Development of a Virtual Floor Maze Test - Effects of Distal Visual Cues and Correlations With Executive Function in Healthy Adults.

Virtual reality (VR) is a useful tool to assess and improve spatial navigation, a complex skill and relevant marker for progression of dementia. A fully-immersive VR system that allows the user to physically navigate in the space can provide an ecologically valid environment for early detection and remediation of cognitive and navigational deficits. The aim of this study was to develop a virtual version of the floor maze test (VR-FMT), a navigational test that requires navigating through an unfamiliar two-dimensional floor maze. With the VR-FMT, mazes of desired complexity and walls of preferred height can be built to challenge navigational ability and mask visual clues. Fifty-five healthy adults completed the FMT in three different conditions: real environment (RE), virtual environment with no walls (VE-NW), and virtual environment with walls (VE-W). In addition, they completed two neuropsychological tests, the Trail Making Test and Digit Symbol Substitution Test. Results showed that the time to complete the maze in the VE was significantly higher than in the RE. The introduction of walls increased the number of errors, the completion time, and the length of the path. Only time to exit in the VE-W correlated with results of the cognitive tests. Participants were further subdivided on the basis of their time to exit the maze in the RE, VE-NW, and VE-W (low navigational time - LNT, and high navigational time - HNT). Only when analyzing the time to exit the maze in the VE-W, the LNT group outperformed the HNT group in all cognitive tests.