Applicability of an immersive virtual reality system for assessing route learning in older adults

Santos, Michelle Didone dos; Silva, Juliana Magalhães da; Costa, Raquel Quimas Molina da; Viveiro, Larissa Alamino Pereira de; Moretto, Emerson Galves; Lopes, Roseli de Deus; Brucki, Sonia Maria Dozzi; Pompeu, José Eduardo

doi:10.1590/1980-5764-DN-2021-0006

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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 16 (2) • Apr-Jun 2022 • https://doi.org/10.1590/1980-5764-DN-2021-0006 copy

Applicability of an immersive virtual reality system for assessing route learning in older adults

APLICABILIDADE DE UM SISTEMA DE REALIDADE VIRTUAL IMERSIVO PARA AVALIAÇÃO DA APRENDIZAGEM DE ROTAS EM IDOSOS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

Spatial orientation is defined as the ability to find one’s way around an environment, follow familiar routes, recognize places, and learn new routes. Spatial disorientation is one of the early symptoms of Alzheimer’s disease (AD), and traditional cognitive evaluation lacks ecological validity. Therefore, new assessment methods are needed for the early identification of this cognitive impairment.

Objective:

This study aimed to compare the applicability and stability of an immersive virtual reality (VR) system developed to assess route learning between older adults with and without mild cognitive impairment (MCI).

Methods:

The study sample included 43 older adults: 22 without MCI and 23 with MCI. Applicability was assessed based on the recording of adverse events and the sense of presence reported through questionnaires. The Mann–Whitney U test was applied to compare the applicability of the Spatial Orientation in Immersive Virtual Environment Test (SOIVET)-Route task between older adults with and without MCI. Both short- and long-term stabilities of the task were evaluated using the intraclass correlation coefficient (ICC).

Results:

The mean age of participants was 71.4 years (SD=5.5). A minimum number of adverse events (mean=1.46; SD=2.11) and high levels of presence (mean=138.04; SD=14.80) were reported, and there was no difference between groups with and without MCI. A good to excellent correlation was found for short-term stability (CCI 0.78) and a reasonable correlation was found for long-term stability (CCI 0.58).

Conclusions:

The VR system was applicable for older adults and showed a good to excellent correlation for short-term stability.

Keywords:
Orientation, Spatial; Aged; Virtual Reality; Technology; Validation Study

		Total sample (n=45)	Elderly people without MCI (n=22)	Elderly people with MCI (n=23)	p-value
Age (years)		71.4±5.5	71.0±5.7	71.8±5.4	0.53^a a p-value referring to the Mann-Whitney U test;
Gender, n (%)	Female	28 (62)	14 (64)	14 (61)	1.00^c c p-value referring to Fisher’s exact test. MCI: mild cognitive impairment; ACE-R: Addenbrooke’s Cognitive Examination – Revised.
Gender, n (%)	Male	17 (37)	8 (36)	9 (39)
Education, n (%)	First grade completed	2 (4)	2 (9)	0 (0)	0.005^c c p-value referring to Fisher’s exact test. MCI: mild cognitive impairment; ACE-R: Addenbrooke’s Cognitive Examination – Revised.
	Second grade completed	12 (27)	2 (9)	10 (43)
	Higher education	29 (65)	18 (82)	11 (48)
	Graduate course	2 (4)	0 (0)	2 (9)
ACE-R		90.5±6.3	94.9±2.8	86.3±5.8	<0.001^b b p-value referring to the Student’s t-test for independent samples;
Motion sickness screening		0.55±1.13	0.40±1.18	0.69±1.10	0.08^a a p-value referring to the Mann-Whitney U test;
Familiarity with the technology		17.8±8.4	20.4±8.3	15.3±8.0	0.034^a a p-value referring to the Mann-Whitney U test;
Comorbidities, n (%)	Yes	33 (75)	17 (77)	16 (73)	1.00^c c p-value referring to Fisher’s exact test. MCI: mild cognitive impairment; ACE-R: Addenbrooke’s Cognitive Examination – Revised.
Comorbidities, n (%)	No	12 (25)	5 (23)	6 (27)

	Total sample (n=45)	Elderly people without MCI (n=22)	Elderly people with MCI (n=23)	p-value	Hedge’s g
Cybersickness	1.46±2.11	1.13±1.93	1.78±2.27	0.29	0.30
Sense of presence and immersion	138.04±14.80	137.81±14.62	138.26±15.30	0.73	0.03

	ICC D1×D2		ICC Immediate×late
Total sample (n=45)	Immediate recall (virtual)	0.58^b b p≤0.01.	D1	0.78^b b p≤0.01.
Total sample (n=45)	Late recall (virtual)	0.37^a a p<0.05	D2	0.81^b b p≤0.01.
Elderly people without MCI (n=22)	Immediate recall (virtual)	0.28	D1	0.60^b b p≤0.01.
Elderly people without MCI (n=22)	Late recall (virtual)	0.03	D2	0.73^b b p≤0.01.
Elderly people with MCI (n=23)	Immediate recall (virtual)	0.63^b b p≤0.01.	D1	0.80^b b p≤0.01.
Elderly people with MCI (n=23)	Late recall (virtual)	0.44	D2	0.85^b b p≤0.01.

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Correspondence: Michelle Didone dos Santos; Email: michelle.didone@hotmail.com.