Yan Mingli, Yin Huiru, Meng Qiuyan, Wang Shuo, Ding Yiwen, Li Guichen, Wang Chunyan, Chen Li
School of Nursing, Jilin University, Changchun, China.
Senior Officials Inpatient Ward, First Hospital of Jilin University, Changchun, China.
JMIR Serious Games. 2021 Dec 3;9(4):e30919. doi: 10.2196/30919.
Mild cognitive impairment (MCI) is often a precursor of dementia, and patients with MCI develop dementia at a higher rate than healthy older adults. Early detection of cognitive decline at the MCI stage supports better planning of care and interventions. At present, the use of virtual reality (VR) in screening for MCI in older adults is promising, but there is little evidence regarding the use of virtual supermarkets to screen for MCI.
The objectives of this study are to validate a VR game-based test, namely, the Virtual Supermarket Program (VSP), for differentiating patients with MCI and healthy controls and to identify cutoff scores for different age levels.
Subjects were recruited from several nursing homes and communities in Changchun, China. They were divided into a healthy control group (n=64) and an MCI group (n=62). All subjects were administered the VSP and a series of neuropsychological examinations. The study determined the optimal cutoff, discriminating validity, concurrent validity, and retest reliability of the VSP. We used the area under the receiver operating characteristic curve (AUC) to evaluate the discriminating validity and obtain the optimal cutoff values. Pearson correlation analysis and the intraclass correlation coefficient were used to evaluate the concurrent validity and retest reliability, respectively.
A cutoff score of 46.4 was optimal for the entire sample, yielding a sensitivity of 85.9% and specificity of 79.0% for differentiating individuals with MCI and healthy controls, and the AUC was 0.870 (95% CI 0.799-0.924). The median index of VSP score was 51.1 (range 42.6-60.0). There was a moderate positive correlation between the VSP total score and Mini-Mental State Examination score (r=0.429, P<.001). There was a strong positive correlation between VSP total score and Montreal Cognitive Assessment score (r=0.645, P<.001). The retest reliability of the VSP was feasible (r=0.588, P=.048).
The VSP is interesting and feasible for subjects. It shows high sensitivity and specificity for the identification of MCI in older adults, which makes it a promising screening method. The VSP may be generalized to older adults in other countries, although some cultural adaptation may be necessary.
Chinese Clinical Trial Registry ChiCTR2000040074; https://www.chictr.org.cn/showprojen.aspx?proj=64639.
轻度认知障碍（MCI）通常是痴呆症的先兆，MCI患者发展为痴呆症的几率高于健康的老年人。在MCI阶段早期发现认知衰退有助于更好地规划护理和干预措施。目前，虚拟现实（VR）在老年人MCI筛查中的应用前景广阔，但关于使用虚拟超市进行MCI筛查的证据很少。
本研究的目的是验证一种基于VR游戏的测试，即虚拟超市程序（VSP），用于区分MCI患者和健康对照，并确定不同年龄水平的临界值。
在中国长春的几家养老院和社区招募受试者。他们被分为健康对照组（n = 64）和MCI组（n = 62）。所有受试者均接受VSP测试和一系列神经心理学检查。本研究确定了VSP的最佳临界值、区分效度、同时效度和重测信度。我们使用受试者工作特征曲线（AUC）下的面积来评估区分效度并获得最佳临界值。分别使用Pearson相关分析和组内相关系数来评估同时效度和重测信度。
整个样本的最佳临界值为46.4分，区分MCI患者和健康对照的敏感性为85.9%，特异性为79.0%，AUC为0.870（95%CI 0.799 - 0.924）。VSP评分的中位数为51.1（范围42.6 - 60.0）。VSP总分与简易精神状态检查表评分之间存在中度正相关（r = 0.429，P <.001）。VSP总分与蒙特利尔认知评估量表评分之间存在强正相关（r = 0.645，P <.001）。VSP的重测信度是可行的（r = 其0.588，P =.048）。
VSP对受试者来说有趣且可行。它在识别老年人MCI方面具有较高的敏感性和特异性，这使其成为一种有前景的筛查方法。尽管可能需要一些文化适应性调整，但VSP可能适用于其他国家的老年人。
中国临床试验注册中心ChiCTR2000040074；https://www.chictr.org.cn/showprojen.aspx?proj=64639 。
