A Novel Virtual Reality-Based Training Protocol for the Enhancement of the “Mental Frame Syncing” in Individuals with Alzheimer's Disease: A Development-of-Concept Trial

Abstract

A growing body of evidence suggests that people with Alzheimer's Disease (AD) show compromised spatial abilities. In addition, there exists from the earliest stages of AD a specific impairment in “mental frame syncing,” which is the ability to synchronize an allocentric viewpoint-independent representation (including object-to-object information) with an egocentric one by computing the bearing of each relevant “object” in the environment in relation to the stored heading in space (i.e., information about our viewpoint contained in the allocentric viewpoint-dependent representation). The main objective of this development-of-concept trial was to evaluate the efficacy of a novel VR-based training protocol focused on the enhancement of the “mental frame syncing” of the different spatial representations in subjects with AD. We recruited 20 individuals with AD who were randomly assigned to either “VR-based training” or “Control Group.” Moreover, eight cognitively healthy elderly individuals were recruited to participate in the VR-based training in order to have a different comparison group. Based on a neuropsychological assessment, our results indicated a significant improvement in long-term spatial memory after the VR-based training for patients with AD; this means that transference of improvements from the VR-based training to more general aspects of spatial cognition was observed. Interestingly, there was also a significant effect of VR-based training on executive functioning for cognitively healthy elderly individuals. In sum, VR could be considered as an advanced embodied tool suitable for treating spatial recall impairments.

Effects of Combined Physical and Cognitive Virtual Reality-Based Training on Cognitive Impairment and Oxidative Stress in MCI Patients: A Pilot Study

“…The major features of VR are aimed at providing easy and intuitive interaction and multidimensional sensory feedback, offering the patient an opportunity to practice activities of daily living that cannot occur in conventional rehabilitation programs, through motivational activities facilitating treatment compliance and customizable on the patient’s characteristics (Rizzo and Kim, 2005 ; García-Betances et al, 2015b ). Therefore, research on VR applied to neurorehabilitation has recently flourished, with increasing evidence of efficacy (Rizzo and Kim, 2005 ; Serino et al, 2017 ; Anderson-Hanley et al, 2018 ; Tieri et al, 2018 ).…”

Disentangling the Contribution of Spatial Reference Frames to Executive Functioning in Healthy and Pathological Aging: An Experimental Study with Virtual Reality

“…The efforts in understanding the relationship between cognitive weaknesses in AD population may also open interesting rehabilitation possibilities. For example, Serino and colleagues found that a VR-based training specifically built for the empowerment of the “Mental Frame Syncing” in a sample of patients with AD led also to an improvement in some tests tapping executive functioning (i.e., Verbal Fluency Test, Verbal Categorical Test, and FAB) [ 37 ]. Influencing higher-order cognitive abilities, such as the executive functions, the spatial reference frames appear to dramatically impact the way individuals categorize information.…”

“…Besides the opportunity for an ecological, controlled and secure testing, within virtual environments, it is possible to set-up a “reorientation task” by systematically varying the starting point of the retrieval phase with respect to the encoding phase [ 35 , 36 ]. This strategy (i.e., the virtual disorientation) forces participants to refer to their stored allocentric map and synchronize it with new egocentric input (i.e., the MFS ability) to orient in the environment [ 37 , 38 , 39 ]. In a recent study from our group, we exploited the potential of VR to study the presence of allocentric and syncing deficits in a sample of patients with AD and amnestic MCI.…”

Digital Biomarkers for the Early Detection of Mild Cognitive Impairment: Artificial Intelligence Meets Virtual Reality

“…This, in turn, has supported its deployment for both clinical and non-clinical samples of elderly people and young adults ( García-Betances et al, 2015 ; De Tommaso et al, 2016 ; Plancher and Piolino, 2017 ). Within medical and neuropsychological settings, VR has been extensively applied as an assessment and a rehabilitation tool for elderly people suffering from consequences of a traumatic brain injury ( Aida et al, 2018 ; Alashram et al, 2019 ; Maggio et al, 2019 ), for post-stroke patients ( Henderson et al, 2007 ; Saposnik and Levin, 2011 ; Laver et al, 2017 ), and for spatial memory and balance ( Allain et al, 2014 ; Serino et al, 2017 ; Gerber et al, 2018 ; Soares et al, 2018 ), among other applications (see Plancher and Piolino, 2017 ; Moreno et al, 2019 ). Crucially, VR allows the therapy to be tailored in a controlled way, according to each disease starting from a continuous assessment of the individual’s behaviors.…”