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Randomized Controlled Trial
. 2021 May 6;23(5):e24526.
doi: 10.2196/24526.

Effect of Cognitive Training in Fully Immersive Virtual Reality on Visuospatial Function and Frontal-Occipital Functional Connectivity in Predementia: Randomized Controlled Trial

Jae Myeong Kang  1   2 , Nambeom Kim  3 , Sook Young Lee  1 , Soo Kyun Woo  1 , Geumjin Park  1 , Byeong Kil Yeon  4 , Jung Woon Park  5 , Jung-Hae Youn  6 , Seung-Ho Ryu  7 , Jun-Young Lee  8 , Seong-Jin Cho  1
Affiliations
Randomized Controlled Trial

Effect of Cognitive Training in Fully Immersive Virtual Reality on Visuospatial Function and Frontal-Occipital Functional Connectivity in Predementia: Randomized Controlled Trial

Jae Myeong Kang et al. J Med Internet Res. .

Abstract

Background: Cognitive training can potentially prevent cognitive decline. However, the results of recent studies using semi-immersive virtual reality (VR)-assisted cognitive training are inconsistent.

Objective: We aimed to examine the hypothesis that cognitive training using fully immersive VR, which may facilitate visuospatial processes, could improve visuospatial functioning, comprehensive neuropsychological functioning, psychiatric symptoms, and functional connectivity in the visual brain network in predementia.

Methods: Participants over 60 years old with subjective cognitive decline or mild cognitive impairment from a memory clinic were randomly allocated to the VR (n=23) or the control (n=18) group. The VR group participants received multidomain and neuropsychologist-assisted cognitive training in a fully immersive VR environment twice a week for 1 month. The control group participants did not undergo any additional intervention except for their usual therapy such as pharmacotherapy. Participants of both groups were evaluated for cognitive function using face-to-face comprehensive neuropsychological tests, including the Rey-Osterrieth Complex Figure Test (RCFT) copy task; for psychiatric symptoms such as depression, apathy, affect, and quality of life; as well as resting-state functional magnetic resonance imaging (rsfMRI) at baseline and after training. Repeated-measures analysis of variance was used to compare the effect of cognitive training between groups. Seed-to-voxel-based analyses were used to identify the cognitive improvement-related functional connectivity in the visual network of the brain.

Results: After VR cognitive training, significant improvement was found in the total score (F1,39=14.69, P=.001) and basic components score of the RCFT copy task (F1,39=9.27, P=.005) compared with those of the control group. The VR group also showed improvements, albeit not significant, in naming ability (F1,39=3.55, P=.07), verbal memory delayed recall (F1,39=3.03, P=.09), and phonemic fluency (F1,39=3.08, P=.09). Improvements in psychiatric symptoms such as apathy (F1,39=7.02, P=.01), affect (F1,39=14.40, P=.001 for positive affect; F1,39=4.23, P=.047 for negative affect), and quality of life (F1,39=4.49, P=.04) were found in the VR group compared to the control group. Improvement in the RCFT copy task was associated with a frontal-occipital functional connectivity increase revealed by rsfMRI in the VR group compared to the control group.

Conclusions: Fully immersive VR cognitive training had positive effects on the visuospatial function, apathy, affect, quality of life, and increased frontal-occipital functional connectivity in older people in a predementia state. Future trials using VR cognitive training with larger sample sizes and more sophisticated designs over a longer duration may reveal greater improvements in cognition, psychiatric symptoms, and brain functional connectivity.

Trial registration: Clinical Research Information Service KCT0005243; https://tinyurl.com/2a4kfasa.

Keywords: cognitive training; fMRI; mild cognitive impairment; virtual reality; visual network; visuospatial function.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Trial flow chart. VR: virtual reality; MRI: magnetic resonance imaging.
Figure 2
Figure 2
Seed-to-voxel analyses based on the right lateral region (a) and the medial region (b) of the visual network (blue circles). Increased frontal-occipital functional connectivity related to the Rey-Osterrieth Complex Figure Test copy task improvement after virtual reality cognitive training. False discovery rate–corrected P<.05 for cluster threshold; uncorrected P<.001 for voxel threshold.
See this image and copyright information in PMC

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