JMIR Publications

ABSTRACT

Background:

Neuropsychological assessments have traditionally focused on executive functioning (EF) due to the significant role it plays in everyday life and its association with a variety of mental disorders. Although traditional assessment methods of EF are well established, they lack ecological validity and are limited to evaluating a single cognitive process. While these traditional EF assessment tools may be appropriate for clinical populations, they provide less information about EF in healthy individuals. Recognizing these limitations, there has been a growing interest in Virtual Reality (VR)-based assessments of EF due to their potential to increase test sensitivity, ecological validity, and accessibility to neuropsychological assessment.

Objective:

This systematic review aims to explore the literature on VR assessments of EF. Specifically, we intended to identify: (1) the EF components being assessed, (2) how these assessments are validated, and (3) the monitoring strategies for potential adverse (cybersickness) and beneficial (immersion) effects.

Methods:

EBSCOHost, Scopus, and Web of Science (WoS) were searched using keywords that reflected the main themes of Virtual Reality, Neuropsychological Tests and Executive Function. The search retrieved 555 unique articles, of which 19 met the inclusion criteria. Articles had to be an English written peer-reviewed manuscript published after 2013 that detailed an empirical, clinical or proof of concept study where a virtual environment using a head-mounted display was employed to assess EF in an adult population.

Results:

The reviewed articles comprised a range of EF constructs, including inhibitory control, cognitive flexibility, working memory, planning, and attention. Although VR paradigms were typically validated against gold-standard traditional tasks, some studies did not report a-priori planned correlations, others did not detail the target EF constructs to be assessed by the VR paradigm, and there was often incomplete reporting of results. Further, cybersickness was assessed by only four of the 19 studies.

Conclusions:

The authors propose several recommendations to improve the theory and practice of VR assessments of EF. A key conclusion is the critical need to address the methodological and psychometric properties during the development of these assessments to ensure their validity and reliability. Furthermore, we suggest an increased focus on potential adverse effects such as cybersickness. Future research should consider the integration of biosensors into VR systems, and the potential of VR in assessing spatial navigation. While VR assessments show promising potential, their adoption must be systematic and validated to ensure their utility in real-world applications.