Determining the virtual reality factors that are important for the development of new and effective cognitive rehabilitation and training tools

Abstract

Interventions such as cognitive training may help older individuals delay or prevent the development of neurodegenerative diseases such as mild cognitive impairment (MCI) and dementia, while they may also slow the progression of cognitive decline in these conditions. A major criticism of these interventions is the lack of ecological validity and the extent to which the learned effects transfer to real-life settings. Virtual reality (VR) applications may address this issue by allowing simulations of real-life scenarios where training can occur in a safe and controlled environment. In this thesis, I aim to investigate the efficacy of VR training in individuals with MCI and dementia and explore the factors that may influence this effect.

First, I present a review of the existing literature to evaluate the evidence on the efficacy of VR training in individuals with dementia and MCI, and I review factors related to VR that may influence these effects. The review concludes that studies demonstrating the effectiveness of VR training often incorporate other types of applications, not focusing solely on VR training. There also appears to be inconsistency regarding which cognitive domains are most affected. Moreover, the literature suggests that VR factors such as immersion, agency, presence, and cybersickness may be crucial in influencing the effects of VR applications. Although these factors seem to interact, they are rarely studied together, and their isolated effects are often contradicting.

Next, I conduct a meta-analysis to investigate the efficacy of VR training in individuals with MCI and dementia and explore the role of VR factors on these effects. The results suggest that VR training is more effective than traditional methods in improving global cognition, memory, and attention for both individuals with MCI and dementia. However, most clinical studies that have employed VR training have not considered factors such as immersion, agency, presence, or cybersickness. Subsequently, I explore the effects of these factors on memory and attention, considering their interplay. To this end, I develop two custom VR applications targeting memory and attention. The findings from these studies indicate that immersion may have a variable effect depending on factors such as agency, presence, cybersickness, and the type of task. In memory tasks, immersion and active agency appear to benefit spatial and prospective memory, though these effects are sometimes influenced by presence, cybersickness, and age. Additionally, the benefits are more pronounced in older individuals, suggesting that aspects enhancing immersive technologies, like increased cues, are more advantageous for this population. Presence is found to have a boosting effect on agency, which again seems to benefit older individuals more than younger ones, improving performance in prospective memory tasks. Furthermore, the findings suggest that cybersickness negatively affects spatial and prospective memory when immersion is high, but it also seems to act as a booster under low immersion conditions, particularly for older people. The effects of immersion on attention are more varied although still influenced by presence and cybersickness. Cybersickness seems to boost attention sometimes, especially when immersion is low, while presence generally negatively affects performance. Findings from a pilot of the same studies in individuals with dementia and MCI suggest that the applications are feasible within this population, although some aspects of patients’ cognitive profiles may need consideration when developing VR applications targeted at these individuals.

The findings of this thesis extend existing evidence that shows VR training to be an effective intervention by demonstrating that VR training improves cognitive functions and has significant effects on memory and attention. Additionally, this thesis reveals for the first time the interplay effects of different VR factors on memory and attention. The results suggest that presence boosts the effects of immersion and agency on spatial and prospective memory, but not for attention, which primarily seems to be negatively affected by presence. Finally, the thesis provides evidence for the feasibility of VR applications in people with dementia and MCI.

Date of Award	25 Jun 2025
Original language	English
Awarding Institution	University of Bath
Supervisor	Alexandra Voinescu (Supervisor), Danae Stanton Fraser (Supervisor) & Karin Petrini (Supervisor)