Use of Immersive Virtual Reality in the Assessment and Treatment of Alzheimer's Disease: A Systematic Review

Felix Clay, David Howett, James FitzGerald, Paul Fletcher, Dennis Chan, Annabel Price, Felix Clay, David Howett, James FitzGerald, Paul Fletcher, Dennis Chan, Annabel Price

Abstract

Background: Immersive virtual reality (iVR) allows seamless interaction with simulated environments and is becoming an established tool in clinical research. It is unclear whether iVR is acceptable to people with Alzheimer's disease (AD) dementia or useful in their care. We explore whether iVR is a viable research tool that may aid the detection and treatment of AD.

Objectives: This review examines the use of iVR in people with AD or mild cognitive impairment (MCI).

Methods: Medline, PsycINFO, Embase, CINAHL, and Web of Science databases were searched from inception. PRISMA guidelines were used with studies selected by at least two researchers.

Results: Nine studies were eligible for inclusion. None reported any issues with iVR tolerability in participants with MCI and AD on assessment or treatment tasks. One study demonstrated capability for detecting prodromal AD and correlated with neuroanatomical substrates. Two studies showed iVR to have high accuracy in differentiating participants with AD from controls but were not hypothesis driven or with adequate controls measures. In a small validation study and two longitudinal case studies, iVR cognitive training was positively rated but did not demonstrate reliable benefit.

Conclusion: iVR is emerging as a viable method of assessing older adults and people with AD. Strongest benefits were seen when closely integrated with theoretical models of neurodegeneration and existing screening methods. Further randomized controlled trials integrated with clinical populations are required. This will consolidate the power of iVR for assessment of MCI and clarify treatment efficacy beyond current applications in physical rehabilitation.

Keywords: Alzheimer’s disease; cognitive remediation; mild cognitive impairment; spatial navigation; virtual reality.

Conflict of interest statement

Authors’ disclosures available online (https://www.j-alz.com/manuscript-disclosures/19-1218r1).

Figures

Fig.1
Fig.1
PRISMA Diagram.

References

    1. Prince M, Bryce R, Ferri C (2011) World Alzheimer Report 2011: The benefits of early diagnosis and intervention. Alzheimer’s Disease International, London, UK.
    1. Cogné M, Taillade M, N’Kaoua B, Tarruella A, Klinger E, Larrue F, Sauzéon H, Joseph PA, Sorita E (2017) The contribution of virtual reality to the diagnosis of spatial navigation disorders and to the study of the role of navigational aids: A systematic literature review. Ann Phys Rehabil Med 60, 164–176.
    1. Alzheimer’s Research UK (2019) A Walk Through Dementia . Accessed 28 May, 2019.
    1. Johnson L (2018) For people with dementia, virtual reality can be life-changing. Wired, . Posted 21 May 2018, Accessed 9 July 2019.
    1. McNaughton BL, Battaglia FP, Jensen O, Moser EI, Moser MB (2006) Path integration and the neural basis of the “cognitive map.”. Nat Rev Neurosci 7, 663–678.
    1. Freeman D, Reeve S, Robinson A, Ehlers A, Clark D, Spanlang B, Slater M (2017) Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychol Med 47, 2393–2400.
    1. Slobounov SM, Ray W, Johnson B, Slobounov E, Newell KM (2015) Modulation of cortical activity in 2D versus 3D virtual reality environments: an EEG study. Int J Psychophysiol 95, 254–260.
    1. Yew B, Alladi S, Shailaja M, Hodges JR, Hornberger M (2013) Lost and forgotten? Orientation versus memory in Alzheimer’s disease and frontotemporal dementia. J Alzheimers Dis 33, 473–481.
    1. Faraji J, Soltanpour N, Moeeini R, Roudaki S, Soltanpour N, Abdollahi AA, Metz GAS (2014) Topographical disorientation after ischemic mini infarct in the dorsal hippocampus: Whispers in silence. Front Behav Neurosci 8,, 216.
    1. Widmann CN, Beinhoff U, Riepe MW (2012) Everyday memory deficits in very mild Alzheimer’s disease. Neurobiol Aging 33, 297–303.
    1. Allison SL, Fagan AM, Morris JC, Head D (2016) Spatial navigation in preclinical Alzheimer’s disease. J Alzheimers Dis 52, 77–90.
    1. Moodley K, Minati L, Contarino V, Prioni S, Wood R, Cooper R, D’Incerti L, Tagliavini F, Chan D (2015) Diagnostic differentiation of mild cognitive impairment due to Alzheimer’s disease using a hippocampus-dependent test of spatial memory. Hippocampus 25, 939–951.
    1. Mokrisova I, Laczo J, Andel R, Gazova I, Vyhnalek M, Nedelska Z, Levcik D, Cerman J, Vlcek K, Hort J (2016) Real-space path integration is impaired in Alzheimer’s disease and mild cognitive impairment. Behav Brain Res 307, 150–158.
    1. Vlček K, Laczó J (2014) Neural correlates of spatial navigation changes in mild cognitive impairment and Alzheimer’s disease. Front Behav Neurosci 8,, 89.
    1. Dejos M, Sauzeon H, N’Kaoua B (2012) Virtual reality for clinical assessment of elderly people: Early screening for dementia. Rev Neurol (Paris) 168, 404–414.
    1. Abichou K, La Corte V, Piolino P (2017) Does virtual reality have a future for the study of episodic memory in aging? Geriatr Psychol Neuropsychiatr Vieil 15, 65–74.
    1. García-Betances RI, Arredondo Waldmeyer MT, Fico G, Cabrera-Umpiérrez MF (2015) A succinct overview of virtual reality technology use in Alzheimer’s disease. Front Aging Neurosci 7, 80.
    1. García-Casal JA, Loizeau A, Csipke E, Franco-Martín M, Perea-Bartolomé MV, Orrell M (2017) Computer-based cognitive interventions for people living with dementia: a systematic literature review and meta-analysis. Aging Ment Health 21, 454–467.
    1. D’Cunha NM, Nguyen D, Naumovski N, McKune AJ, Kellett J, Georgousopoulou EN, Frost J, Isbel S (2019) A mini-review of virtual reality-based interventions to promote well-being for people living with dementia and mild cognitive impairment. Gerontology 65, 430–440.
    1. Hill NTM, Mowszowski L, Naismith SL, Chadwick VL, Valenzuela M, Lampit A (2017) Computerized cognitive training in older adults with mild cognitive impairment or dementia: a systematic review and meta-analysis. Am J Psychiatry 174, 329–340.
    1. Kim O, Pang Y, Kim JH (2019) The effectiveness of virtual reality for people with mild cognitive impairment or dementia: A meta-analysis. BMC Psychiatry 19, 219.
    1. Moreno A, Wall KJ, Thangavelu K, Craven L, Ward E, Dissanayaka NN (2019) A systematic review of the use of virtual reality and its effects on cognition in individuals with neurocognitive disorders. Alzheimers Dement (N Y) 5, 834–850.
    1. Woods B, O’Philbin L, Farrell EM, Spector AE, Orrell M (2018) Reminiscence therapy for dementia. Cochrane Database Syst Rev 3, CD001120.
    1. Rose V, Stewart I, Jenkins KG, Ang CS, Matsangidou M (2018) A scoping review exploring the feasibility of virtual reality technology use with individuals living with dementia. ICAT-EGVE 2018, pp. 131–139.
    1. Manera V, Chapoulie E, Bourgeois J, Guerchouche R, David R, Ondrej J, Drettakis G, Robert P (2016) A feasibility study with image-based rendered virtual reality in patients with mild cognitive impairment and dementia. PLoS One 11, e0151487.
    1. Rose V, Stewart I, Jenkins KG, Tabbaa L, Ang CS, Matsangidou M (2019) Bringing the outside in: The feasibility of virtual reality witheople with dementia in an inpatient psychiatric care setting,Dementia (London), doi: 10.1177/1471301219868036.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med 6, e1000097.
    1. Booth A, Clarke M, Dooley G, Ghersi D, Moher D, Petticrew M, Stewart L (2012) The nuts and bolts of PROSPERO: an international prospective register of systematic reviews. Syst Rev 1, 2.
    1. Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M (2017) Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev 11, CD008349.
    1. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan—a web and mobile app for systematic reviews. Syst Rev 5, 210.
    1. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (2019) Cochrane Handbook for Systematic Reviews of Interventions version 6.0. Cochrane, .
    1. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JAC (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343, d5928.
    1. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan A-W, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355, i4919.
    1. Howett D, Castegnaro A, Krzywicka K, Hagman J, Marchment D, Henson R, Rio M, King JA, Burgess N, Chan D (2019) Differentiation of mild cognitive impairment using an entorhinal cortex-based test of virtual reality navigation. Brain 142, 1751–1766.
    1. Fernandez Montenegro JM, Argyriou V (2017) Cognitive evaluation for the diagnosis of Alzheimer’s disease based on Turing Test and virtual environments. Physiol Behav 173, 42–51.
    1. Gago MF, Yelshyna D, Bicho E, Silva HDHD, Rocha LL, Lurdes Rodrigues M, Sousa N (2016) Compensatory postural adjustments in an oculus virtual reality environment and the risk of falling in Alzheimer’s disease. Dement Geriatr Cogn Dis Extra 6, 252–267.
    1. Seo K, Kim J-K, Oh DH, Ryu H, Choi H (2017) Virtual daily living test to screen for mild cognitive impairment using kinematic movement analysis. PLoS One 12, e0181883.
    1. Zakzanis KK, Quintin G, Graham SJ, Mraz R (2009) Age and dementia related differences in spatial navigation within an immersive virtual environment. Med Sci Monit 15, CR140–150.
    1. Bourrelier J, Ryard J, Dion M, Merienne F, Manckoundia P, Mourey F (2016) Use of a virtual environment to engage motor and postural abilities in elderly subjects with and without mild cognitive impairment (MAAMI Project). IRBM 37, 75–80.
    1. White PJF, Moussavi Z (2016) Neuro-cognitive treatment for an Alzheimer’s patient using a virtual reality navigational environment. J Exp Neurosci 10,, 129–135.
    1. Optale G, Capodieci S, Pinelli P, Zara D, Gamberini L, Riva G (2001) Music-enhanced immersive virtual reality in the rehabilitation of memory-related cognitive processes and functional abilities: A case report. Presence Teleoperators Virtual Environ 10, 450–462.
    1. Micarelli A, Viziano A, Micarelli B, Augimeri I, Alessandrini M (2019) Vestibular rehabilitation in older adults with and without mild cognitive impairment: Effects of virtual reality using a head-mounted display. Arch Gerontol Geriatr 83, 246–256.
    1. Yelshyna D, Gago MF, Bicho E, Fernandes V, Gago NF, Costa L, Silva H, Rodrigues ML, Rocha L, Sousa N (2016) Compensatory postural adjustments in Parkinson’s disease assessed via a virtual reality environment. Behav Brain Res 296, 384–392.
    1. Reggente N, Essoe JK-YKY, Aghajan ZM, Tavakoli AV, McGuire JF, Suthana NA, Rissman J (2018) Enhancing the ecological validity of fMRI memory research using virtual reality. Front Neurosci 12, 1–9.
    1. Dolins FL1, Klimowicz C, Kelley J, Menzel CR (2016) Cognitive abilities in chimpanzees and humans. Am J Primatol 76, 496–513.
    1. Corbett A, Owen A, Hampshire A, Grahn J, Stenton R, Dajani S, Burns A, Howard R, Williams N, Williams G, Ballard C (2015) The effect of an online cognitive training package in healthy older adults: an online randomized controlled trial. J Am Med Dir Assoc 16, 990–997.
    1. Perez-Marcos D, Bieler-Aeschlimann M, Serino A (2018) Virtual reality as a vehicle to empower motor-cognitive neurorehabilitation. Front Psychol 9, 2120.
    1. Foloppe DA, Richard P, Yamaguchi T, Etcharry-Bouyx F, Allain P (2018) The potential of virtual reality-based training to enhance the functional autonomy of Alzheimer’s disease patients in cooking activities: A single case study. Neuropsychol Rehabil 28, 709–733.
    1. Davis R, Ohman JM, Weisbeck C (2017) Salient cues and wayfinding in Alzheimer’s disease within a virtual senior residence. Environ Behav 49, 1038–1065.
    1. Burdea G, Polistico K, Krishnamoorthy A, House G, Rethage D, Hundal J, Damiani F, Pollack S (2015) Feasibility study of the BrightBrainer integrative cognitive rehabilitation system for elderly with dementia. Disabil Rehabil Assist Technol 10, 421–432.
    1. Brimelow RE, Dawe B, Dissanayaka N (2020) Preliminary research: Virtual reality in residential aged care to reduce apathy and improve mood. Cyberpsychol Behav Soc Netw 23, 165–170.
    1. Bennett CR, Corey RR, Giudice U, Giudice NA (2016) Immersive virtual reality simulation as a tool for aging and driving research In Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics). Springer Verlag, pp. 377–385.

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