Virtual reality-based monitoring test for MCI: A multicenter feasibility study

Abstract

Objectives: As the significance of the early diagnosis of mild cognitive impairment (MCI) has emerged, it is necessary to develop corresponding screening tools with high ecological validity and feasible biomarkers. Virtual reality (VR)-based cognitive assessment program, which is close to the daily life of the older adults, can be suitable screening tools for MCI with ecological validity and accessibility. Meanwhile, dehydroepiandrosterone (DHEA) has been observed at a low concentration in the older adults with dementia or cognitive decline, indicating its potential as a biomarker of MCI. This study aimed to determine the efficacy and usability of a VR cognitive assessment program and salivary DHEA for screening MCI.

Methods: The VR cognitive assessment program and the traditional Montreal Cognitive Assessment (MOCA) test were performed on 12 patients with MCI and 108 healthy older adults. The VR program operates in a situation of caring for a grandchild, and evaluates the memory, attention, visuospatial, and executive functions. An analysis of covariance (ANCOVA), a partial correlation analysis, and receiving operating characteristic (ROC) curve analysis were conducted for statistical analysis.

Results: According to the ANCOVA, no significant difference in MOCA scores was found between the normal and MCI groups (F = 2.36, p = 0.127). However, the VR total score of the MCI group was significantly lower than that of the normal group (F = 8.674, p = 0.004). There was a significant correlation between the MOCA and VR scores in the total and matched subdomain scores. The ROC curve analysis also showed a larger area under the curve (AUC) for the VR test (0.765) than for the MOCA test (0.598), and the sensitivity and specificity of the VR program were 0.833 and 0.722, respectively. Salivary DHEA was correlated with VR total (R ² = 0.082, p = 0.01) and attention scores (R ² = 0.086, p = 0.009).

Conclusion: The VR cognitive test was as effective as the traditional MOCA test in the MCI classification and safe enough for older adults to perform, indicating its potential as a diagnostic tool. It has also been shown that salivary DHEA can be used as a biomarker for MCI.

Keywords: DHEA; MOCA; cognitive assessment; mild cognitive impairment; screening; virtual reality.

FIGURE 1

Screenshots of VARABOM test. (A) In the “preparation recall” mission, the grandchild asks to find the preparation which was told before. (B) In the “phone call” mission, the grandchild asks to call her mother and tells the phone number. (C) In the “toilet use” mission, the grandchild asks to help her use toilet.

FIGURE 2

ROC curve comparison between total scores of VARABOM test and MOCA-K test. ROC curves with VR total score (blue-solid line) and MOCA total score (green-dashed line). ROC curve, receiver operating characteristic curve; VARABOM, virtual reality-based MCI monitoring; MOCA-K, Montreal Cognitive Assessment-Korean version.

FIGURE 3

Partial correlation of scores of VR cognitive test and MOCA test. VR, virtual reality; MOCA-K, Montreal Cognitive Assessment-Korean version. Correlation between VR scores and MOCA scores. Correlation between (A) total scores, (B) memory scores (C) attention scores, (D) executive functions, and (E) visuospatial scores of MOCA and VR test were analyzed with partial correlation test. Line and R² value indicate regression of the dataset.

FIGURE 4

VRSQ total and sub-scores of each group. VRSQ, Virtual Reality Sickness Questionnaire; MCI, mild cognitive impairment.

FIGURE 5

Partial correlation of scores of VR cognitive test and DHEA_sum. VR, virtual reality; DHEA, dehydroepiandrosterone; AUC, area under the curve. Correlation between salivary DHEA and (A) VR total score and (B) VR attention score were analyzed by partial correlation test. Line and R² value indicate regression of the dataset.