Immersive Video Games for Cognitive Impairment

(Quest-Tablet Trial)

Overseen By Melissa Arioli

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of California, San Francisco

Must not be taking: Psychotropic medications

Disqualifiers: Concussions, Dizziness, Balance problems, others

Compensation: Varies

Number of Visits: 2

200 Participants Needed

Trial Summary

What is the purpose of this trial?

Therapeutic treatment is yet available for declining memory, which is an impairment affecting the quality of life for many older adults and patients with cognitive impairment. Cognitive training with an immersive video game promises to drive hippocampal-cortical plasticity and associated gains that can restore memory capability or provide therapeutic treatment for memory deficits.

Will I have to stop taking my current medications?

If you are taking psychotropic medications (drugs that affect your mind, emotions, or behavior), you will need to stop taking them to participate in this trial.

What data supports the effectiveness of the treatment Wayfinding Intervention for cognitive impairment?

Research shows that a virtual reality wayfinding game, similar to the treatment, improved memory in older adults and helped a person with Alzheimer's disease improve navigation skills in daily life. This suggests that the treatment could be beneficial for cognitive impairment by enhancing memory and navigation abilities. ^{1 2 3 4 5}

Is the immersive video game treatment generally safe for humans?

The research does not provide specific safety data for the immersive video game treatment, but it has been used in studies with older adults and individuals at risk for cognitive impairment without reported safety concerns. ^{1 3 6 7 8}

How is the Wayfinding Intervention treatment unique for cognitive impairment?

The Wayfinding Intervention treatment is unique because it uses immersive virtual reality (VR) games to improve memory and cognitive skills by engaging users in spatial navigation tasks, which is different from traditional cognitive therapies that do not typically use VR technology. ^{1 2 7 9 10}

Research Team

Peter E Wais, PhD

Principal Investigator

Neuroscape, Department of Neurology

Eligibility Criteria

This trial is for older adults with memory issues or mild cognitive impairment. Participants must have good vision (with glasses if needed), be fluent in English, have completed at least 12 years of education, and be able to operate a response box. They should also be physically able to take brisk walks and not have conditions that make fMRI scans unsafe.

Inclusion Criteria

Fluent speakers of English

Dexterity to comfortably operate the scanner-compatible response box

Completed 12 or more years of education

Exclusion Criteria

I am taking medication for my mental health.

Significant discomfort with virtual reality experiences

I have had concussions or issues with dizziness and balance.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training

Participants undergo a 15 to 20-hour training regimen using virtual reality and tablet-based cognitive interventions

2-3 weeks

Remote training sessions

Post-training Assessment

Pre- and post-training assessments to evaluate cognitive improvements and collect MRI data

1 week

2 visits (in-person)

Follow-up

Participants are monitored for sustained cognitive improvements and any long-term effects

4 weeks

Treatment Details

Interventions

• Wayfinding Intervention

Trial Overview The study tests whether immersive video games can improve memory by changing brain activity. It uses LabyrinthVR software and other similar tools compared against placebo games to see if they can help restore memory functions or provide therapeutic benefits.

Participant Groups

Group I: LabyrinthVR Scoot Experimental Treatment 1 Intervention

Multi-session cognitive intervention with VIVE high-resolution head-mounted display virtual reality computer game that presents an adaptive spatial wayfinding challenge. Game movement via handheld controllers.

Group II: Labyrinth VR wireless Experimental Treatment 1 Intervention

Multi-session cognitive intervention with QUEST head-mounted display virtual reality computer game using wireless technology to present an adaptive spatial wayfinding challenge. Game movement via handheld controllers.

Group III: Labyrinth Tablet Experimental Treatment 1 Intervention

Multi-session cognitive intervention with tablet computer, displaying 2.5D version of Labyrinth game in an adaptive spatial wayfinding challenge. Game movement via on-screen control buttons.

Group IV: Placebo Controls Placebo Group 1 Intervention

Multi-session cognitive intervention with handheld tablet or wireless virtual reality headset presentation of commercially available, narrative computer games.

Who Is Running the Clinical Trial?

University of California, San Francisco

Lead Sponsor

Trials

2,636

Recruited

19,080,000+

Findings from Research

A virtual reality (VR) spatial wayfinding game called Labyrinth-VR was tested on 48 older adults (average age 68.7 years) and showed significant improvements in long-term memory (LTM) capabilities after 12 hours of gameplay over four weeks.

Participants who played Labyrinth-VR achieved memory performance levels comparable to younger adults, indicating that this VR intervention can enhance LTM in older adults and may benefit hippocampal-dependent memory functions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual reality video game improves high-fidelity memory in older adults. Wais, PE., Arioli, M., Anguera-Singla, R., et al.[2021]

A case study of a man with early Alzheimer's disease showed that he could successfully learn to navigate in a virtual reality environment, indicating potential for cognitive training in AD.

Feedback from his caregiver suggested that this training not only improved his navigation skills in the virtual setting but also translated to real-life benefits, such as better driving skills and overall cognitive improvement at home.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neurocognitive Treatment for a Patient with Alzheimer's Disease Using a Virtual Reality Navigational Environment. White, PJ., Moussavi, Z.[2020]

Virtual reality (VR) testing of navigation skills closely correlates with real-world navigation performance in older adults and those with early Alzheimer's disease, indicating that VR can be a valid assessment tool.

Both aging and Alzheimer's disease patients exhibit similar difficulties in self-orientation and scene localization, with Alzheimer's patients also facing challenges in verbal recall, highlighting the risks associated with navigational deficits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Detecting navigational deficits in cognitive aging and Alzheimer disease using virtual reality. Cushman, LA., Stein, K., Duffy, CJ.[2022]

A virtual reality (VR) technique was developed to assess spatial orientation, showing significant differences in performance between individuals with mild Alzheimer's disease (AD) and those with mild cognitive impairment (MCI), based on a study of 93 participants.

The results indicate that this VR localization method could serve as a quick and effective diagnostic tool to differentiate early stages of AD from MCI, with longitudinal tracking of patients supporting its potential clinical utility.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Egocentric spatial orientation differences between Alzheimer's disease at early stages and mild cognitive impairment: a diagnostic aid. Moussavi, Z., Kimura, K., Lithgow, B.[2022]

Individuals with Alzheimer's disease (AD) or mild cognitive impairment (MCI) showed significantly impaired wayfinding abilities compared to older adults without cognitive impairments, highlighting the challenges they face in navigation.

Using salient cues (like colorful and memorable markers) in a virtual reality simulation improved wayfinding performance for all participants, suggesting that enhancing environments with such cues can help those with AD and MCI navigate more effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Salient Cues and Wayfinding in Alzheimer's Disease within a Virtual Senior Residence. Davis, R., Ohman, JM., Weisbeck, C.[2019]

The pilot study involved 27 low-active adults aged 45 to 62 years who participated in a 10-week trial, showing that iPad-enhanced aerobic exercise improved wayfinding self-efficacy, indicating increased confidence in navigation skills.

While the experimental group did not show significant differences in behavioral wayfinding tasks compared to the control group, they performed better on an attentional-control cognitive assessment, suggesting potential cognitive benefits from the virtual reality component of the exercise.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Traditional vs. iPad-Enhanced Aerobic Exercise on Wayfinding Efficacy and Cognition: A Pilot Randomized Controlled Trial. Palac, D., Bullard, T., Cohen, JD., et al.[2020]

A study involving 11 neurologic patients with spatial disorientation and 11 healthy controls showed that a VR-based passive navigation training program significantly improved route finding abilities over five training sessions.

Both neurologic patients and healthy controls demonstrated enhanced general spatial cognition after the VR training, suggesting that this method could be effective for rehabilitating spatial deficits caused by brain damage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual reality in neurologic rehabilitation of spatial disorientation. Kober, SE., Wood, G., Hofer, D., et al.[2021]

A novel mediated reality wayfinding system was developed to assist individuals with Topographical Disorientation (TD) by providing different types of positional information for indoor navigation.

Among the evaluated tools, the locator and minimap were preferred by users, as they offered the most relevant navigation information while also reducing energy expenditure during navigation tasks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Navigation in smart environments using mediated reality tools. Torres-Solis, J., Guan, M., Biddiss, E., et al.[2009]

A collaborative design approach involving 7 individuals with dementia/MCI, exercise professionals, and game designers led to the creation of a VR exergame called 'Seas the Day', which promotes physical activity tailored for this population.

The study highlights that involving multiple stakeholders in the design process results in more effective and engaging VR games that meet the specific needs of persons living with dementia, demonstrating the potential for personalized health interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic. Muñoz, J., Mehrabi, S., Li, Y., et al.[2022]

Virtual reality (VR) tools can significantly enhance cognitive rehabilitation for individuals with mild cognitive impairment (MCI) and early-stage Alzheimer's disease, addressing the growing need for effective support services for the elderly population.

The immersive and interactive nature of VR technology offers unique advantages in improving daily life activities for those affected by cognitive impairments, suggesting a promising avenue for healthcare and caregiver assistance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using virtual reality for cognitive training of the elderly. García-Betances, RI., Jiménez-Mixco, V., Arredondo, MT., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Virtual reality video game improves high-fidelity memory in older adults. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Neurocognitive Treatment for a Patient with Alzheimer's Disease Using a Virtual Reality Navigational Environment. [2020]

3. United States pubmed.ncbi.nlm.nih.gov

Detecting navigational deficits in cognitive aging and Alzheimer disease using virtual reality. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Egocentric spatial orientation differences between Alzheimer's disease at early stages and mild cognitive impairment: a diagnostic aid. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Salient Cues and Wayfinding in Alzheimer's Disease within a Virtual Senior Residence. [2019]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Effects of Traditional vs. iPad-Enhanced Aerobic Exercise on Wayfinding Efficacy and Cognition: A Pilot Randomized Controlled Trial. [2020]

7. England pubmed.ncbi.nlm.nih.gov

Virtual reality in neurologic rehabilitation of spatial disorientation. [2021]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Navigation in smart environments using mediated reality tools. [2009]

9. Canada pubmed.ncbi.nlm.nih.gov

Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Using virtual reality for cognitive training of the elderly. [2022]