Age-related performance in using a fully-immersive and automated virtual reality system to assess cognitive function (Preprint)
Authors: Tan Ngiap Chuan , Lim Jie En , Allen Jr John Carson , Wong Wei Teen , Lai Wern Shen Maksim , Quah Hui Min Joanne , Paulpandi Muthulakshmi , Teh Tuan Ann , Lim Soon Huat , Malhotra Rahul 
Published: April 2021

BACKGROUND

Cognition generally declines gradually over time due to progressive degeneration of the brain, leading to dementia and eventual loss of independent functions. Cognition in the six domains (perceptual motor, executive function, complex attention, learning and memory, social cognition and language) varies in their rate of regression. Current modality of cognitive assessment using neuropsychological, questionnaire-based such as the Montreal Cognitive Assessment (MoCA) has its limitations and is influenced by age. Virtual reality (VR) has been introduced as a potential alternative tool to assess cognition. A novel fully immersive automated VR system (CAVIRE) has been developed to assess the six cognitive domains. As cognition is associated with age, VR performance is postulated to vary with age using this system.

OBJECTIVE

This study aimed to evaluate the VR performance of cognitively healthy adults using the CAVIRE system based on its automated scoring matrix and completion time.

METHODS

Conducted in a public primary care clinic in Singapore, the study recruited 25 multi-ethnic Asian adults in each of the age groups in years: 1. 35-44; 2. 45-54; 3. 55-64 and 4. 65-74. Their eligibility included a MoCA score of 26 or higher to reflect normal cognition and understanding the automated English instructions in the CAVIRE system. They completed common daily activities from brushing teething to shopping across 13 virtual segments. Their performances were automatically evaluated and computed using cognitive domain score matrix and completion time of the VR tasks. These VR performance indices were compared across the age groups using a one-way ANOVA, F-test of the hypothesis, followed by pair-wise comparisons in the event of a significant F-test (p<0.05).

RESULTS

One participant dropped out from Group 1. The demographic characteristics of 99 participants were similar across the 4 age groups. Overall, younger participants in Groups 1 and 2 attained higher VR performance scores and shorter completion time using the CAVIRE system, compared to those in Groups 3 and 4 in every cognitive domain (all p<0.05).
Significant differences in performance scores are noted in sequential age groups from 1 to 3 in “Executive Functions”; Group 1 and those in Groups 3 and 4 in “perceptual motor; Group 1 and those in Groups 2, 3 and 4 in “complex attention” and “social cognition”; Group 1 and 4 In “learning and memory”; Groups 1 and 2 and those in Groups 3 and 4 in language. Significant differences in completion time are noted between Groups 1 and 3 except for “social cognition”; and between Groups 2 and 3, except for “learning and memory”.

CONCLUSIONS

The CAVIRE VR performance scores and completion time significantly differ between the younger and older Asian participants with normal cognition. Enhancements to the system are needed to establish the age-group specific normal performance indices.

CLINICALTRIAL

INTERNATIONAL REGISTERED REPORT

RR2-10.3389/fnagi.2020.604670