Effect of virtual reality exercise on interventions for patients with Alzheimer's disease: A systematic review

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

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.

Comparing episodic memory outcomes from walking augmented reality and stationary virtual reality encoding experiences

Episodic Memory (EM) is the neurocognitive capacity to consciously recollect personally experienced events in specific spatio-temporal contexts. Although the relevance of spatial and temporal information is widely acknowledged in the EM literature, it remains unclear whether and how EM performance and organisation is modulated by self-motion, and by motor- and visually- salient environmental features (EFs) of the encoding environment. This study examines whether and how EM is modulated by locomotion and the EFs encountered in a controlled lifelike learning route within a large-scale building. Twenty-eight healthy participants took part in a museum-tour encoding task implemented in walking Augmented Reality (AR) and stationary Virtual Reality (VR) conditions. EM performance and organisation were assessed immediately and 48-hours after trials using a Remember/Familiar recognition paradigm. Results showed a significant positive modulation effect of locomotion on distinctive EM aspects. Findings highlighted a significant performance enhancement effect of stairway-adjacent locations compared to dead-end and mid-route stimuli-presentation locations. The results of this study may serve as design criteria to facilitate neurocognitive rehabilitative interventions of EM. The underlying technological framework developed for this study represents a novel and ecologically sound method for evaluating EM processes in lifelike situations, allowing researchers a naturalistic perspective into the complex nature of EM.

Impact of AI-Powered Solutions in Rehabilitation Process: Recent Improvements and Future Trends

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.

Use of Virtual Reality to Improve Spatial Orientation in Alzheimer's Disease and Mild Cognitive Impairment: A Systematic Review

BACKGROUND

Alzheimer's disease is a chronic, neurodegenerative condition that leads to a significant cognitive decline. One of the symptoms that greatly reduces the quality of daily functioning is the deterioration of spatial orientation abilities. A non-pharmacological treatment option for Alzheimer's disease, which is also employed to improve the cognitive functioning of individuals with mild cognitive impairment, is virtual reality training.

OBJECTIVE

To the best of the authors' knowledge, there is no existing systematic review on the use of virtual reality training to enhance spatial orientation in individuals with Alzheimer's disease or mild cognitive impairment. The review was therefore conducted to fill this gap. The findings of this review may support the efficacy of virtual reality in enhancing spatial orientation.

METHODS

Five databases were searched. The primary inclusion criteria were study participants aged over 60 years with a diagnosis of Alzheimer's disease or mild cognitive impairment and the use of virtual reality for improving spatial orientation. Six studies meeting these criteria were ultimately included in the review.

RESULTS

All included studies demonstrated an improvement in the spatial orientation of individuals with Alzheimer's disease or mild cognitive impairment following virtual reality training. This indicates the effectiveness of virtual reality technology in cognitive rehabilitation.

CONCLUSION

As virtual reality cognitive training has proven effective, its use should be more widely adopted. Further research on the application of virtual reality for enhancing spatial orientation in individuals with dementia is recommended.

Association between anxiety and skin conductance according to the intensity of shaking of virtual reality images

Introduction

Despite the advantages of virtual reality (VR), cyber sickness makes it difficult to apply VR to those who are already anxious and in distress. Skin conductance (SC) is widely used as a bio-signal reflecting anxiety. It is positively correlated with anxiety. The objective of this study was to determine the association between SC and anxiety in VR.

Methods

Healthy volunteers with moderate-to-high stress defined as a Perceived Stress Scale-10 (PSS-10) score ≥20 were enrolled. STAI-X-1 was used to measure anxiety, and galvanic skin response was used to measure SC. This study used an open, randomized, crossover design. In this study, 360° videos consisted of two types, namely, less dizzying video (G1) and more dizzying video (G2). We randomized subjects into two groups according to video exposure order: G1 after watching G2 (Order 1) and G2 after watching G1 (Order 2). Of 81 subjects, the average age (±SD) was 39.98 ± 10.94 years for the Order 1 group and 36.54 ± 12.44 years for the Order 2 group.

Results

Anxiety was significantly decreased in the Order 2 group (p < 0.035) after watching videos, whereas there was no significant change in anxiety in the Order 1 group. In both groups, SC was significantly increased after exposure to a dizzying video. Mean difference (SD) between the second VR video and baseline SC was 1.61 (1.07) (p < 0.0001) in the Order 1 group and 0.92 (0.90) (p < 0.0001) in the Order 2 group, showing a significant difference between the two groups (p < 0.003). However, there was no significant difference between the two groups (p < 0.077) after baseline correction.

Conclusion

Anxiety was decreased significantly in the Order 2 group. The Order 1 group showed a high rate of change in skin conductivity. It is possible to reduce SC and anxiety by viewing a less dizzying VR video first and then viewing a more dizzying video later.

Cognitive-motor interventions based on virtual reality and instrumental activities of daily living (iADL): an overview

Non-invasive, non-pharmacological interventions utilizing virtual reality (VR) represent a promising approach to enhancing cognitive function in patients with degenerative cognitive disorders. Traditional "pen and paper" therapies often lack the practical engagement in everyday activities that older individuals encounter in their environment. These activities pose both cognitive and motor challenges, underscoring the necessity of understanding the outcomes of such combined interventions. This review aimed to assess the advantages of VR applications that integrate cognitive-motor tasks, simulating instrumental activities of daily living (iADLs). We systematically searched five databases-Scopus, Web of Science, Springer Link, IEEE Xplore, and PubMed, from their inception until January 31, 2023. Our review revealed that motor movements, coupled with VR-based cognitive-motor interventions, activate specific brain areas and foster improvements in general cognition, executive function, attention, and memory. VR applications that meld cognitive-motor tasks and simulate iADLs can offer significant benefits to older adults. Enhanced cognitive and motor performance can promote increased independence in daily activities, thereby contributing to improved quality of life.