Technology and interventions with older adults and MCI
Dr Clara Calia, Dr Mei Yii Lim, Dr Serge Hoefeijzers and Dr Mario Parra
To date, there are no effective pharmacological treatments for patients with mild cognitive impairment (MCI) or dementia. Existing pharmacological therapies have only shown mild to moderate effects on behaviour, cognition and function (Winblad et al., 2004). On the contrary, some studies have shown that cognitive interventions can have a positive effect on patients with MCI (Belleville et al., 2006; Kinsella et al., 2009; Simon et al, 2012; Unverzagt et al., 2007).
A new line of investigation in the development of neuropsychological assessment and intervention programmes for memory deficits in older subjects is relying on virtual reality (VR) technologies (Optale, Urgesi, Busato, Marin, Piron, Priftis, et al. 2010; García-Betances, Arredondo Waldmeyer, Fico & Cabrera-Umpiérrez, 2015; Rizzo, Schultheis, Kerns & Mateer, 2004). The high ecological validity of VR technologies make VR a promising tool for both neuropsychological assessments and intervention treatments (Campbell, Zakzanis, Jovanovski, Joordens, Mraz & Graham, 2009; Lesk, Shamsuddin, Elizabeth, Walters & Ugail, 2014; Shah, Torres, Kannusamy, Chnq, He & Klainin- Yobas, 2015; Tarnanas, Schlee, Tsolaki, Müri, Mosimann, & Nef 2013; Parsons, 2015). Several studies ascertained the efficiency of VR supporting both patients in the early stages of dementia and their family by giving educational support and memory assistance (Cotelli, Manenti, Zanetti, & Miniussi, 2012; García-Betances, Jiménez-Mixco, Arredondo & Cabrera- Umpiérrez, 2014; Gregg & Tarrier, 2007; Man, Chung, & Lee, 2012). To date several research studies have focused on specific aspects of cognitive impairments in AD using virtual reality as a diagnostic and training tool. A good summary of the relevant studies have been described in the mini-review by García-Betances, Arredondo Waldmeyer, Fico and Cabrera-Umpiérrez (2015; (https://ep70.eventpilotadmin.com/web/page.php?page=IntHtml&project=AAIC16&id=a7969). The authors reported VR benefits for each cognitive function investigated (e.g. attention, memory, and executive functions).
At the same time, VR seems to be a valid tool for memory training in subjects with MCI (Man et al., 2012; Plancher, Tirard, Gyselinck, Nicolas, & Piolino, 2012; Weniger, Ruhleder, Lange, Wolf, & Irl, 2011).
The promising results from computer-based brain training have been also recently presented at the Alzheimer’s Association International Conference in Toronto (July 2016). Studies like ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), which started in 1998 involving 2,832 healthy older adults and the Staying Keen in Later Life study (SKILL) (Andel, Lister, Gamaldo, Bush & Edwards, 2016), showed beneficial long-term effects of VR-training on memory in Healthy older adults (https://ep70.eventpilotadmin.com/web/page.php?page=IntHtml&project=AAIC16&id=a7969). For example, participants who were trained in the ACTIVE program on one skill (i.e., speed of processing) significantly improved on that skill right after the programme, as well as five years later, compared to those who had different training or none at all (https://www.statnews.com/2016/07/24/brain-training-cuts-dementia-risk/).
Our lab is currently developing a VR system for the assessment and intervention (i.e., VRAIS) of people with dementia or at risk of dementia. VRAIS (VR Assessment and Intervention System) incorporates state of the art VR and AI tools to create a tailored intervention program that responds to the needs of each individual living with dementia. The aim of VRAIS is to overcome some key limitations of available tools by having (1) a person-centred approach rather than fixed intervention platforms, (2) customised intervention environments rather than predefined unfamiliar settings, (3) flexible, tailored and developmental intervention schedules rather than preset schedules, and (4) meaningful long-lasting improvements rather than transient gains. In our Everyday Life Settings Lab at Heriot Watt University (Edinburgh) we have built a kitchen environment both as a real setting (Picture 1) and as a VR setting (Picture 2). VRAIS will host this environment and will use it to boost performance, functionality and quality of life of those experiencing cognitive decline.
Picture 1: Real Kitchen
Picture 2: VRAIS Kitchen