This chapter aimed to analyse state-of-the-art digital solutions based on virtual reality and serious games that might be used as a screening tool for cognitive impairment of older adults in their residential environments by identifying: (i) terminal equipment being used; (ii) interaction paradigms being reported; (iii) cognitive domains being assessed; and (iv) user-centred evaluations being conducted. A systematic electronic search was performed, and 41 studies were included. In terms of results, (i) personal computers and virtual reality setups were used by a significant number of studies, (ii) the most used interaction paradigm was simulation of daily tasks, (iii) memory, executive functions, and attention were the cognitive domains most assessed, and (iv) the proposed digital solutions were evaluated in terms of usability, feasibility, validity and reliability, and diagnostic accuracy. The results of the diagnostic accuracy studies that were reported indicate that the proposed solutions discriminate between normal cognition and nonnormal cognition.
TopIntroduction
Neurodegenerative diseases (e.g., Alzheimer, Parkinson, Huntington, amyotrophic lateral sclerosis, or frontotemporal dementia) represent a major threat to human health with impact both in terms of cognition and dysfunctions such as reduced speech rate, higher daily caloric intake, increased rigidity, reduced dexterity, essential tremors or even difficulties in breathing (Lanctôt et al., 2003; Gitler, Dhillon & Shorter, 2017).
Although there are several known risk factors (e.g., diabetes, hypertension, hypercholesterolemia, depression, physical frailty, low education, or low social support level) contributing for neurodegenerative diseases, ageing is the strongest one (Holsinger, Deveau, Boustani & Williams, 2007; Plassman, Williams Jr, Burke, Holsinger & Benjamin, 2010; Ritchie et al., 2010; Boyle, Buchman, Wilson, Leurgans & Bennett, 2010; Livingston et al., 2017; Owens et al., 2020), which means that the prevalence of these diseases is increasing (Hou et al., 2019). Considering all major groups of diseases, the diseases of the nervous system represent the greatest contribution to the global impact on the health of populations worldwide (i.e., more than 6%) and are responsible for high disability rates and global burden of disease (Cicerone et al., 2011).
Mild cognitive impairment (MCI), an intermediate stage between normal aging and dementia, is characterized by an objective cognitive decline in one or more cognitive domains (e.g., attention, executive function, language, or memory) without any significant impairment in daily activities and may be associated with a variety of underlying causes, including Alzheimer’s pathophysiology (Petersen et al., 2014; Jack Jr et al., 2018; Sabbagh et al., 2020a). In turn, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association, dementia is a major neurocognitive disorder that is characterized by a significant decline in one or more cognitive domains that interferes with the individual’s independence in daily activities (American Psychiatric Association, 2013).
Although some patients with MCI have experienced reversion to cognitive normality, there is a high probability that this condition will progress to be dementia (Roberts et al., 2014; Limpawattana & Manjavong, 2021). Therefore, early detection of MCI is critical to effectively initiate the intervention, including counselling, psychoeducation, cognitive training, or medication, and guarantee patients and relative’s access to relevant healthcare services (Brodaty, Low, Gibson & Burns, 2006; De Roeck, De Deyn, Dierckx & Engelborghs, 2019).
At present, two of the commonly used cognitive screening tests are the Mini-Mental State Examination (MMSE) (Folstein, Folstein & McHugh, 1975) and the Montreal Cognitive Assessment (MoCA) (Nasreddine et al., 2005). The MMSE is useful for studying deterioration of cognitive abilities, while the MoCA was developed to detect subtle cognitive deficits, which are typical of early stages of neurodegenerative diseases, and include tasks related to executive function and visuospatial processing, which are usually affected by these diseases (Siqueira, Hagemann, Coelho, Santos & Bertolucci, 2019).