Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Brain Health Center, Gil Medical Center, Incheon, Republic of Korea.
J Med Internet Res. 2021 May 6;23(5):e24526. doi: 10.2196/24526.
Cognitive training can potentially prevent cognitive decline. However, the results of recent studies using semi-immersive virtual reality (VR)-assisted cognitive training are inconsistent.
We aimed to examine the hypothesis that cognitive training using fully immersive VR, which may facilitate visuospatial processes, could improve visuospatial functioning, comprehensive neuropsychological functioning, psychiatric symptoms, and functional connectivity in the visual brain network in predementia.
Participants over 60 years old with subjective cognitive decline or mild cognitive impairment from a memory clinic were randomly allocated to the VR (n=23) or the control (n=18) group. The VR group participants received multidomain and neuropsychologist-assisted cognitive training in a fully immersive VR environment twice a week for 1 month. The control group participants did not undergo any additional intervention except for their usual therapy such as pharmacotherapy. Participants of both groups were evaluated for cognitive function using face-to-face comprehensive neuropsychological tests, including the Rey-Osterrieth Complex Figure Test (RCFT) copy task; for psychiatric symptoms such as depression, apathy, affect, and quality of life; as well as resting-state functional magnetic resonance imaging (rsfMRI) at baseline and after training. Repeated-measures analysis of variance was used to compare the effect of cognitive training between groups. Seed-to-voxel-based analyses were used to identify the cognitive improvement-related functional connectivity in the visual network of the brain.
After VR cognitive training, significant improvement was found in the total score (F=14.69, P=.001) and basic components score of the RCFT copy task (F=9.27, P=.005) compared with those of the control group. The VR group also showed improvements, albeit not significant, in naming ability (F=3.55, P=.07), verbal memory delayed recall (F=3.03, P=.09), and phonemic fluency (F=3.08, P=.09). Improvements in psychiatric symptoms such as apathy (F=7.02, P=.01), affect (F=14.40, P=.001 for positive affect; F=4.23, P=.047 for negative affect), and quality of life (F=4.49, P=.04) were found in the VR group compared to the control group. Improvement in the RCFT copy task was associated with a frontal-occipital functional connectivity increase revealed by rsfMRI in the VR group compared to the control group.
Fully immersive VR cognitive training had positive effects on the visuospatial function, apathy, affect, quality of life, and increased frontal-occipital functional connectivity in older people in a predementia state. Future trials using VR cognitive training with larger sample sizes and more sophisticated designs over a longer duration may reveal greater improvements in cognition, psychiatric symptoms, and brain functional connectivity.
Clinical Research Information Service KCT0005243; https://tinyurl.com/2a4kfasa.
认知训练可能有助于预防认知能力下降。然而，最近使用半沉浸式虚拟现实（VR）辅助认知训练的研究结果并不一致。
我们旨在检验假设，即使用完全沉浸式 VR 进行认知训练，这可能有助于视觉空间处理，可以改善前痴呆期的视觉空间功能、综合神经心理学功能、精神症状和视觉大脑网络的功能连接。
来自记忆诊所的 60 岁以上有主观认知下降或轻度认知障碍的参与者被随机分配到 VR（n=23）或对照组（n=18）。VR 组参与者每周在完全沉浸式 VR 环境中接受两次多领域和神经心理学家辅助的认知训练，为期 1 个月。对照组参与者除了接受常规治疗（如药物治疗）外，不进行任何额外干预。两组参与者均使用面对面的综合神经心理学测试评估认知功能，包括 Rey-Osterrieth 复杂图形测试（RCFT）复制任务；评估精神症状，如抑郁、冷漠、情绪和生活质量；以及静息状态功能磁共振成像（rsfMRI）。采用重复测量方差分析比较两组认知训练的效果。种子到体素的分析用于确定大脑视觉网络中与认知改善相关的功能连接。
与对照组相比，VR 认知训练后，RCFT 复制任务的总分（F=14.69，P=.001）和基本成分得分（F=9.27，P=.005）显著提高。VR 组在命名能力（F=3.55，P=.07）、言语记忆延迟回忆（F=3.03，P=.09）和语音流畅性（F=3.08，P=.09）方面也有改善，尽管不显著。与对照组相比，VR 组在冷漠（F=7.02，P=.01）、情绪（正性情绪 F=14.40，P=.001；负性情绪 F=4.23，P=.047）和生活质量（F=4.49，P=.04）方面的精神症状也有所改善。与对照组相比，VR 组的 RCFT 复制任务的改善与 rsfMRI 显示的额-枕功能连接增加有关。
完全沉浸式 VR 认知训练对老年人前痴呆状态下的视觉空间功能、冷漠、情绪、生活质量和额-枕功能连接增加有积极影响。未来使用 VR 认知训练的更大样本量、更复杂设计和更长时间的试验可能会显示出认知、精神症状和大脑功能连接的更大改善。
临床研究信息服务 KCT0005243；https://tinyurl.com/2a4kfasa。
