Mild Cognitive Impairment (MCI) represents a transitional stage between normal aging and dementia. Although topographical disorientation is considered a significant indicator of dementia, deficits in spatial navigation and spatial memory have historically received less attention in research, despite their profound impact on daily functioning and quality of life, highlighting the critical importance of developing targeted training interventions in this domain. This study presents preliminary data from a cognitive training protocol that integrates low-cost virtual reality (VR) technology with embodied cognition theory, specifically designed to improve spatial navigation abilities in patients with MCI. The protocol compares different bodily interaction conditions during encoding, based on the embodied cognition theory that memory retrieval is enhanced when it aligns with the modality (in this case, bodily interaction) used during initial encoding. We developed an improved version of the ANTaging software, previously implemented with Cave Automatic Virtual Environment, adapting it to scalable, low-cost VR solutions. The study protocol includes three experimental conditions: (1) embodied VR training, incorporating physical bodily interaction through a platform device;(2) treatment as usual (TAU) consisting of traditional 'paper and pencil' visuospatial exercises used in clinical routine and (3) non-embodied VR training, without physical bodily interaction during the encoding phase. This design allows us to test: 1) the clinical efficacy of VR compared to classic spatial cognitive training and 2) the efficacy of embodied VR training compared to non-embodied VR training. Participants completed 8 sessions of 30-40 minutes, 2-3 times per week for 3-4 weeks. The virtual environment featured a circular arena with internal (egocentric) and boundary (allocentric) reference points for the VR conditions, plus distal landmarks. To prevent learning effects, we randomly selected 4 out of 8 possible objects for each navigation session. Patients were instructed to collect four items presented one at a time, with each object viewed four times in random order. They followed an illuminated path and positioned themselves over each object to confirm visualization, with specific sounds providing feedback. In the recall phase, patients had to place each object in its exact original location. Crucially, each object was tested four times under either egocentric or allocentric reference conditions, thus providing separate measures of egocentric and allocentric spatial memory. Egocentric and allocentric memory were tested by manipulating the virtual environment (e.g., changing viewpoints or removing relevant landmarks). All training sessions followed the 'decreasing assistance' cognitive rehabilitation method, which allows progressive adjustment of memory training difficulty throughout the intervention.
Spatial Memory Rehabilitation Using Low-Cost Virtual Reality in Patients with Mild Cognitive Impairment: Methodological Proposal
Borghesi F.;Simoncini G.;Cipresso P.;
2025-01-01
Abstract
Mild Cognitive Impairment (MCI) represents a transitional stage between normal aging and dementia. Although topographical disorientation is considered a significant indicator of dementia, deficits in spatial navigation and spatial memory have historically received less attention in research, despite their profound impact on daily functioning and quality of life, highlighting the critical importance of developing targeted training interventions in this domain. This study presents preliminary data from a cognitive training protocol that integrates low-cost virtual reality (VR) technology with embodied cognition theory, specifically designed to improve spatial navigation abilities in patients with MCI. The protocol compares different bodily interaction conditions during encoding, based on the embodied cognition theory that memory retrieval is enhanced when it aligns with the modality (in this case, bodily interaction) used during initial encoding. We developed an improved version of the ANTaging software, previously implemented with Cave Automatic Virtual Environment, adapting it to scalable, low-cost VR solutions. The study protocol includes three experimental conditions: (1) embodied VR training, incorporating physical bodily interaction through a platform device;(2) treatment as usual (TAU) consisting of traditional 'paper and pencil' visuospatial exercises used in clinical routine and (3) non-embodied VR training, without physical bodily interaction during the encoding phase. This design allows us to test: 1) the clinical efficacy of VR compared to classic spatial cognitive training and 2) the efficacy of embodied VR training compared to non-embodied VR training. Participants completed 8 sessions of 30-40 minutes, 2-3 times per week for 3-4 weeks. The virtual environment featured a circular arena with internal (egocentric) and boundary (allocentric) reference points for the VR conditions, plus distal landmarks. To prevent learning effects, we randomly selected 4 out of 8 possible objects for each navigation session. Patients were instructed to collect four items presented one at a time, with each object viewed four times in random order. They followed an illuminated path and positioned themselves over each object to confirm visualization, with specific sounds providing feedback. In the recall phase, patients had to place each object in its exact original location. Crucially, each object was tested four times under either egocentric or allocentric reference conditions, thus providing separate measures of egocentric and allocentric spatial memory. Egocentric and allocentric memory were tested by manipulating the virtual environment (e.g., changing viewpoints or removing relevant landmarks). All training sessions followed the 'decreasing assistance' cognitive rehabilitation method, which allows progressive adjustment of memory training difficulty throughout the intervention.
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