Being in the Past and Perform the Future in a Virtual World: VR Applications to Assess and Enhance Episodic and Prospective Memory in Normal and Pathological Aging

The use of virtual reality as a perspective-taking manipulation to improve self-awareness in Alzheimer's disease

Lack of awareness of symptoms or having a condition referred to as anosognosia is a common feature of individuals with Alzheimer's Disease (AD). Previous literature on AD reported difficulties in evaluating self-abilities, often showing underestimation of limitations. There is increasing evidence that the perspective through which information is presented may moderate the performance appraisal and that anosognosia in AD might be a consequence of a deficit in assuming a third-person perspective. In this context, some studies showed that subjects may better recognize self-and other-difficulties when exposed to a third-person perspective. Considering the variety of approaches aiming to investigate the lack of awareness, there is still a scarcity of methods that provide great ecological validity and consider more than one facet of awareness, thus failing to offer more accurate evaluations of daily experiences. The present paper primarily addresses the theme of the multidimensional character of awareness of abilities in AD and the effect of perspective-taking on its trajectories. The focus turns to virtual reality as a promising tool for a greater evaluation of perspective-taking and self-awareness. Particularly, these systems offer the possibility to involve users in cognitive and sensorimotor tasks that simulate daily life conditions within immersive and realistic environments, and a great sense of embodiment. We propose that virtual reality might allow a great level of complexity, veracity, and safety that is needed for individuals with AD to behave according to their actual abilities and enable to explore the liaison between the subject's viewpoint, performance, and self-evaluation. In addition, we suggest promising clinical implications of virtual reality-based methods for individualized assessments, investigating specific impacts on subjects' life and possible improvements in their awareness.

Development of the Virtual Kitchen Protocol for Prospective Memory: a virtual reality-based measure of everyday prospective memory abilities

INTRODUCTION

Prospective memory is the ability to remember to accomplish a task at a specified point in the future. While this cognitive ability has a large impact on daily functioning, it is rarely assessed during neuropsychological evaluations. Furthermore, existing clinical prospective memory measures are few in number and have significant limitations, including applicability to everyday functioning and appropriate norming for older adulthood. There are also many gaps in the literature on prospective memory, such as how environmental factors affect performance across the lifespan.

METHOD

In the current study, we develop and establish a new virtual reality-based measure of prospective memory, the Virtual Kitchen Protocol for Prospective Memory. Young adults (ages 18-29; n = 56), healthy older adults (ages 60-90; n = 94), and clinical older adults (ages 62-90; n = 30) were compared on their performances on both the developed virtual reality prospective memory test and a parallel paper-and-pencil prospective memory test to investigate the impact of test environment across participant group.

RESULTS

The Virtual Kitchen Protocol for Prospective Memory was found to adequately differentiate between young adult, healthy older adult, and clinical older adult populations - suggesting baseline ability for prospective memory assessment in clinical settings with older adults and potential for future improvement of neuropsychological evaluations. Additionally, the developed virtual prospective memory task appeared to mimic environmental factors in everyday life but did not replicate the benefit previously measured in healthy older adults' prospective memory ability in naturalistic settings.

CONCLUSIONS

Overall, the current study built upon extant knowledge of prospective memory in both normal and abnormal aging, suggesting future directions in replicating familiar home environments. Findings provided additional evidence toward future validation of virtual reality assessment tools in clinical neuropsychological evaluations of cognitive abilities, such as prospective memory, with both healthy and clinical older adult populations.

The benefits of mind wandering on a naturalistic prospective memory task

Mind wandering (MW) occurs when our attention spontaneously shifts from the task at hand to inner thoughts. MW is often future-oriented and may help people remember to carry out their planned actions (Prospective Memory, PM). Past-oriented MW might also play a critical role in boosting PM performance. Sixty participants learned 24 PM items and recalled them during an immersive virtual walk in a town. The items were divided into event-based-EB and time-based-TB. During the PM retention phase, participants were randomly assigned to a high or a low cognitive load condition, in order to manipulate MW frequency. Some PM items were encoded before this MW manipulation (pre-PM) and some during the virtual walk (post-PM). A high MW frequency was linked with better global PM performances. Spontaneous past-oriented MW predicted better pre-EB retrospective PM retrieval, while spontaneous future-oriented MW predicted better Pre-EB prospective PM retrieval. Voluntary future-oriented MW predicted better post-EB retrospective retrieval. We highlighted, for the first time, a differential impact of spontaneous MW content depending on the PM component (retrospective or prospective). Past-oriented MW is crucial for (re)consolidating PM intentions, and episodic future thinking MW for the execution of PM intentions. We discuss the twofold functional role of MW, namely, to consolidate an already programmed intention and to plan future actions.

Inhibition mediates the relationship between age cohort and virtual reality-based prospective memory

INTRODUCTION

Prospective memory has received relatively little attention from a clinical perspective, yet it is an important part of daily functioning. Executive functions have been linked with prospective memory abilities, and age differences are found in both executive functions and prospective memory. The purpose of this study was to investigate whether age cohort differences in prospective memory abilities are mediated by executive functions, specifically inhibition.

METHOD

Participants (N = 108) consisted of young adults (n= 53) and older adults (n= 55) without any neurocognitive impairment. Participants completed a clinical interview and a battery of neuropsychological tests that included the Mini-Mental Status Exam-2 Standard Version (MMSE-2-SV), the Wisconsin Card Sorting Test-64 (WCST-64), the Delis-Kaplan Executive Functioning System Color-Word Interference Test (D-KEFS CWIT), and the Virtual Kitchen Protocol (VKP).

RESULTS

Young adults had higher prospective memory scores than older adults. Inhibition (i.e., D-KEFS CWIT) mediated the relationship between age cohort and prospective memory, while cognitive flexibility did not mediate the relationship.

CONCLUSIONS

Older adults may have diminished inhibition abilities that may negatively affect their ability to complete prospective memory tasks.

Assessment of goal-directed behavior with the 3D videogame EPELI: Psychometric features in a web-based adult sample

EPELI (Executive Performance in Everyday LIving) is a recently developed gaming tool for objective assessment of goal-directed behavior and prospective memory (PM) in everyday contexts. This pre-registered study examined psychometric features of a new EPELI adult online version, modified from the original child version and further developed for self-administered web-based testing at home. A sample of 255 healthy adults completed EPELI where their task was to perform household chores instructed by a virtual character. The participants also filled out PM-related questionnaires and a diary and performed two conventional PM tasks and an intelligence test. We expected that the more "life-like" EPELI task would show stronger associations with conventional PM questionnaires and diary-based everyday PM reports than traditional PM tasks would do. This hypothesis did not receive support. Although EPELI was rated as more similar to everyday tasks, performance in it was not associated with the questionnaires and the diary. However, there were associations between time-monitoring behavior in EPELI and the traditional PM tasks. Taken together, online adult-EPELI was found to be a reliable method with high ecological face validity, but its convergent validity requires further research.

Validity and diagnostic performance of a virtual reality-based supermarket application "MEMOSHOP" for assessing episodic memory in normal and pathological aging

Objective

MEMOSHOP is a virtual reality (VR)-based supermarket application for assessing episodic memory in aging. The aim of this study was to examine its construct validity against the gold standard paper-and-pencil neuropsychological test for clinical memory assessment in mild cognitive impairment (MCI) in older adults.

Methods

Patients with isolated subjective cognitive complaints (SCCs) or MCI were recruited in the Bordeaux Memory Clinic (MEMENTO cohort). Cognitively normal elderly controls were also recruited. MEMOSHOP allows a near-ecological evaluation of episodic memory during a usual daily life activity, i.e. shopping at the supermarket. MEMOSHOP and the gold standard Free and Cued Selective Reminding Test (FCSRT: French adaptation) were administered to all participants to assess episodic memory. Non-parametric tests and receiver operating characteristic curves were computed to compare their performances.

Results

Twenty-nine patients (21 females, age = 71 years ±7) and 29 matched controls were evaluated. The performance trends observed with MEMOSHOP and FCSRT on free and cued recall were associated (p < .01) and comparable (p < .0001), without any participants' groups interaction. Although easier than FCSRT in free recall for participants, MEMOSHOP demonstrated better diagnostic performance based on cued recall in isolated SCCs/MCI patients (p < .05).

Conclusion

MEMOSHOP demonstrated its reliability and validity for VR-based episodic memory assessment in the early stage of MCI and is potentially of interest for use in memory clinic settings.

Appraising Virtual Technologies' Impact on Older Citizens' Mental Health-A Comparative between 360° Video and Virtual Reality

Aging populations across the world are facing a number of challenges in the context of health and healthcare. These challenges are driven by the aging process and the illnesses associated with aging. Healthcare for older people has become a point of concern with most health organizations, and this is particularly the case with palliative care. In this instance, the movement of the patient may be restricted to a room with no or limited access to the outdoors. This research focuses on the active integration of immersive technologies with healthcare. By addressing the problem of providing patients with the experience of being present in an outdoors space, the associated psychological and physiological benefits can be identified. In this mixed methods research paper, the impact of a crossover study to discern technology preferences in relation to immersive technologies among a sample of older people is reported. In addition, the study highlights factors that contribute to a meaningful immersive experience that can improve psychological and physiological wellbeing. The study identifies that there are two significant categorical aspects that contribute to such immersive experiences, technological aspects (including, for example, the weight of headsets, visual impairment, pixelation, and gamification) and emotive aspects (for example, joy, anger, and fear). The study suggests that older people prefer immersive Virtual Reality (VR) environments rather than 360 video experiences. This can be attributed to the greater flexibility in the provision of interactivity in virtual reality systems.

A Virtual Supermarket Program for the Screening of Mild Cognitive Impairment in Older Adults: Diagnostic Accuracy Study

Background

Mild cognitive impairment (MCI) is often a precursor of dementia, and patients with MCI develop dementia at a higher rate than healthy older adults. Early detection of cognitive decline at the MCI stage supports better planning of care and interventions. At present, the use of virtual reality (VR) in screening for MCI in older adults is promising, but there is little evidence regarding the use of virtual supermarkets to screen for MCI.

Objective

The objectives of this study are to validate a VR game–based test, namely, the Virtual Supermarket Program (VSP), for differentiating patients with MCI and healthy controls and to identify cutoff scores for different age levels.

Methods

Subjects were recruited from several nursing homes and communities in Changchun, China. They were divided into a healthy control group (n=64) and an MCI group (n=62). All subjects were administered the VSP and a series of neuropsychological examinations. The study determined the optimal cutoff, discriminating validity, concurrent validity, and retest reliability of the VSP. We used the area under the receiver operating characteristic curve (AUC) to evaluate the discriminating validity and obtain the optimal cutoff values. Pearson correlation analysis and the intraclass correlation coefficient were used to evaluate the concurrent validity and retest reliability, respectively.

Results

A cutoff score of 46.4 was optimal for the entire sample, yielding a sensitivity of 85.9% and specificity of 79.0% for differentiating individuals with MCI and healthy controls, and the AUC was 0.870 (95% CI 0.799-0.924). The median index of VSP score was 51.1 (range 42.6-60.0). There was a moderate positive correlation between the VSP total score and Mini-Mental State Examination score (r=0.429, P<.001). There was a strong positive correlation between VSP total score and Montreal Cognitive Assessment score (r=0.645, P<.001). The retest reliability of the VSP was feasible (r=0.588, P=.048).

Conclusions

The VSP is interesting and feasible for subjects. It shows high sensitivity and specificity for the identification of MCI in older adults, which makes it a promising screening method. The VSP may be generalized to older adults in other countries, although some cultural adaptation may be necessary.

Trial Registration

Chinese Clinical Trial Registry ChiCTR2000040074; https://www.chictr.org.cn/showprojen.aspx?proj=64639