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A new study, published in the Journal of Medical Internet Research, looking at the effectiveness of VR in screening for cognitive impairment has been hailed a success.

The trial was conducted at a public primary care clinic in Singapore, where 60 people aged 65-85 years were recruited based on a cut-off score of 26 on the Montreal Cognitive Assessment (MoCA) scale.

The motivation behind the study was due to the increasing prevalence of dementia worldwide. For instance, according to recent figures from the Office for National Statistics, dementia was the leading cause of death in England and Wales in 2018, accounting for 12.8 percent of all deaths registered. Such prevalence prompts further research into dementia in an attempt to prevent or delay the onset of the disease.

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According to the study, mild cognitive impairment (MCI) represents a “middle ground” between normal ageing and dementia. Considering this, the trial explored whether the use of virtual reality (VR) could be used as an effective tool to screen for cognitive impairment in older people in a primary care setting.

The VR platform used in the study is a new tool, referred to as the RE@CH assessment module, developed by the Institute of Technical Education (ITE) in Singapore.

To perform the RE@CH assessment, participants were split into two key groups:

  • Group 1: Cognitively intact individuals, as defined by a MoCA score of ≥26. Those with pre-existing formal diagnosis of cognitive impairment of any degree or a history of cerebrovascular accident or neurological deficits were excluded.
  • Group 2: Cognitively impaired individuals, as defined by a MoCA score of <26.

Using VR and motion sensor technology, the RE@CH assessment module replicates activities encountered in daily living as 3D games. Through providing an immersive experience for the users, several aspects of their cognitive function were assessed: learning and memory, perceptual-motor function, and executive function.

The study team designed a scoring algorithm to appraise the participant’s performance on the RE@CH assessment module. Seven relevant tasks were selected and scored depending on the participants’ ability to complete the task correctly within a stipulated time, the number of attempts, and the proportion of tasks performed correctly.

Participants were assessed on their performance in the following seven activities:

  1. Opening a door using the correct key and passcode number
  2. Making a phone call by recalling a predefined eight-digit number
  3. Identifying: (a) Famous people, (b) Advertisement of groceries, and (c) four-digit number on a lottery slip on a newspaper
  4. Sorting household objects according to category
  5. Picking an outfit appropriate for a specified occasion
  6. Withdrawing cash from an automated teller machine
  7. Shopping for groceries in a provision shop

The primary aim of the trial was to examine the feasibility – number of people who successfully complete RE@CH – and acceptability – feedback from participants about their experience with the VR tool – of using VR to screen for cognitive impairment in older people in a primary care setting.

The secondary aim was to assess the ability of the RE@ACH assessment module to differentiate between cognitively intact and cognitively impaired participants.

All 60 participants successfully completed the study.

Across both groups, feedback revealed positive attitudes towards their VR experience, with the largest proportion of responses to all questions asked about RE@CH being “Agree” or “Strongly agree.” There was a response rate of 43.8 percent, suggesting that almost one in two older persons are receptive to the use of novel technology for assessing their cognitive function, says the study.

Furthermore, in general, the mean scores for each task was higher in the cognitively intact compared to the cognitively impaired participants. These differences were statistically significant for tasks 2, 3 and 7, and the total performance score (sum of task 1 to task 7 scores) exhibited statistically significant differences, says the study.

Overall, from the findings of the study, it suggests that the use of VR to screen for cognitive impairment in older people in a primary care setting is an effective and viable method, with overall positive feedback and contrasting results between the two groups of participants.

To read the full comparative study, click here

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