One important feature of a neuropsychological test is its ecological validity, which defines how much patients’ test scores are linked to real-life functioning. However, many of the currently available neuropsychological tools show low to moderate levels of ecological validity. Virtual reality (VR) emerged as a possible solution that might enhance the ecological value of standard paper-and-pencil tests, thanks to the possibility of simulating realistic environments and situations where patients can behave as they do in real life. Moreover, a recent kind of virtual environments, the 360° spherical photos and videos, seems to guarantee high levels of graphical realism and lower technical complexity than standard VR, despite their limitations concerning interactive design. In this pilot study, we tested the possible application of 360° technology for the assessment of memory, developing an adaptation of a standardized test. We focused on Free Recall and Recognition accuracies as indexes of memory function, confronting and correlating the performances obtained by the participants in the standard and in the 360° test. The results, even if preliminary, support the use of 360° technology for enhancing the ecological value of standard memory assessment tests.

Cognitive impairment is a condition that results in a person's inability to remember, learn, concentrate or make decisions that affect his/her everyday life. The assessment of these deficits is usually performed using standardized paper and pencil or computerized tests within a controlled clinical setting. Many traditionally designed tools show only low to moderate levels of ecological validity, limiting the reliability of the collected measures. The proposed system adapts existing screening tests within an immersive virtual reality environment with 360°video, recreating a familiar setting for the patient. This faithful reproduction of everyday environments and situations can enhance the ecological validity of the assessment procedure while maintaining a standardized stimuli delivery, all in a controlled and safe setting. As a computerized system, virtual reality technology allows an error-free computation of the test scores, here collected by means of accuracy for each task. The system involves many technologies aimed at capturing any kind of user input provided by the patient. Additionally, using a visor with integrated eye-tracker sensor, the system can register the visual exploration pattern adopted by the patient during the task execution, providing information concerning the attentional and visuo-spatial functioning which are not obtainable using traditional assessment procedures. Finally, the results of an exploratory study that was conducted with 11 users on the reliability and usability of the system are presented.

Neuropsychological testing aims to measure individuals' cognitive abilities (e.g. memory, attention), analysing their performance on specific behavioural tasks. Most neuropsychological tests are administered in the so-called 'paper-and-pencil' modality or via computerised protocols. The adequacy of these procedures has been recently questioned, with more specific concerns about their ecological validity, i.e. the relation between test scores observed in the laboratory setting and the actual everyday cognitive functioning. In developing more ecological tasks, researchers started to implement virtual reality (VR) technology as an administration technique focused on exposing individuals to simulated but realistic stimuli and environments, maintaining at the same time a controlled laboratory setting and collecting advanced measures of cognitive functioning. This systematic review aims to present how VR procedures for neuropsychological testing have been implemented in the last years. We initially explain the rationale for supporting VR as an advanced assessment tool, but we also discuss the challenges and risks that can limit the widespread implementation of this technology. Then, we systematised the large body of studies adopting VR for neuropsychological testing, describing the VR tools' distribution amongst different cognitive functions through a PRISMA-guided systematic review. The systematic review highlighted that only very few instruments are ready for clinical use, reporting psychometric proprieties (e.g. validity) and providing normative data. Most of the tools still need to be standardised on large cohorts of participants, having published only limited data on small samples up to now. Finally, we discussed the possible future directions of the VR neuropsychological test development linked to technological advances.