Abstract
BackgroundCognitive training can potentially prevent cognitive decline. However, the results of recent studies using semi-immersive virtual reality (VR)-assisted cognitive training are inconsistent.ObjectiveWe aimed to examine the hypothesis that cognitive training using fully immersive VR, which may facilitate visuospatial processes, could improve visuospatial functioning, comprehensive neuropsychological functioning, psychiatric symptoms, and functional connectivity in the visual brain network in predementia.MethodsParticipants over 60 years old with subjective cognitive decline or mild cognitive impairment from a memory clinic were randomly allocated to the VR (n=23) or the control (n=18) group. The VR group participants received multidomain and neuropsychologist-assisted cognitive training in a fully immersive VR environment twice a week for 1 month. The control group participants did not undergo any additional intervention except for their usual therapy such as pharmacotherapy. Participants of both groups were evaluated for cognitive function using face-to-face comprehensive neuropsychological tests, including the Rey-Osterrieth Complex Figure Test (RCFT) copy task; for psychiatric symptoms such as depression, apathy, affect, and quality of life; as well as resting-state functional magnetic resonance imaging (rsfMRI) at baseline and after training. Repeated-measures analysis of variance was used to compare the effect of cognitive training between groups. Seed-to-voxel–based analyses were used to identify the cognitive improvement–related functional connectivity in the visual network of the brain.ResultsAfter VR cognitive training, significant improvement was found in the total score (F1,39=14.69, P=.001) and basic components score of the RCFT copy task (F1,39=9.27, P=.005) compared with those of the control group. The VR group also showed improvements, albeit not significant, in naming ability (F1,39=3.55, P=.07), verbal memory delayed recall (F1,39=3.03, P=.09), and phonemic fluency (F1,39=3.08, P=.09). Improvements in psychiatric symptoms such as apathy (F1,39=7.02, P=.01), affect (F1,39=14.40, P=.001 for positive affect; F1,39=4.23, P=.047 for negative affect), and quality of life (F1,39=4.49, P=.04) were found in the VR group compared to the control group. Improvement in the RCFT copy task was associated with a frontal-occipital functional connectivity increase revealed by rsfMRI in the VR group compared to the control group.ConclusionsFully immersive VR cognitive training had positive effects on the visuospatial function, apathy, affect, quality of life, and increased frontal-occipital functional connectivity in older people in a predementia state. Future trials using VR cognitive training with larger sample sizes and more sophisticated designs over a longer duration may reveal greater improvements in cognition, psychiatric symptoms, and brain functional connectivity.Trial RegistrationClinical Research Information Service KCT0005243; https://tinyurl.com/2a4kfasa
Highlights
Dementia is a major neurodegenerative disorder, affecting approximately 10% of older people [1]
Improvement in the Rey-Osterrieth Complex Figure Test (RCFT) copy task was associated with a frontal-occipital functional connectivity increase revealed by resting-state functional magnetic resonance imaging (rsfMRI) in the virtual reality (VR) group compared to the control group
This study found that 1-month multidomain cognitive training using fully immersive VR was effective in improving visuospatial function and frontal-occipital functional connectivity, as well as apathy, affect, and quality of life (QoL) in older people in a predementia cognitive state
Summary
Dementia is a major neurodegenerative disorder, affecting approximately 10% of older people [1]. According to a recent large study, one-third of Alzheimer disease (AD) cases are attributable to potentially modifiable risk factors such as educational attainment, vascular factors, and depression [6]. Lifelong exposure to cognitively and mentally engaging activities has been shown to protect against cognitive decline [7], and performance of cognitively stimulating activities in advanced age was associated with better cognitive function [8]. Recent cognitive training studies have shown that repeated practice of exercises to restore brain and cognitive reserves resulted in small to moderate positive improvements in cognition in patients with mild to moderate dementia [9]. The results of recent studies using semi-immersive virtual reality (VR)-assisted cognitive training are inconsistent
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