Virtual Reality for Depression in Alzheimer's Disease

(VRN Trial)

Overseen By Ashnie Sukhu, BSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Centre for Addiction and Mental Health

Disqualifiers: Unstable medical, psychiatric condition, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 8

Duration: 4 weeks

50 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to evaluate how virtual reality (VR) can alleviate symptoms like depression in individuals with Alzheimer's disease. Participants will use VR headsets at home to experience calming nature scenes, potentially improving mood and reducing anxiety. The study will compare this Nature-based Virtual Reality Intervention to watching nature videos on a device like a tablet. Ideal participants are those with mild to early-moderate Alzheimer's who are comfortable with technology and have a caregiver present during sessions. If successful, this approach could help individuals with dementia remain at home longer, delaying the need for institutional care. As an unphased trial, the study offers a unique opportunity to explore innovative ways to enhance the quality of life for those with Alzheimer's.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the study team or your doctor.

What prior data suggests that this virtual reality intervention is safe for individuals with dementia?

Research has shown that virtual reality (VR) can safely and effectively assist people with dementia, particularly in alleviating symptoms like depression. In one study, older adults with mild dementia engaged in nature-based VR experiences and experienced emotional improvement, feeling less anxious and more relaxed. Another study found that after just a month of VR use, caregivers reported feeling less stressed and burdened.

These findings suggest that VR is generally safe for people with dementia, with no major reports of negative reactions or side effects. This makes VR a promising option for those seeking non-medication-based ways to improve well-being. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the nature-based virtual reality treatment for depression in Alzheimer's patients because it offers a unique immersive experience that standard treatments, like medication and talk therapy, can't provide. Unlike traditional methods, this intervention uses virtual reality to transport patients into calming, nature-based environments, potentially enhancing emotional well-being and engagement. Additionally, this approach leverages cutting-edge technology to create a stimulating yet soothing experience that may be particularly beneficial for individuals with Alzheimer's, who often struggle with conventional therapies.

What evidence suggests that this virtual reality intervention is effective for depression in Alzheimer's disease?

Research has shown that nature-based virtual reality (VR) can help reduce symptoms of depression and anxiety. One study found that people using a nature-themed VR program felt less depressed and experienced better emotional health than those who did not use the VR program. Another study discovered that short VR mindfulness sessions eased symptoms of depression and anxiety. In this trial, participants in the treatment group will receive nature-based VR applications, while the control group will watch nature-based videos on a device. These findings suggest that using VR to create calming, nature-like experiences might effectively improve mood and emotional well-being in people with dementia. ^{1 2 6 7 8}

Who Is on the Research Team?

HARMEHR SEKHON, PhD

Principal Investigator

CAMH and McGill/St. Mary's Research Centre

Eric Brown, MD

Principal Investigator

CAMH and UofT

Are You a Good Fit for This Trial?

This trial is for individuals with Alzheimer's Disease who are experiencing depression. It's designed to test if nature-based virtual reality (VR) can help reduce their symptoms without needing to leave home. Caregivers of participants may also join the study.

Inclusion Criteria

Investigator judgement on whether the participant is comfortable with technology

I have WiFi and a smart device for health apps and WebEx.

I am 50 years old or older.

Exclusion Criteria

I do not have severe visual or hearing impairments.

Patient Health Questionnaire score 15-27 and/or score of 1 or 2 in section E question 1 of the Cornell Scale for Depression in Dementia

Unstable medical or psychiatric condition, including substance use based on an investigator opinion

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive a nature-based VR program for BPSD, delivered in-home, with 15-minute sessions twice per week

4 weeks

8 sessions (in-home)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Nature-based Virtual Reality Intervention

Trial Overview

Participants will use a VR program at home, featuring nature scenes, for four weeks—15 minutes per session, twice a week—to see if it helps with depression related to dementia.

How Is the Trial Designed?

Group I: Treatment Group Experimental Treatment 1 Intervention

Participants will receive nature-based applications available on the Oculus platform, as well as nature-based 360 videos with the same content as the control group however in a 360 format.

Group II: Control Group Active Control 1 Intervention

Participants will receive YouTube links to watch nature-based videos on a device (e.g., a tablet).

Who Is Running the Clinical Trial?

Centre for Addiction and Mental Health

Lead Sponsor

Trials

388

Recruited

84,200+

St. Mary's Research Center, Canada

Collaborator

Trials

11

Recruited

1,800+

Published Research Related to This Trial

A 6-session trial with 25 aged care residents showed that group-based immersive virtual reality (VR) significantly reduced depressive symptoms and apathy, while improving participants' pleasure and alertness.

The VR sessions were well-tolerated with minimal side effects, indicating that this innovative approach could be a feasible option for enhancing the emotional well-being of cognitively diverse residents in aged care facilities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of Group-Based Multiple Virtual Reality Sessions to Reduce Behavioral and Psychological Symptoms in Persons Living in Residential Aged Care. Brimelow, RE., Thangavelu, K., Beattie, R., et al.[2022]

A study involving 66 older adults (average age 80.5) demonstrated that immersive Virtual Reality (VR) therapy is feasible and safe for individuals with varying cognitive and physical impairments, with no reported negative side effects.

Participants generally found the VR experience enjoyable and relaxing, with 76% expressing a desire to try it again, indicating its potential as a non-pharmacological intervention to improve well-being in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Older Adults With Cognitive and/or Physical Impairments Can Benefit From Immersive Virtual Reality Experiences: A Feasibility Study. Appel, L., Appel, E., Bogler, O., et al.[2020]

In a study of 6440 patients aged 60 and older with dementia, the overall prevalence of depressive disorders was found to be 27.41%, with significantly higher rates in patients with vascular dementia (44.14%) and unspecified dementia (32.48%) compared to those with Alzheimer's disease (18.53%).

Patients with vascular dementia exhibited a notably higher prevalence of specific depressive subtypes, including major depressive disorder and dysthymic disorder, indicating that clinicians should be particularly vigilant for depression in this group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Subtypes of depression among patients with Alzheimer's disease and other dementias. Castilla-Puentes, RC., Habeych, ME.[2010]

In a study of 26 subjects with mild to moderate Alzheimer's disease, 15.4% were diagnosed with major depression, highlighting the common occurrence of depressive syndromes in this population.

The study found that traditional criteria for diagnosing major depression were less effective than alternative criteria, such as nonverbal signs of depression and irritability, which showed better sensitivity and specificity in identifying depression in Alzheimer's patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prevalence of depression in Alzheimer's disease and validity of Research Diagnostic Criteria. Vida, S., Des Rosiers, P., Carrier, L., et al.[2017]

The Virtual Reality Forest (VRF) experience positively impacted the mood and engagement of 10 residents with dementia, leading to increased pleasure and alertness during the session.

Despite the positive effects, residents also reported higher levels of fear and anxiety compared to a normative sample, indicating that while VR can enhance quality of life, it may also evoke some negative emotions that need to be addressed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of a Virtual Reality Forest on People With Dementia: A Mixed Methods Pilot Study. Moyle, W., Jones, C., Dwan, T., et al.[2019]

In a study of 108 matched pairs of patients with vascular dementia (VaD) and Alzheimer's disease (AD), major depressive disorder (MDD) was found to be significantly more prevalent in the VaD group (20.4%) compared to the AD group (10.2%), indicating a higher risk of depression in VaD patients.

The study also revealed that neurovegetative symptoms, such as persistent fatigue and unexplained weight changes, were more common in VaD patients, suggesting that depression in VaD is not only more prevalent but also presents with more severe and distinct symptoms compared to AD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Depression in vascular dementia is quantitatively and qualitatively different from depression in Alzheimer's disease. Park, JH., Lee, SB., Lee, TJ., et al.[2015]

Current virtual reality (VR) technologies for Alzheimer's disease applications are underutilizing immersive features, often relying on conventional 2D displays instead of fully engaging 3D environments.

To enhance the effectiveness of VR in diagnosing and training for Alzheimer's, improvements such as advanced head-mounted displays, multi-sensory interactions, and neuro-physiological feedback are recommended, along with making these technologies accessible for home and nursing home use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A succinct overview of virtual reality technology use in Alzheimer's disease. García-Betances, RI., Arredondo Waldmeyer, MT., Fico, G., et al.[2022]

Depression is a common issue in patients with dementia, and it can sometimes indicate the early stages of dementia rather than being a separate condition, highlighting the importance of accurate diagnosis in this population.

Despite cognitive impairments, reliable assessments of depression can be made using tools like the Geriatric Depression Scale and the Hamilton Rating Scale, and effective treatments are available for managing depression in dementia patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diagnosis and treatment of depression in patients with Alzheimer's disease and other dementias. Katz, IR.[2007]

In a study involving 21 Alzheimer's disease (AD) patients and 21 healthy controls, it was found that AD patients with depression exhibited higher cerebral blood flow (CBF) in specific brain regions compared to those without depression, indicating a potential link between brain perfusion and depressive symptoms.

The research identified that the combination of CBF measurements in the right supplementary motor area and right supramarginal gyrus, along with age, could accurately distinguish AD patients with depression from those without, achieving a specificity of 100% and an accuracy of 85.71%.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Altered Cerebral Blood Flow in Alzheimer's Disease With Depression. Li, R., Zhang, Y., Zhuo, Z., et al.[2021]

A 79-year-old woman with Alzheimer's disease successfully relearned cooking tasks using non-pharmacological interventions, including virtual reality techniques, over a training period of four days per task.

The improvements in her cooking abilities were stable over time and transferred to real-life situations, suggesting that virtual reality can be an effective tool for enhancing autonomy in daily activities for Alzheimer's patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The potential of virtual reality-based training to enhance the functional autonomy of Alzheimer's disease patients in cooking activities: A single case study. Foloppe, DA., Richard, P., Yamaguchi, T., et al.[2018]

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