Virtual Reality Cognitive Training Research Articles

Cognitive Training Using Virtual Reality: An Assessment of Usability and Adverse Effects

ObjectiveTo evaluate the usability and adverse effects associated with virtual reality(VR) cognitive training and identify factors influencing them. DesignSurvey-based observational study SettingDepartment of Rehabilitation Medicine in the hospital Participant20 rehabilitation professionals(mean(standard deviation) age; 30.0(4.8) years, male 8(40%) and female 12(60%)) and 10 patients with stroke(mean(standard deviation) age; 64.1(13.6) years, male 2(20%) and female 8(80%)). InterventionsThe participants wore a Head-Mounted Display (Meta Quest2) and consecutively underwent custom-designed five cognitive training. Main outcome measuresAfter the training, participants completed three questionnaires: the Systemic Usability Scale (SUS), User Experience Questionnaire (UEQ), and CyberSickness in Virtual Reality Questionnaire (CSO-VR). ResultsThe mean SUS score was 55.1 and 52.3 for rehabilitation professionals and patients, respectively. For the UEQ, the mean score for each item, including Attractiveness, Perspicuity, Efficiency, Dependability, Stimulation, and Novelty, were 0.9/0.2, 0.6/0.2, 0.5/-0.5, 1.2/0.8, 0.9/0.4, and 0.6/0.8 for rehabilitation professionals/patients, respectively. Rehabilitation professionals had slightly higher scores in most UEQ items. The mean CSQ-VR scores were 18.6 and 19.0 for rehabilitation professionals and patients, respectively. ConclusionsParticipants reported moderate usability and a generally below-average user experience, with mild to moderate VR sickness during VR cognitive training. The rehabilitation professionals rated usability higher than the patient group, while patients experienced more severe VR sickness. These findings may serve as a significant insight for developing virtual reality cognitive training for application to patients in the future.

Development and Validation of Virtual Reality Cognitive Training for Older Adults with Mild Cognitive Impairment: Protocol for a Mixed-Methods Program Evaluation Study.

As research on cognitive training methods for older adults with mild cognitive impairment (MCI) progresses, fully immersive virtual reality cognitive training (fi-VRCT) has shown promise in enhancing cognitive function. However, its effectiveness in improving instrumental activities of daily living (IADL) and fostering independence is still unclear. This study aims to address these uncertainties by developing and validating a fi-VRCT program focused on IADL, with the goal of enhancing both cognitive function and IADL performance in older adults with MCI. This mixed methods program evaluation study consists of three phases: feasibility, intervention, and extension. In the feasibility phase, we will implement fi-VRCT in real-world community settings and invite 20 older adults with MCI to participate in a single training session. Participants will provide feedback through questionnaires and individual interviews. The intervention phase will involve a double-blind, cluster-randomized controlled trial with 52 older adults with MCI, who will be randomly assigned to either the fi-VRCT or control groups. Both groups will complete 16 sessions over eight weeks, with cognitive and functional performance assessed at various intervals. During the extension phase, feedback will be gathered from 26 participants who underwent fi-VRCT through focus group interviews and ongoing questionnaires. Quantitative and qualitative findings will be synthesized to refine the fi-VRCT program and elucidate training outcomes. Ultimately, fi-VRCT has the potential to enhance cognitive and functional abilities in older adults with MCI in community settings. Ethical approval has been obtained from the Research Ethics Committee at National Taiwan Normal University (202312EM009). The research findings will be disseminated through reputable, peer-reviewed journals and professional international conferences to engage and inform academic and clinical audiences. NCT06392412.

Immersive Virtual Reality Cognitive Training for Improving Cognition and Depressive Symptoms Among Older Adults. Current Evidence and Future Recommendations. A Systematic Review.

Older adults, particularly impacted by the pandemic, are anticipated to face considerable challenges to their cognitive and psychological health. Various cognitive training methods have been proposed to improve their cognitive decline through regular practice. Immersive virtual reality (IVR) offers a promising avenue to bolster cognitive and mental health care accessibility for older adults and has shown potential in augmenting traditional cognitive training methods. This systematic review aims to assess the efficacy of IVR-based cognitive training on improving cognitive impairments and depressive symptoms among older adults, irrespective of their level of cognitive decline. Systematic searches were conducted across MEDLINE-PubMed, EMBASE, and Web of Science databases from inception to December 2022. Only peer-reviewed articles reporting results from randomized controlled trials and pilot studies, focusing on the effects of VR-based cognitive training on adults aged 55 or older, were deemed eligible. Using the Cochrane Handbook for Systematic Reviews of Interventions, the risk of bias was appraised for each selected study. Out of 3,835 studies identified, 9 met the inclusion criteria. The qualitative analyses concluded that IVR cognitive training interventions enhanced certain cognitive functions and well-being among older adults, notably those with mild cognitive impairments. These interventions were particularly effective in boosting memory, visuospatial abilities, and measures related to depressive symptoms and overall well-being. However, enhancements were less pronounced for executive functions, attention, and global cognition. Based on these findings, we propose a set of tailored, inclusive, and evidence-based recommendations to adapt emerging technologies to better accommodate the needs of older adults.

The influence of eight cognitive training regimes upon cognitive screening tool performance in post-stroke survivors: a network meta-analysis.

Traditional meta-analysis offers only direct comparative evidence. The optimal cognitive training for poststroke cognitive impairment (PSCI) remains largely undetermined. This study aims to assess and compare the effectiveness of selected cognitive training methods for PSCI patients and to identify and rank the most effective intervention programs. Searches were conducted in PubMed, Embase, Cochrane Library, Web of science, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and China Biomedical Database for randomized controlled trials up to September 30, 2023. Two researchers independently performed literature screening, data extraction, and quality assessment. Network meta-analysis was utilized to synthesize the main findings. The primary outcome focused on the intervention's impact on subjective cognitive function, with secondary outcomes including effects on activities of daily living, motor function, and functional independence. This study is registered with PROSPERO (CRD42023463282). Fifty eligible randomized controlled trials were identified, revealing eight distinct interventions. These interventions collectively demonstrate efficacy in enhancing cognition. Traditional cognitive training significantly improves overall cognitive function, daily living function, motor function, and functional independence. In Loewenstein Occupational Therapy Cognitive Assessment, Barthel Index, Fugl-Meyer Assessment, and Functional Independence Measure scales, a combination of computer-based and traditional cognitive training outperformed the conventional control group MD = 29.97 (95%CI: 16.3, 44.2), MD = 18.67 (95%CI: 9.78, 27.45), MD = 28.76 (95%CI: 5.46, 51.79) and MD = 42.2 (95%CI: 5.25, 78.99). In the MMSE scale, virtual reality cognitive training combined with traditional training was most effective MD = 8.01 (95%CI: 3.6, 12.4). On the MoCA scale, the combination of exercise and cognitive training showed superior results MD = 6.68 (95%CI: 2.55, 10.78). Only the combined computer-based and traditional cognitive training, as well as traditional cognitive training alone, significantly enhanced functional independence, with no notable differences in other pairwise interventions. The network meta-analysis suggests that augmenting traditional training with other modalities may enhance overall effectiveness. Specifically, interventions incorporating computer-based cognitive training appear to surpass other methods in improving cognition, daily living function, motor skills, and functional independence. The findings of this network meta-analysis provide evidence-based guidance for clinical decision-making. https://www.crd.york.ac.uk/PROSPERO/, identifier in PROSPERO (CRD42023463282).

Effects of Virtual Reality Cognitive Training on Neuroplasticity: A Quasi-Randomized Clinical Trial in Patients with Stroke.

Cognitive Rehabilitation (CR) is a therapeutic approach designed to improve cognitive functioning after a brain injury, including stroke. Two major categories of techniques, namely traditional and advanced (including virtual reality-VR), are widely used in CR for patients with various neurological disorders. More objective outcome measures are needed to better investigate cognitive recovery after a stroke. In the last ten years, the application of electroencephalography (EEG) as a non-invasive and portable neuroimaging method has been explored to extract the hallmarks of neuroplasticity induced by VR rehabilitation approaches, particularly within the chronic stroke population. The aim of this study is to investigate the neurophysiological effects of CR conducted in a virtual environment using the VRRS device. Thirty patients with moderate-to-severe ischemic stroke in the chronic phase (at least 6 months after the event), with a mean age of 58.13 (±8.33) for the experimental group and 57.33 (±11.06) for the control group, were enrolled. They were divided into two groups: an experimental group and a control group, receiving neurocognitive stimulation using VR and the same amount of conventional neurorehabilitation, respectively. To study neuroplasticity changes after the training, we focused on the power band spectra of theta, alpha, and beta EEG rhythms in both groups. We observed that when VR technology was employed to amplify the effects of treatments on cognitive recovery, significant EEG-related neural improvements were detected in the primary motor circuit in terms of power spectral density and time-frequency domains. Indeed, EEG analysis suggested that VR resulted in a significant increase in both the alpha band power in the occipital areas and the beta band power in the frontal areas, while no significant variations were observed in the theta band power. Our data suggest the potential effectiveness of a VR-based rehabilitation approach in promoting neuroplastic changes even in the chronic phase of ischemic stroke.

Effect of Individual Virtual Reality Cognitive Training Programs on Cognitive Function and Depression in Middle-Aged Women: Randomized Controlled Trial.

Given the increasing incidence of early-onset Alzheimer disease, strategies for early diagnosis and swift treatment interventions are crucial for mitigating cognitive problems in women and middle-aged individuals who face a high risk of cognitive impairment. This study aimed to assess the effectiveness of individual cognitive training programs based on virtual reality (VR), a nonpharmacological intervention, on cognitive function and depression in middle-aged women at risk of cognitive impairment. It used VR technology, which has recently been recognized as a promising tool. We administered a VR-based cognitive training program for 30 minutes daily, twice a week, for 12 weeks (24 sessions). This study included middle-aged women residing in older adults' welfare facilities in G-gu, Busan, from May to August 2021. A total of 60 participants were randomly divided into the training (n=30) and control (n=30) groups. Cognitive and depressive functions were assessed using the Korean versions of the Montreal Cognitive Assessment (K-MoCA), Digit Span Test (DST), Korean-Color Word Stroop Test (K-CWST), and Short Form of the Geriatric Depression Scale (SGDS-K) before the intervention. The training group underwent a VR-based cognitive training program, whereas the control group was educated to maintain regular daily activities. The same assessments were performed 12 weeks after treatment. A comparison of the mean scores before and after K-MoCA in the training group revealed a significant increase from 24.87 (SD 2.62) to 27.50 (SD 1.70; P<.01), indicating substantial cognitive improvement. Similarly, the mean DST forward scores increased significantly from 6.97 (SD 1.10) to 7.90 (SD 1.18; P<.01), suggesting enhanced short-term auditory memory and attention. The mean DST backward scores also showed a significant improvement from 4.10 (SD 0.71) to 4.77 (SD 1.2; P=.01). Notably, the mean SGDS-K scores decreased significantly from 3.97 (SD 2.51) to 2.13 (SD 1.87; P<.01), indicating a reduction in depression within the training group. The VR-based cognitive training programs significantly enhanced cognitive function and reduced depression in middle-aged women. Consequently, these programs are considered beneficial nonpharmacological cognitive training interventions for middle-aged women at high risk of cognitive impairment. UMIN Clinical Trials Registry UMIN000049752; https://tinyurl.com/z5du989z.

Psychodynamic-based virtual reality cognitive training system with personalized emotional arousal elements for mild cognitive impairment patients

Background and objectiveMild cognitive impairment (MCI) is a serious threat to the physical health and quality of life of the elderly, as well as a heavy burden on families and society. The current computer-based rehabilitation training ignores the role of emotions in cognitive impairment rehabilitation, making it difficult to improve patient engagement and efficiency. To address this, a psychodynamics-based cognitive rehabilitation training method with personalized emotional arousal elements was proposed using virtual reality technology. MethodsOur proposed method contains four training tasks, which cover (audiovisual memory, attention & processing, working memory, abstract & Logic, spatial pathfinding) and six positive emotional arousal elements (sensory feedback, achievement system, multiplayer interaction, score comparison, relaxation scenarios, and peaceful videos) to motivate participants to persist during cognitive training continuously and maintain a positive mental attitude toward training. The six emotional arousal elements were divided into two personalized combinations—full combination and half combination—based on the results of the pre-assessment and were dynamically distributed throughout both the training tasks and post-training. ResultsFifteen participants with MCI were recruited to complete the proposed experiment and validate the effectiveness of the system. They were first asked to complete two assessments (e.g., the big five scale and the positive and negative affect scale) to investigate their personalities. Based on the results of the assessments, they were provided with a full or half combination of arousal elements in the training tasks and post-training. Finally, the acceptability of the system and task experience were assessed using questionnaires. Notably, there was a significant increase in training scores for participants who completed a six-week training period (66.7%, 33.4%, and 25.0% for attention and processing, working memory, and abstraction and logic, respectively). The results show that positive emotional arousal had a positive effect on the MCI participants. The training tasks and arousal elements can improve cognitive function and enhance the confidence and engagement of participants. There were no significant differences in cognitive domain training scores between the two groups. ConclusionsThis personalized cognitive training system has the potential to serve as a convenient solution for complementary treatment of MCI.

Do Individuals with Spinal Cord Injury Benefit from Semi-Immersive Virtual Reality Cognitive Training? Preliminary Results from an Exploratory Study on an Underestimated Problem.

A spinal cord injury (SCI) is damage to any part of the spinal cord, caused by traumatic or non-traumatic events. Clinically, SCI is associated with partial or complete loss of motor, sensory, and autonomic functions below the site of injury. However, cognitive alterations in specific domains can also occur. The aim of this study was to evaluate the effects of semi-immersive virtual reality (VR) cognitive training (using the BTS Nirvana, Italy) in promoting global functional recovery in patients with SCI. Forty-two SCI patients were included in this retrospective case-control study, and the analysis was carried out using an electronic data retrieval system. The enrolled patients were divided into two groups with the same demographic and medical characteristics: the control group (CG: 21 patients) participated in traditional therapy, whereas the experimental group (EG: 21 patients) received training using semi-immersive VR. In both groups, there were patients with A- or B-grade impairments according to the American Spinal Injury Association (ASIA) scale. Both study groups underwent the same amount of cognitive training (but using a different type of training: conventional vs. innovative), consisting of three weekly sessions for eight weeks (24 sessions in total), each session lasting approximately sixty minutes, as well as the same amount of physiotherapy. The effect of the two treatments (EG/CG) was significantly different in global cognitive functioning (MOCA: p = 0.001), mood (BDI: p = 0.006), and overall quality of life (SF12 Total: p < 0.001), especially in physical perception (SF12-Physics: p = 0.004). Our results suggest that SCI patients could benefit from cognitive training using semi-immersive VR. Indeed, the integration of cognitive exercises that require movement and provide increased feedback could allow for better motor and cognitive recovery in people with SCI.

The effect of a virtual reality based intervention on processing speed and working memory in individuals with ADHD—A pilot-study

Introduction: This study aimed to evaluate the effectiveness of a virtual reality based intervention in processing speed and working memory in students with ADHD symptomatology.Methods: A randomized experimental study was conducted, with a sample consisting of 25 adult participants recruited from the Escola Superior de Saúde do Politécnico do Porto. The participants were allocated into two groups: a passive control group and an intervention group that completed 10 sessions using virtual reality-based games from the Enhance VR app. The intervention included 6 games: Whack-a-mole, Shuffled, Assembly, React, Memory Wall, and Maestro. The participants underwent pre- and post-intervention evaluations using the Southwestern Assessment of Processing Speed (SWAPS) and the Sequence of Letters and Numbers and Spatial Location of the Wechsler Adult Intelligence Scale - 3rd Edition - WAIS-III. Descriptive statistics were used to characterize the sample and a mixed ANOVA was used to test the effectiveness of the intervention.Results: There was an improvement in the results of processing speed in the group exposed to the intervention (p &amp;lt; 0.001) and the value of the interaction between intervention and time was also significant (p = 0.004). There were no statistically significant differences between the participants’ working memory in the different variables under study, except for the values of the Spatial location test in the experimental group that improved relative to the initial assessment (p = 0.034).Discussion: A virtual reality cognitive training intervention resulted in improvements in the processing speed measures, which were not found in the control group. Although we cannot make the same conclusions regarding working memory, these results suggest that the VR intervention resulted in progress in the experimental group, possibly influenced by the intervention, which should be verified in future studies with longer interventions.

Effects of incorporating virtual reality training intervention into health care on cognitive function and wellbeing in older adults with cognitive impairment: A randomized controlled trial

High prevalence of cognitive impairment in older adults coupled with often missed and delayed diagnosis of dementia has raised interest in the nonpharmacologic interventions such as virtual reality (VR) technology for cognitive training, prevention or risk reduction. The present study aimed to investigate the effects of a VR cognitive training intervention (VRCTI) on changes of cognitive function measured with a cognitive test battery and improvement of quality of life in older adults with cognitive impairment in long-term care facilities. A 1-hour session which was implemented weekly over 8 weeks, targeted mainly the sustained and selective attention, memory, cognitive functions, and rule deduction. Each VRCTI session comprised 12 different tasks with different difficulty levels: baseline, intermediate, and advanced. The passive control group received usual care. In this study, sixty older adults (mean age = 80.35) were recruited and randomly assigned to either VR or control groups. Accuracy, error, and repetition rates were measured in each session. Compared to the control group, the VR group improved significantly in the overall cognitive composite score, driven by processing speed, working memory and cognitive domains. The VR group also perceived significant improvements in quality of life. Our results show that VRCTI can improve cognitive function and quality of life. When this pragmatic and effective intervention is implemented jointly with regular health care for older adults, it can be an adequate supplement strategy in maintaining cognitive health and protecting against cognitive decline for cognitively impaired older adults.

Effectiveness of the VR Cognitive Training for Symptom Relief in Patients with ADHD

This study aimed to verify the effectiveness of virtual reality (VR) cognitive training by measuring the sense of presence and electroencephalography (EEG) in children with ADHD. A clinical trial was conducted to verify the effect of VR cognitive training on children with ADHD. The experimental group included eight children with ADHD, and the control group included eight healthy children without ADHD. The sense of presence increased significantly after the VR cognitive training in children with ADHD. Also, no significant changes in the alpha, beta, delta, and gamma wave amplitudes were found in both groups after the VR cognitive training. Thus, the VR training content developed in this study can help measure the patients’ behavioral inhibition, increase their sense of presence by inducing interaction with distraction stimuli, and alleviate their symptoms. However, EEG could only be used as an auxiliary means, at the clinician’s judgment, for ADHD diagnosis in children because no significant EEG changes were observed in the experimental or control groups after the VR cognitive training.

Efficacy of Immersive Virtual Reality-Based Cognitive Training in Older Adults with Hearing Impairment: Three Case Reports

The purpose of this study was to investigate the effects of immersive virtual reality (VR)-based cognitive training in older adults with hearing impairment. Participants were three older adults with hearing impairment. Three assessment tools, audiometric, neuropsychological, and outcome measurements of the subjective hearing handicap inventory for the elderly, were examined before and after the VR cognitive training. The VR cognitive training was conducted once per week for 6 weeks and consisted of five different VR games classified into three specific cognitive domains (attention, memory, and executive function). The improved VR game performances were constantly observed across the training sessions in all three participants. After the VR cognitive training, first, the scores on the forward digit span test (attention), immediate recall on the SVLT-E (memory), and word reading and color reading on the K-CWST (executive function) were improved for all participants. In addition, the reaction time on the K-TMT-E (executive function) was shortened. Second, the sentence recognition scores in adverse listening conditions (SNR 0 dB and -5 dB) were improved. Third, the Korean version of hearing handicap inventory for the elderly (K-HHIE) scores which are reflective of subjective hearing handicap were decreased. Preventive intervention for cognitive deficits in older adults with hearing impairment is needed because hearing impairment is one of the major risk factors for dementia in older age. In this respect, the present case study demonstrates that VR cognitive training could improve cognitive function, speech-in-noise perception, and subjective hearing handicap in the hearing-impaired elderly.

A systematic review on the effectiveness of virtual reality cognitive training (VRCT) and computer‐based cognitive training (CBCT) for individuals with mild cognitive impairment (MCI)

AbstractBackgroundTechnological advancement and enhanced education level of aging population demand more effective and evidence‐based cognitive trainings. Besides conventional computer‐based cognitive training (CBCT), immersive virtual reality cognitive training (VRCT) has been gaining popularity over the last decade.MethodThe overall aim of this study is to assess the effectiveness on VRCT and CBCT in five specific cognitive domains [i.e. global cognitive function (GCF), memory (Mem), executive function (EF), language (Lang) and visuospatial skills (VS)] of individuals with mild cognitive impairment. The specific objectives were to: a) identify advantages and limitations of VRCT and CBCT; b) observe and report the trend of cognitive trainings; and c) suggest future research directions.ResultSystematic review was performed on 320 studies were yielded from five electronic databases. 18 randomized controlled trials met the PRISMA criteria, with 10 related to VRCT and 8 related to CBCT. Random‐effect model was used in determining the main effect of cognitive training in 5 specific cognitive domains.ConclusionVRCT provided the largest effect size on VS and Lang while the smallest on EF. CBCT provided the largest effect size on Mem and Lang while the smallest on EF. VRCT and CBCT generate an opposite effect on VS. VRCT outweighs CBCT in treatment effectiveness of GCF, EF, Lang and VS. More immersive‐and‐interactive experiences in VRCT may help individuals with MCI better engage in real‐life experiences which supports skills generalization and reduces external distractions. CBCT tends to improve Mem but no definite conclusions can be made. Further investigation with more stringent research design and specific protocol are required to reach consensus about the optimum intervention regime.

Effects of virtual reality cognitive training in individuals withmild cognitive impairment: A systematic review and meta-analysis.

Virtual reality (VR) is used to improve specific health needs by combining multiple technologies; it is increasingly being used in the medical field, showing satisfactory effects, especially in the management of chronic disease. The aim of this study was to assess the effects of VR cognitive training for individuals with mild cognitive impairment (MCI). Peer-reviewed articles were searched from the PubMed, Embase, Web of Science, the Cochrane Library, Science Direct, and EBSCOhost databases, as well as CNKI, Sinomed, Vip. and Wan Fang, through 23 May 2021. We only included randomized controlled trials (RCTs) enrolling participants with MCI. Seventeen RCTs were included, with a total of 744 participants. Evidence of moderate quality showed that VR cognitive training significantly enhanced MCI patients' global cognitive function, as measured by the Montreal Cognitive Assessment (standardized mean difference [SMD]=0.42; 95% confidence interval [CI], 0.04-0.79; p=0.03) and executive function, as measured by trail making test A (SMD=-0.58; 95% CI, -0.80 to -0.35; p<0.001). The meta-analysis indicated that the effects of VR cognitive training on delayed memory, immediate memory, attention and instrumental activities of daily living were not statistically significant (p>0.05). The available data showed that VR cognitive training might be beneficial for improving global cognitive function and executive function in individuals with MCI, although the effects were short term.

Effect of Cognitive Training in Fully Immersive Virtual Reality on Visuospatial Function and Frontal-Occipital Functional Connectivity in Predementia: Randomized Controlled Trial.

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

Virtual Reality Cognitive Training Among Individuals With Alcohol Use Disorder Undergoing Residential Treatment: Pilot Randomized Controlled Trial.

BackgroundAlcohol use disorder (AUD) has been associated with diverse physical and mental morbidities. Among the main consequences of chronic and excessive alcohol use are cognitive and executive deficits. Some of these deficits may be reversed in specific cognitive and executive domains with behavioral approaches consisting of cognitive training. The advent of computer-based interventions may leverage these improvements, but randomized controlled trials (RCTs) of digital interactive-based interventions are still scarce.ObjectiveThe aim of this study is to explore whether a cognitive training approach using VR exercises based on activities of daily living is feasible for improving the cognitive function of patients with AUD undergoing residential treatment, as well as to estimate the effect size for this intervention to power future definitive RCTs.MethodsThis study consisted of a two-arm pilot RCT with a sample of 36 individuals recovering from AUD in a therapeutic community; experimental group participants received a therapist-guided, VR-based cognitive training intervention combined with treatment as usual, and control group participants received treatment as usual without cognitive training. A comprehensive neuropsychological battery of tests was used both at pre- and postassessments, including measurement of global cognition, executive functions, attention, visual memory, and cognitive flexibility.ResultsIn order to control for potential effects of global cognition and executive functions at baseline, these domains were controlled for in the statistical analysis for each individual outcome. Results indicate intervention effects on attention in two out of five outcomes and on cognitive flexibility in two out of six outcomes, with effect sizes in significant comparisons being larger for attention than for cognitive flexibility. Patient retention in cognitive training was high, in line with previous studies.ConclusionsOverall, the data suggest that VR-based cognitive training results in specific contributions to improving attention ability and cognitive flexibility of patients recovering from AUD.Trial RegistrationClinicalTrials.gov NCT04505345; https://clinicaltrials.gov/show/NCT04505345

Meta-Analysis on the Effectiveness of Virtual Reality Cognitive Training (VRCT) and Computer-Based Cognitive Training (CBCT) for Individuals with Mild Cognitive Impairment (MCI)

This meta-analysis aims to assess the effectiveness of virtual reality cognitive training (VRCT) and conventional computer-based cognitive training (CBCT) in five specific cognitive domains (i.e., global cognitive function (GCF), memory (Mem), executive function (EF), language (Lang) and visuospatial skills (VS)) of individuals with mild cognitive impairment. A total of 320 studies were yielded from five electronic databases. Eighteen randomized controlled trials met the PRISMA criteria, with 10 related to VRCT and 8 related to CBCT. A random-effect model was used in determining the main effect of cognitive training in five specific cognitive domains. VRCT provided the largest effect size on VS and Lang while the smallest on EF. CBCT provided the largest effect size on Mem and Lang while the smallest on EF. VRCT and CBCT generate an opposite effect on VS. VRCT outweighs CBCT in treatment effectiveness of GCF, EF, Lang and VS. More immersive and interactive experiences in VRCT may help individuals with MCI better engage in real-life experiences, which supports skill generalization and reduces external distractions. CBCT tends to improve Mem but no definite conclusions can be made. Further investigation with more stringent research design and specific protocol are required to reach consensus about the optimum intervention regime.

Developing an Exergame Intervention to Prevent Alzheimer’s Disease

Delaying the onset of Alzheimer’s Disease by five years could save the U.S. ~$89 billion by 2030. Aerobic exercise and cognitive training are two promising interventions for AD prevention and the two together may have a synergistic cognitive effect than either alone. The purposes of this study were to develop an integrated virtual-reality cognitive training (VRCT) and cycling intervention known as exergame and test its feasibility in older adults with subjective cognitive decline (SCD). The VRCT included grocery shopping from a list, flower shopping from a list, dinnerware sorting, book sorting, and postage estimation. Twelve participants enrolled in the 1-month program (12 sessions) achieved 81.2% session adherence and 81.4% adherence to the exercise prescription. The exergame was well accepted by 75% of the participants and 100% were satisfied with the exergame quality and delivery. To conclude, exergame is a flexible intervention that is feasible for older adults with SCD.

Improvements of visuospatial function and frontal‐occipital connectivity after cognitive training using virtual reality in old adults with subjective cognitive decline and mild cognitive impairment

AbstractIntroductionCognitive intervention is believed as a potential therapy to prevent incident dementia. Previous studies using virtual reality (VR)‐assisted cognitive training have shown inconsistent results with minimal effect for patients with mild cognitive impairment (MCI). We investigated the hypothesis that fully immersive VR‐assisted cognitive training would be effective in multidomain cognition, psychological symptoms, and brain connectivity in old adults with subjective cognitive decline (SCD) and MCI.MethodsParticipants were randomly assigned as VR group (n=23; SCD=13 and MCI=10) and control group (n=18; SCD=13 and MCI=5). VR group participants conducted a multi‐domain cognitive training program using fully immersive 3D VR twice a week for a month. Both groups were evaluated of their cognitive function, psychological states, and resting‐state functional magnetic resonance imaging (fMRI) before and after the program.ResultsAfter the VR cognitive training, the VR group showed improvements in the Rey‐Osterrieth complex figure test (RCFT) copy (p&lt;0.001), positive and negative affect schedule‐positive affect (p&lt;0.001), and apathy evaluation scale (p=0.006) compared to control group. Seed‐based correlation analyses on fMRI results showed that improvement in RCFT copy was associated with activation in the frontal‐occipital connectivity in the VR group compared to the control group.ConclusionWe found that the fully immersive 3D VR program had positive effects on visuospatial function, positive affect, apathy, and the frontal‐occipital connectivity in old adults with SCD and MCI. Future trials using VR cognitive training with larger sample sizes, selected participants, and longer duration may find extended improvements in multidomain cognition, psychological aspects, and evidence in the brain activation.

Cognitive Training Using Fully Immersive, Enriched Environment Virtual Reality for Patients With Mild Cognitive Impairment and Mild Dementia: Feasibility and Usability Study.

BackgroundCognitive training using virtual reality (VR) may result in motivational and playful training for patients with mild cognitive impairment and mild dementia. Fully immersive VR sets patients free from external interference and thus encourages patients with cognitive impairment to maintain selective attention. The enriched environment, which refers to a rich and stimulating environment, has a positive effect on cognitive function and mood.ObjectiveThe aim of this study was to investigate the feasibility and usability of cognitive training using fully immersive VR programs in enriched environments with physiatrists, occupational therapists (OTs), and patients with mild cognitive impairment and mild dementia.MethodsThe VR interface system consisted of a commercialized head-mounted display and a custom-made hand motion tracking module. We developed the virtual harvest and cook programs in enriched environments representing rural scenery. Physiatrists, OTs, and patients with mild cognitive impairment and mild dementia received 30 minutes of VR training to evaluate the feasibility and usability of the test for cognitive training. At the end of the test, the usability and feasibility were assessed by a self-report questionnaire based on a 7-point Likert-type scale. Response time and finger tapping were measured in patients before and after the test.ResultsParticipants included 10 physiatrists, 6 OTs, and 11 patients with mild cognitive impairment and mild dementia. The mean scores for overall satisfaction with the program were 5.75 (SD 1.00) for rehabilitation specialists and 5.64 (SD 1.43) for patients. The response time of the dominant hand in patients decreased after the single session of cognitive training using VR, but this was not statistically significant (P=.25). There was no significant change in finger tapping in either the right or left hand (P=.48 and P=.42, respectively). None of the participants reported headaches, dizziness, or any other motion sickness after the test.ConclusionsA fully immersive VR cognitive training program may be feasible and usable in patients with mild cognitive impairment and mild dementia based on the positive satisfaction and willingness to use the program reported by physiatrists, OTs, and patients. Although not statistically significant, decreased response time without a change in finger tapping rate may reflect a temporary increase in attention after the test. Additional clinical trials are needed to investigate the effect on cognitive function, mood, and physical outcomes.