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

Abstract

The growing elderly population and the increased incidence of mild cognitive impairment (MCI) and Alzheimer’s disease (AD) call for the improvement of the quality and the efficacy of the healthcare and social support services. Exercise and cognitive stimulation have been demonstrated to mitigate cognitive impairment and oxidative stress (OxS) has been recognized as a factor that contributes to the advancement of neurodegenerative diseases. Taking these aspects into account, the impact of a novel virtual reality (VR)-based program combining aerobic exercise and cognitive training has been evaluated in the pilot study proposed here. Ten patients (aged 73.3 ± 5.7 years) with MCI (Mini-Mental State Examination, MMSE: 23.0 ± 3.4) were randomly assigned to either 6 weeks physical and cognitive training (EXP) or control (CTR) group. Evaluations of cognitive profile, by a neuropsychological tests battery, and OxS, by collection of blood and urine samples, were performed before and at the end of the experimental period. The assessment of the patients’ opinions toward the intervention was investigated through questionnaires. EXP group showed a tendency towards improvements in the MMSE, in visual-constructive test and visuo-spatial tests of attention, while CTR worsened. EXP group showed a greater improvement than CTR in the executive test, memory functions and verbal fluency. No statistical significance was obtained when comparing within and between both the groups, probably due to small number of subjects examined, which amplifies the effect of the slight heterogeneity in scores recorded. Despite a greater worsening of Daily Living Activities tests, all participants reported a better performance in real life, thanks to the elicited self-perceived improvement. After training intervention OxS (i.e., reactive oxygen species (ROS) production, oxidative damage of lipids and DNA) decreased resulting in significantly (range p < 0.05–0.001) lower in EXP vs. CTR group. Although not conclusive, the recorded effects in the present study are promising and suggest that this proposal would be a useful tool in support of cognitive training reducing OxS too. However, further studies on larger scale samples of patients are needed.

Effectiveness of Exergaming in Improving Cognitive and Physical Function in People With Mild Cognitive Impairment or Dementia: Systematic Review

“…The exergames in 5 studies were implemented on sensor-based platforms [ 50 , 67 , 68 , 71 , 72 ] such as Nintendo Wii-Fit and FitForAll; 4 studies used video camera systems such as Xbox 360 Kinect, X-Torp, and Bike Labyrinth to capture physical movements [ 52 , 66 , 69 , 70 ]; and another study used a handheld controller [ 45 ]. The interventions were administered by a researcher [ 45 , 50 , 68 - 70 , 72 ], therapist [ 66 ], clinical doctor [ 52 ], and family caregiver [ 71 ]. In the study of Bamidies et al [ 67 ], the intervention was carried out in a group setting with psychologists, physical education instructors, researchers, or nurses.…”

“…In the study of Bamidi et al [ 67 ], a group of psychologists, physical education instructors, researchers, and nurses helped each elderly person design a plan that included aerobic, resistance, and strength exercises. However, due to the small sample size, short intervention duration [ 70 - 72 ], and lack of specific exercises [ 72 ], a positive result was not obtained in several other preliminary experiments [ 50 , 70 - 72 ]. In addition, some studies reported “small” to “moderate” effect sizes for the cognitive function results [ 50 , 52 , 72 , 80 ].…”

Effects of Virtual Reality-Based Physical and Cognitive Training on Executive Function and Dual-Task Gait Performance in Older Adults With Mild Cognitive Impairment: A Randomized Control Trial

“…The advantages of using VR interventions include enhancing accessibility and cost-effectiveness, creating an immersive experience, and providing immediate feedback based on an individual’s performance. Previous articles have shown positive effects of these VR interventions on attention and visual and verbal memory, as well as executive functioning, in older adults with MCI (Coyle et al, 2015; Mrakic-Sposta et al, 2018). Due to the advantages of VR, integrating physical and cognitive training into VR appears to be a good intervention approach.…”

Oxidative Stress and New Pathogenetic Mechanisms in Endothelial Dysfunction: Potential Diagnostic Biomarkers and Therapeutic Targets

“…Several factors appear to affect endothelial dysfunction, and different strategies have been proposed to change these factors and counteract it. Other than conventional drug therapies, lifestyle and dietary interventions are majorly encouraged, especially in age-related vascular endothelial dysfunction [ 198 ]. For example, regular exercise and caloric restriction can exert beneficial effects increasing NO bioavailability, eNOS, and SOD activity, as well as reducing oxidative stress, cholesterol, and systolic blood pressure.…”