A systematic review of the use of virtual reality and its effects on cognition in individuals with neurocognitive disorders

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Abstract

Introduction

Virtual reality (VR) interventions are increasingly used in individuals with brain injuries. The objective of this study was to determine the effects of VR on overall cognitive functioning in individuals with neurocognitive disorders (NCDs).

Methods

Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the published literature on immersive and nonimmersive VR technologies targeting cognition in minor and major NCDs was conducted: (PROSPERO registration number: CRD42019121953).

Results

A total of 22 studies were included in the review, for an aggregated sample of 564 individuals with NCDs. Most of the studies were conducted on patients who had stroke (27.3%), followed by mild cognitive impairment (22.7%) and Alzheimer's disease (13.6%). VR interventions used for cognitive rehabilitation suggested to improve cognition (e.g. memory, dual tasking, and visual attention), and secondarily to psychological functioning (e.g. reduction of anxiety, higher levels of well-being, and increased use of coping strategies).

Conclusion

VR interventions are useful to improve cognition and psychological symptoms in NCDs.

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Most cited references 39

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Computerized and virtual reality cognitive training for individuals at high risk of cognitive decline: systematic review of the literature.

Hannah Coyle, Victoria Traynor, Nadia Solowij (2015)

The aim of this study was to assess the efficacy of cognitive training, specifically computerized cognitive training (CCT) and virtual reality cognitive training (VRCT), programs for individuals living with mild cognitive impairment (MCI) or dementia and therefore at high risk of cognitive decline. After searching a range of academic databases (CINHAL, PSYCinfo, and Web of Science), the studies evaluated (N = 16) were categorized as CCT (N = 10), VRCT (N = 3), and multimodal interventions (N = 3). Effect sizes were calculated, but a meta-analysis was not possible because of the large variability of study design and outcome measures adopted. The cognitive domains of attention, executive function, and memory (visual and verbal) showed the most consistent improvements. The positive effects on psychological outcomes (N = 6) were significant reductions on depressive symptoms (N = 3) and anxiety (N = 2) and improved perceived use of memory strategy (N = 1). Assessments of activities of daily living demonstrated no significant improvements (N = 8). Follow-up studies (N = 5) demonstrated long-term improvements in cognitive and psychological outcomes (N = 3), and the intervention groups showed a plateau effect of cognitive functioning compared with the cognitive decline experienced by control groups (N = 2). CCT and VRCT were moderately effective in long-term improvement of cognition for those at high risk of cognitive decline. Total intervention time did not mediate efficacy. Future research needs to improve study design by including larger samples, longitudinal designs, and a greater range of outcome measures, including functional and quality of life measures, to assess the wider effect of cognitive training on individuals at high risk of cognitive decline.

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Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients

Ana Lucia Cosenza Faria, Andreia Andrade, Luísa Soares … (2016)

Background Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients’ capability to live independently. There is substancial evidence on post-stroke cognitive rehabilitation benefits, but its implementation is generally limited by the use of paper-and-pencil methods, insufficient personalization, and suboptimal intensity. Virtual reality tools have shown potential for improving cognitive rehabilitation by supporting carefully personalized, ecologically valid tasks through accessible technologies. Notwithstanding important progress in VR-based cognitive rehabilitation systems, specially with Activities of Daily Living (ADL’s) simulations, there is still a need of more clinical trials for its validation. In this work we present a one-month randomized controlled trial with 18 stroke in and outpatients from two rehabilitation units: 9 performing a VR-based intervention and 9 performing conventional rehabilitation. Methods The VR-based intervention involved a virtual simulation of a city – Reh@City - where memory, attention, visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. The intervention had levels of difficulty progression through a method of fading cues. There was a pre and post-intervention assessment in both groups with the Addenbrooke Cognitive Examination (primary outcome) and the Trail Making Test A and B, Picture Arrangement from WAIS III and Stroke Impact Scale 3.0 (secondary outcomes). Results A within groups analysis revealed significant improvements in global cognitive functioning, attention, memory, visuo-spatial abilities, executive functions, emotion and overall recovery in the VR group. The control group only improved in self-reported memory and social participation. A between groups analysis, showed significantly greater improvements in global cognitive functioning, attention and executive functions when comparing VR to conventional therapy. Conclusions Our results suggest that cognitive rehabilitation through the Reh@City, an ecologically valid VR system for the training of ADL’s, has more impact than conventional methods. Trial registration This trial was not registered because it is a small sample study that evaluates the clinical validity of a prototype virtual reality system.

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Controlling memory impairment in elderly adults using virtual reality memory training: a randomized controlled pilot study.

Silvia Marín, S Capodieci, Isabel A Bordin … (2010)

Memory decline is a prevalent aspect of aging but may also be the first sign of cognitive pathology. Virtual reality (VR) using immersion and interaction may provide new approaches to the treatment of memory deficits in elderly individuals. The authors implemented a VR training intervention to try to lessen cognitive decline and improve memory functions. The authors randomly assigned 36 elderly residents of a rest care facility (median age 80 years) who were impaired on the Verbal Story Recall Test either to the experimental group (EG) or the control group (CG). The EG underwent 6 months of VR memory training (VRMT) that involved auditory stimulation and VR experiences in path finding. The initial training phase lasted 3 months (3 auditory and 3 VR sessions every 2 weeks), and there was a booster training phase during the following 3 months (1 auditory and 1 VR session per week). The CG underwent equivalent face-to-face training sessions using music therapy. Both groups participated in social and creative and assisted-mobility activities. Neuropsychological and functional evaluations were performed at baseline, after the initial training phase, and after the booster training phase. The EG showed significant improvements in memory tests, especially in long-term recall with an effect size of 0.7 and in several other aspects of cognition. In contrast, the CG showed progressive decline. The authors suggest that VRMT may improve memory function in elderly adults by enhancing focused attention.

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Author and article information

Contributors

Alexander Moreno

Nadeeka N. Dissanayaka

Journal

Journal ID (nlm-ta): Alzheimers Dement (N Y)

Journal ID (iso-abbrev): Alzheimers Dement (N Y)

Title: Alzheimer's & Dementia : Translational Research & Clinical Interventions

Publisher: Elsevier

ISSN (Electronic): 2352-8737

Publication date PMC-release: 22 November 2019

Publication date Collection: 2019

Publication date (Electronic): 22 November 2019

Volume: 5

Pages: 834-850

Affiliations

[a ]Department of Psychology, Université de Montréal, Quebec, Canada

[b ]Centre for Interdisciplinary Research in Rehabilitation (CRIR) - Notre-Dame Hospital, CIUSSS Centre-Sud-de-l'Île-de-Montréal (CCSMTL), Montreal, Quebec, Canada

[c ]Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia

[d ]Faculty of Health, School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia

[e ]QSpectral Systems Pty Ltd, Queensland, Australia

[f ]UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, Australia

[g ]Department of Psychology, Western Colorado University, Gunnison, Colorado, USA

[h ]School of Psychology, The University of Queensland, Queensland, Australia

[i ]Department of Neurology, Royal Brisbane & Woman's Hospital, Queensland, Australia

Author notes

[∗ ]Corresponding author. Tel.: (514) 413-8777 x 23600. jhon.alexander.moreno@ 123456umontreal.ca jhon.moreno@ 123456mail.mcgill.ca

[∗∗ ]Corresponding author. Tel.: +61 7 33466026; Fax: +61 7 33465599. n.dissanayaka@ 123456uq.edu.au

Article

Publisher ID: S2352-8737(19)30077-0

DOI: 10.1016/j.trci.2019.09.016

PMC ID: 6881602

PubMed ID: 31799368

SO-VID: 32c86700-f681-4913-b13e-16fbabd89f62

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

A systematic review of the use of virtual reality and its effects on cognition in individuals with neurocognitive disorders

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Abstract

Introduction

Methods

Results

Conclusion

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Technology, Mind, and Behavior

Most cited references 39

Computerized and virtual reality cognitive training for individuals at high risk of cognitive decline: systematic review of the literature.

Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients

Controlling memory impairment in elderly adults using virtual reality memory training: a randomized controlled pilot study.

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