ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2020 February;56(1):47-57

DOI: 10.23736/S1973-9087.19.05899-4

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Using virtual reality-based training to improve cognitive function, instrumental activities of daily living and neural efficiency in older adults with mild cognitive impairment

Ying-Yi LIAO ¹, Han-Yun TSENG ¹, Yi-Jia LIN ², Chung-Jen WANG ³, Wei-Chun HSU ² ✉

¹ Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; ² Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan; ³ Department of Neurology, Cheng Hsin General Hospital, Taipei, Taiwan

BACKGROUND: A combination of physical and cognitive training appears to be the effective intervention to improve cognitive function in older adults with mild cognitive impairment (MCI). Computing technology such as virtual reality (VR) may have the potential to assist rehabilitation in shaping brain health. However, little is known about the potential of VR-based physical and cognitive training designed as an intervention for cognition and brain activation in elderly patients with MCI. Moreover, whether a VR program designed around functional tasks can improve their instrumental activities of daily living (IADL) requires further investigation.
AIM: This study investigated the effects of 12 weeks of VR-based physical and cognitive training on cognitive function, brain activation and IADL and compared the VR intervention with combined physical and cognitive training.
DESIGN: A single-blinded randomized controlled trial.
SETTING: Communities and day care centers in Taipei, Taiwan.
POPULATION: Older adults with mild cognitive impairment.
METHODS: Thirty-four community-dwelling older adults with MCI were randomized into either a VR-based physical and cognitive training (VR) group or a combined physical and cognitive training (CPC) group for 36 sessions over 12 weeks. Participants were assessed for their cognitive function (global cognition, executive function and verbal memory) and IADL at pre- and postintervention. Changes in prefrontal cortex activation during the global cognition test were also captured by functional near-infrared spectroscopy (NIRS) to identify the potential mediating pathway of the intervention.
RESULTS: Both groups showed improved executive function and verbal memory (immediate recall). However, only the VR group showed significant improvements in global cognition (P<0.001), verbal memory (delayed recall, P=0.002), and IADL (P<0.001) after the intervention. The group × time interaction effects further demonstrated that IADL were more significantly improved with VR training than with CPC training (P=0.006). The hemodynamic data revealed decreased activation in prefrontal areas after training (P=0.0015), indicative of increased neural efficiency, in the VR-trained subjects.
CONCLUSIONS: VR-based physical and cognitive training improves cognitive function, IADL and neural efficiency in older adults with MCI.
CLINICAL REHABILITATION IMPACT: VR training could be implemented for older adults with MCI.

KEY WORDS: Cognitive dysfunction; Aged; Virtual reality; Cognition; Activities of daily living; Near-infrared spectroscopy