tablet and the VR condition. There were no significant differences between the tablet and the control condition.ConclusionThe results indicate that due to its immersive nature, VR can be used effectively to improve mood and temporarily reduce feelings of depression. Long-term effects of FlowVR on participants with depression must be investigated in consecutive research.

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Usefulness of virtual reality-based training to diagnose strabismus

Scientific Reports ◽

10.1038/s41598-021-85265-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hyun Sik Moon ◽

Hyeon Jeong Yoon ◽

Sang Woo Park ◽

Chae Yeon Kim ◽

Mu Seok Jeong ◽

...

Keyword(s):

Virtual Reality ◽

Ease Of Use ◽

Accuracy Score ◽

Performance Score ◽

Deviation Angle ◽

Short Period ◽

Before And After ◽

Vr Training ◽

Real Patients ◽

A Performance

AbstractTo study the usefulness of virtual reality (VR)-based training for diagnosing strabismus. Fourteen residents in ophthalmology performed at least 30 VR training sessions to diagnose esotropia and exotropia. Examinations of real patients with esotropia or exotropia before and after the VR training were video-recorded and presented to a strabismus expert to assess accuracy and performance scores for measuring the deviation angle and diagnosing strabismus with anonymization. A feedback survey regarding the usefulness and ease of use of the VR application was conducted for participants. The mean age of the 14 ophthalmology residents (10 men and 4 women), was 29.7 years. Before VR training, participants showed a mean accuracy score of 14.50 ± 5.45 and a performance score of 9.64 ± 4.67 for measuring the deviation angle and diagnosing strabismus in real patients with strabismus. After VR training, they showed a significantly improved accuracy score of 22.14 ± 4.37 (p = 0.012) and a performance score of 15.50 ± 1.99 (p = 0.011). According to the survey, most participants agreed on the usefulness of VR applications. This study suggests that VR-based training improved ophthalmology residents’ clinical diagnostic skills for strabismus in a short period.

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The Influence of Virtual Reality Head-Mounted Displays on Balance Outcomes and Training Paradigms: A Systematic Review

Frontiers in Sports and Active Living ◽

10.3389/fspor.2020.531535 ◽

2021 ◽

Vol 2 ◽

Author(s):

Pooya Soltani ◽

Renato Andrade

Keyword(s):

Older Adults ◽

Virtual Reality ◽

Assessment Tool ◽

Poor Quality ◽

Risk Of Bias ◽

Display Type ◽

Functional Balance ◽

Head Mounted Display ◽

Vr Training ◽

And Training

Background: Falls are the leading causes of (non)fatal injuries in older adults. Recent research has developed interventions that aim to improve balance in older adults using virtual reality (VR).Purpose: We aimed to investigate the validity, reliability, safety, feasibility, and efficacy of head mounted display (HMD) systems for assessing and training balance in older adults.Methods: We searched EBSCOhost, Scopus, Web of Science, and PubMed databases until 1 September 2020 to find studies that used HMD systems for assessing or training balance. The methodological quality was assessed using a modified version of Downs and Black. We also appraised the risk of bias using Risk of Bias Assessment tool for Non-randomized Studies (RoBANS).Results: A total of 19 articles (637 participants) were included for review. Despite heterogenous age ranges and clinical conditions across studies, VR HMD systems were valid to assess balance and could be useful for fall prevention and for improving postural control and gait patterns. These systems also have the capacity to differentiate healthy and balance-impaired individuals. During VR versions of traditional balance tests, older adults generally acquire a cautious behavior and take more time to complete the tasks.Conclusion: VR HMD systems can offer ecologically valid scenarios to assess and train functional balance and can be used alone or in addition to other interventions. New norms and protocols should be defined according to participants' age, health status, and severity of their illness when using VR HMD systems for balance assessment and training. For safe and feasible training, attention must be given to display type, VR elements and scenarios, duration of exposure, and system usability. Due to high risk of bias and overall poor quality of the studies, further research is needed on the effectiveness of HMD VR training in older adults.

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The Relationship Between Loneliness and the COVID-19 Pandemic on Cognition and Well-Being in Older Adults

Innovation in Aging ◽

10.1093/geroni/igab046.919 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 240-240

Author(s):

Justin Barber ◽

Allison Gibson ◽

Shoshana Bardach ◽

Kelly Parsons ◽

Julia Johnson ◽

...

Keyword(s):

Older Adults ◽

Short Form ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Psychosocial Interventions ◽

Well Being ◽

Subjective Memory ◽

Memory Assessment ◽

Before And After

Abstract Social distancing is necessary to limit the spread of Covid-19. However, many older adults are predisposed to isolation and loneliness despite calls to socially distance. The current study examined loneliness during Covid-19 in relation to cognition and wellbeing in older adults. Data were extracted from a U.S. ADRC longitudinal study of aging database. Cognition was assessed using the NACC UDS 3.0 battery. Measures of well-being include: Short Form Health Survey, Subjective Memory Assessment, and Geriatric Depression Scale. Measurement of loneliness was selected from the NIH ADRC Covid-19 questionnaire. Data were from 115 older adults with normal cognition or MCI with a visit ≤18 months before research stoppage in March 2020 and after resumption in late-June 2020. Cognition and wellbeing are compared before and after onset of pandemic. Isolation due to Covid-19 may have long-term implications. Results of this study will highlight the need for acute assessments and psychosocial interventions.

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LONG-TERM GAIT SPEED TELEMONITORING IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT OR MILD DEMENTIA. THE DECI STUDY

Innovation in Aging ◽

10.1093/geroni/igz038.1212 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S333-S333

Author(s):

Lorenzo M Donini ◽

Alberto Rainoldi ◽

Luca C Feletti ◽

Gianluca Zia ◽

Eleonora Poggiogalle ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Physical Function ◽

Gait Speed ◽

Walking Speed ◽

Cognitive Status ◽

Activity Level ◽

Mild Dementia

Abstract Non-intrusive telemonitoring of physical activity in Older Adults suffering from Mild Cognitive Impairment (MCI), or Mild Dementia (MD), was implemented as part of a 6-month multicomponent digital intervention in the DECI study (EU Horizon2020 grant No 643588). Methods: To estimate gait speed long-term trajectory, a processing algorithm was applied on individual accelerometry data continuously recorded via the ADAMO wrist-watch accelerometer. Speed Trend Analysis was performed if patients wore the device ≥90 days. Only outdoor activity was analyzed to reflect patients’ own natural gait speed. Only time spent in high or very-high-activity level is used, to eliminate rest periods (e.g. sitting on a bench, on a bus or driving). A raw mean walking speed was computed. Stride was computed from gender and height and walked distance from stride and step count. Mean walking speed was estimated by walking distance and duration. A rolling mean algorithm was applied to the computed mean 15-day baseline series, resulting in a new series representing normalized patient’s gait speed trajectory during the study. Results: Baseline characteristics: F/M=21/19; MCI/MD=36/4; age=75.4±6.0 years; BMI= 24.6±5,2; MMSE=26.5±2.4; education=8.9±4.0 years. Monitoring days=147±29. Overall three main patterns of gait speed trajectory were identified: “relative stability”, “improving trend” and “progressive decline”: No evident correlation with cognitive status was observed in the sample. Examples of individual patterns are shown. Conclusions: Gait Speed Analysis can describe physical function trajectory over time and identify decliners from stable or improving older adults. Further analyses may clarify the relationship between physical function changes and cognitive status.

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