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Spatial Navigation Impairment in Mild Cognitive Impairment: A Virtual Reality Study
ABSTRACT
Background:
Spatial navigation impairment is prevalent in people with Alzheimer’s disease (AD) and may appear in its initial clinical stage. To detect this deficit in people at risk may not only help to prevent them from getting lost or going missing, but also provide a useful clinical aid to accurate diagnosis. Traditional assessments for SNI include questionnaires, paper pencil and maze tests, or video games. While a real-world setting is more valid, direct, and accurate, it is plagued by unpredictable conditions such as weather, obstacles, or accidents. Thanks to modern technology, virtual reality (VR) offers a new way to test spatial navigation impairment.
Objective:
To test the feasibility of a VR setting to assess sense of location in people with mild cognitive impairment due to AD (AD MCI) and its power to discriminate among groups in different clinical conditions.
Methods:
We used PJVR to test spatial navigation ability in cognitively unimpaired (CU), subjective cognitive decline (SCD) and mild cognitive impairment due to AD (AD MCI). The PJVR is the VR version (Vive Pro Eye Head-mounted Display, HTC) of the PJ device, which has demonstrated its power to discriminate among CU, AD MCI, and mild AD. With a map provided and using joysticks or handles, participants were requested to reach five points on a 660-meter path. Linear deviation (LD) in meters from each target point and vector deviation in degrees from the direction to the start point at each point were treated as the variable for comparison.
Results:
113 subjects signed informed consent and joined the study. 93 (82.3%) completed the trials, including 22 CU, 39 SCD and 32 AD MCI. Twenty, or 19.7%, failed the trials due to cyber sickness. The LD of the CU, SCD and MCI were 38.2 (39.5), mean (S.D.), 50.4 (40.7), and 100.04 (46.2) meters respectively (p<.001). The MCI showed greater vector deviation, 63.2 (42.4) degrees, than either SCD 39.4 (33.0) or CU 38.6 (37.4) (p=.016). The LD of the PJVR was correlated to the total scores of the Questionnaire on Everyday Navigation Abilities Care-Giver version (p<.0002), indicating a good real-world validity.
Conclusions:
The PJVR is feasible for older adults and AD MCI subjects. The PJVR can detect spatial navigation deficits related to AD pathology, and the results show a close correlation with real world navigation ability. Clinical Trial: NA
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