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      Neurocognitive Treatment for a Patient with Alzheimer’s Disease Using a Virtual Reality Navigational Environment

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          Abstract

          In this case study, a man at the onset of Alzheimer’s disease (AD) was enrolled in a cognitive treatment program based upon spatial navigation in a virtual reality (VR) environment. We trained him to navigate to targets in a symmetric, landmark-less virtual building. Our research goals were to determine whether an individual with AD could learn to navigate in a simple VR navigation (VRN) environment and whether that training could also bring real-life cognitive benefits. The results show that our participant learned to perfectly navigate to desired targets in the VRN environment over the course of the training program. Furthermore, subjective feedback from his primary caregiver (his wife) indicated that his skill at navigating while driving improved noticeably and that he enjoyed cognitive improvement in his daily life at home. These results suggest that VRN treatments might benefit other people with AD.

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          Most cited references21

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          Spatial localization does not require the presence of local cues

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            Detecting navigational deficits in cognitive aging and Alzheimer disease using virtual reality.

            Older adults get lost, in many cases because of recognized or incipient Alzheimer disease (AD). In either case, getting lost can be a threat to individual and public safety, as well as to personal autonomy and quality of life. Here we compare our previously described real-world navigation test with a virtual reality (VR) version simulating the same navigational environment. Quantifying real-world navigational performance is difficult and time-consuming. VR testing is a promising alternative, but it has not been compared with closely corresponding real-world testing in aging and AD. We have studied navigation using both real-world and virtual environments in the same subjects: young normal controls (YNCs, n = 35), older normal controls (ONCs, n = 26), patients with mild cognitive impairment (MCI, n = 12), and patients with early AD (EAD, n = 14). We found close correlations between real-world and virtual navigational deficits that increased across groups from YNC to ONC, to MCI, and to EAD. Analyses of subtest performance showed similar profiles of impairment in real-world and virtual testing in all four subject groups. The ONC, MCI, and EAD subjects all showed greatest difficulty in self-orientation and scene localization tests. MCI and EAD patients also showed impaired verbal recall about both test environments. Virtual environment testing provides a valid assessment of navigational skills. Aging and Alzheimer disease (AD) share the same patterns of difficulty in associating visual scenes and locations, which is complicated in AD by the accompanying loss of verbally mediated navigational capacities. We conclude that virtual navigation testing reveals deficits in aging and AD that are associated with potentially grave risks to our patients and the community.
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              Humans with hippocampus damage display severe spatial memory impairments in a virtual Morris water task.

              For nonhumans, it has been shown that the hippocampus (HPC) is critical for spatial memory. We tested patients with unilateral HPC resections on a virtual analogue of a classic spatial task to assess HPC functioning in nonhumans: the Morris water task. We found that when humans are required to use spatial cues to navigate to a hidden escape platform in a pool, patients with HPC resections display severe impairments in spatial navigation relative to age-matched controls and age-matched patients who have had extra-HPC resections. This effect occurred for every patient tested and was evident regardless of side of surgery. Hence, it is apparent across species and irrespective of which hemisphere is damaged that the human HPC is critical for spatial/relational memory.
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                Author and article information

                Journal
                J Exp Neurosci
                J Exp Neurosci
                Journal of Experimental Neuroscience
                Journal of Experimental Neuroscience
                Libertas Academica
                1179-0695
                2016
                08 November 2016
                : 10
                : 129-135
                Affiliations
                Department of Biomedical Engineering, University of Manitoba, Winnipeg, Manitoba, Canada.
                Author notes
                Article
                jen-10-2016-129
                10.4137/JEN.S40827
                5102253
                27840579
                02f4d6a5-1093-4d71-aa2e-c22d9131e23e
                © 2016 the author(s), publisher and licensee Libertas Academica Ltd.

                This is an open-access article distributed under the terms of the Creative Commons CC-BY-NC 3.0 License.

                History
                : 24 August 2016
                : 03 October 2016
                : 10 October 2016
                Categories
                Original Research

                virtual reality,alzheimer,dementia,cognitive rehabilitation,spatial navigation

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