JMIR Publications

ABSTRACT

Background:

Therapeutic virtual reality (VR) has emerged as an efficacious treatment modality for cognitive and physical training for people with mild cognitive impairment (MCI). However, to replace existing non-pharmaceutical treatment training protocols, VR platforms need significant improvement if they are to appeal to older people with symptoms of cognitive decline and meet their specific needs.

Objective:

The study aimed to design and test the acceptability, usability, and tolerability of an immersive VR platform that allows older people with MCI symptoms to simultaneously practice physical and cognitive skills on a dual task.

Methods:

Based on interviews with 20 older people with MCI symptoms (15 females; mean age 76.25 years; SD 5.03) and on inputs from their health care providers (formative study VR1), an interdisciplinary group of experts developed a VR system called VRADA (Virtual Reality Exercise Application for Dementia and Alzheimer’s Patients). Using an identical training protocol, the VRADA system was first tested with a group of 30 university students (16 females; mean age 20.86 years; SD 1.17) and then with 27 older people (19 females; mean age 73.22 years; SD 9.26) who had been diagnosed with MCI (feasibility studies VR2a and VR2b). Those in the latter group were attending two Hellenic Association Day Care Centers for Alzheimer’s Disease and Related Disorders. Participants in both groups were asked to perform a dual-task training protocol combining physical and cognitive exercises in two different training conditions. In Condition A, participants performed a cycling task in a lab environment while being asked by the researcher to perform oral math calculations (single-digit additions and subtractions). In Condition B, participants performed a cycling task in the virtual environment while performing calculations that appeared within the VR application. Participants in both groups were assessed in the same way; this included questionnaires and semi-structured interviews immediately after the experiment to capture perceptions of acceptability, usability, and tolerability, and to determine which of the two training conditions each participant preferred.

Results:

Participants in both groups showed a significant preference for the VR condition (students: M = .66, SD = .41; t(29) = 8.74, P < .001; MCI patients: M = .72, SD = .51; t(26) = 7.36, P < .001), as well as high acceptance scores for intended future use, attitude to VR training, and enjoyment. Usability scores (SUS) (82.66 for the students and 77.96 for the older group) were well above the acceptability threshold (75/100). Perceived adverse effects were minimal, indicating satisfactory tolerability.

Conclusions:

The findings suggest that VRADA is an acceptable, usable, and tolerable system for physical and cognitive training for older people with MCI as well as university students. Randomized Control Trial (RCT) studies are needed to assess the efficacy of VRADA as a tool to promote physical and cognitive health in MCI patients.