Wayfinding Intervention in High-Fidelity Long-Term Memory (LABYR)

Cognitive Intervention to Restore Capabilities for Learning and Retrieval of High-Fidelity Memory

Therapeutic treatment is yet available for declining memory, which is an impairment affecting the quality of life for many older adults and patients with cognitive impairment. Cognitive training with an immersive video game promises to drive hippocampal-cortical plasticity and associated gains that can restore memory capability or provide therapeutic treatment for memory deficits.

Study Overview

• Status: Completed
• Conditions: Mild Cognitive Impairment; Long-Term Memory Decline
• Intervention / Treatment: Device: LabyrinthVR; Device: Placebo Games; Device: Coherence; Device: Tablet

Detailed Description

A hallmark of higher cognition is the capability for flexible association of diverse bits of information stored in memory, such that experiences can be remembered in detailed and distinct terms (i.e., high-fidelity long-term memory (LTM)). Interventions capable of sustaining improved learning and flexible association of new information into LTM remain elusive. Interventions have yet to be developed to attenuate the decline of high-fidelity LTM in normal aging or provide therapeutic treatment for patients with cognitive impairment without dementia (i.e., MCI).

This project applies a translational neuroscience approach in development of a cognitive training intervention that targets sustained improvement in capabilities for LTM and cognitive control. Treatments use commercially available head-mounted display Virtual Reality (VR) technology and tablet computers to present a deeply immersive spatial wayfinding video game. Based on preliminary results, the hypothesis is that immersion in a game to navigate errands through unfamiliar, visually complex neighborhoods (i.e., wayfinding) will be an effective means to environmental enrichment, which refers to a process whereby new and complex experiences bring change to brain and behavior.

The significance of this platform is from the effects in brain and behavior arising from cognitive training, which can generalize to improvements in untrained capability for high-fidelity LTM. Research in rodents and humans shows that learning a new, enriched environment spurs the healthy function of the hippocampus and supports lifelong neurogenesis. Adult-borne hippocampal neurogenesis has been linked as the neurobiological basis for the formation of new, high-fidelity memories.

The Labyrinth spatial wayfinding game was developed in-house to incorporate full scientific rigor, as with procedures in any properly controlled behavioral experiment. The game uses 3D and 2.5D computer graphics tools, as well as numerous levels of adaptive challenge, to deliver a dynamic, engaging experience for participants throughout the training regimen. Training can be administered with and without participant ambulation in movement through wayfinding runs.

A participant's pre- and post-training assessments will occur promptly before and after their 15 to 20-hour training regimen, including collection of functional MRI (fMRI) and structural MRI data. Cognitive outcome measures will assess capabilities for high-fidelity LTM retrieval.

The a priori hypothesis is that effectiveness of the wayfinding game intervention would be evidenced by post-training improvements in retrieval of high-fidelity LTM and associated cognitive control capabilities. FMRI results associated with the measured cognitive improvements will localize changes in functional brain networks that support gains in memory capabilities. Structural MRI measures will assess morphometric and volumetric changes from pre- to post-training assessments.

• Study Type: Interventional
• Enrollment (Actual): 50
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • San Francisco, California, United States, 94158
      • UCSF Mission Bay

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 62 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• fluent speakers of English
• completed 12 or more years of education
• normal or corrected-to-normal vision
• dexterity to comfortably operate the scanner-compatible response box
• freedom from physical and neurological conditions contra-indicated for fMRI
• must confirm physical stamina and comfort for 45-minute, brisk walks on level ground

Exclusion Criteria:

• use of psychotropic medications
• history of concussions or dizziness, vestibular or balance problems
• significant discomfort with virtual reality experiences

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

6

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: LabyrinthVR Trackers; Multi-session cognitive intervention with head-mounted display virtual reality computer game that presents an adaptive spatial wayfinding challenge. Game movement via participant ambulation wearing leg-position trackers.	Device: LabyrinthVR; Head-mounted display virtual reality game designed to induce environmental enrichment in an adaptive, immersive regimen of wayfinding in novel urban and village neighborhoods.
Experimental: LabyrinthVR Scoot; Multi-session cognitive intervention with head-mounted display virtual reality computer game that presents an adaptive spatial wayfinding challenge. Game movement via teleporting technique.	Device: LabyrinthVR; Head-mounted display virtual reality game designed to induce environmental enrichment in an adaptive, immersive regimen of wayfinding in novel urban and village neighborhoods.
Placebo Comparator: Placebo Controls; Multi-session cognitive intervention with handheld tablet or wireless virtual reality headset presentation of commercially available, narrative computer games.	Device: Placebo Games; Commercially-available, narrative computer games marketed as cognitively enriching.
Active Comparator: Coherence; Multi-session cognitive intervention with head-mounted display virtual reality computer game that presents an adaptive rhythm training game.	Device: Coherence; Head-mounted display virtual reality game designed to present an adaptive rhythm training routine.
Experimental: Labyrinth Tablet; Multi-session cognitive intervention with tablet computer, displaying 2.5D version of Labyrinth game in an adaptive spatial wayfinding challenge. Game movement via on-screen control buttons.	Device: Tablet; Tablet computer playing Labyrinth VR game but in 2.5D
Experimental: Labyrinth VR wireless; Multi-session cognitive intervention with head-mounted display virtual reality computer game using wireless, narrower filed technology to presents an adaptive spatial wayfinding challenge. Game movement via teleporting technique.	Device: LabyrinthVR; Head-mounted display virtual reality game designed to induce environmental enrichment in an adaptive, immersive regimen of wayfinding in novel urban and village neighborhoods.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
MDT Change in Mnemonic Discrimination	Mnemonic discrimination task testing recognition memory for common objects, as reported in scores on a scale of the Lure Discrimination Index ranging from 0.00 to 1.00 where higher values show better performance.	baseline immediately before and post-assessment immediately after training regimen is completed
WALK Change in Recall	Encoding and test of recent autobiographical long-term memory, as reported in scores on a scale of Percentage of Items Recalled ranging from 0.00 to 1.00 where higher values show better performance.	baseline immediately before and post-assessment immediately after training regimen is completed
Changes in Volumetric-based Brain Morphometry Associated With Training-induced Changes in Mnemonic Discrimination	Structural MRI T1 data will be analyzed in terms of volumetric-based morphometry and compared between treatment arms and timepoints.	during collection of Outcome 1, baseline immediately before and post-assessment immediately after training regimen is completed
Changes in Task-based Cortical Functional Connectivity Associated With Training-induced Changes in Mnemonic Discrimination	functional MRI data will be analyzed in terms of beta-series correlations between co-active cortical regions of interest and compared between treatment arms and timepoints.	during collection of Outcome 1, baseline immediately before and post-assessment immediately after training regimen is completed

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Remote Cognitive Module (RCM)	A tablet application using a speech-to-text interface to administer neuropsychological tests comparable to CVLT-II verbal memory, verbal fluency, digit span and Trail Making Test-B. Raw scores from the tasks will be transformed to z-scores, relative to population normative values, and a participant's z-scores will be the uniform measures of their performance across RCM tasks. THESE DATA WERE NOT COLLECTED OR ANALYZED DUE TO FUNDING CONSTRAINTS	baseline immediately before and post-assessment immediately after training regimen is completed
Test of Visual Attention Change in Top-down Control	test of speed and accuracy of visual attention and impulsivity	baseline immediately before and post-assessment immediately after training regimen is completed

Collaborators and Investigators

• Sponsor: University of California, San Francisco
• Investigators: Principal Investigator: Peter E Wais, PhD, Neuroscape, Department of Neurology

Publications and helpful links

General Publications

• Wais PE, Arioli M, Anguera-Singla R, Gazzaley A. Virtual reality video game improves high-fidelity memory in older adults. Sci Rep. 2021 Jan 28;11(1):2552. doi: 10.1038/s41598-021-82109-3.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2019
• Primary Completion (Actual): December 15, 2021
• Study Completion (Actual): December 15, 2021

Study Registration Dates

• First Submitted: January 29, 2020
• First Submitted That Met QC Criteria: January 30, 2020
• First Posted (Actual): February 5, 2020

Study Record Updates

• Last Update Posted (Estimate): February 27, 2023
• Last Update Submitted That Met QC Criteria: February 1, 2023
• Last Verified: February 1, 2023

More Information

Terms related to this study

• Keywords: cognitive training; amnestic MCI without dementia
• Additional Relevant MeSH Terms: Mental Disorders; Neurocognitive Disorders; Cognition Disorders; Cognitive Dysfunction
• Other Study ID Numbers: 19-27586-A

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No