Can VR replace pen-and-paper cognitive function tests?

Virtual reality (VR) systems can capture differences in cognitive function between older and younger users, according to a recent Singapore study, suggesting that VR could potentially be used to conduct cognitive assessments.

“The findings in this study show that cognitively healthy younger Asian adults tended to attain higher performance scores and completed the VR within shorter time compared to their older counterparts,” the researchers said.

The current feasibility study included a multiethnic Asian population (n=25) divided into four groups according to age: group 1 (35–44 years; n=24), group 2 (45–54 years; n=25), group 3 (55–64 years; n=25), and group 4 (65–74 years; n=25). All participants were cognitively healthy, as indicated by a Montreal Cognitive Assessment score of ≥26.

Participants underwent the Cognitive Assessment using Virtual Reality (CAVIRE) system, which was developed to evaluate the cognitive status of community-dwelling, ambulatory elderly adults as they perform tasks across six cognitive domains (language, social cognition, learning and memory, complex attention, executive function, and perceptual motor).

Across all six domains, young participants performed significantly better than their older counterparts (p<0.05 for all). In particular, group 4 scored significantly worse than group 1 across all domains. The same was true for group 3 vs group 1, except for the domain of learning and memory, in which both groups performed similarly. [Front Psychol 2022;doi:10.3389/fpsyg.2022.847590]

Of note, groups 3 and 4 performed comparably across all cognitive domains, except for social cognition, in which the younger group was fared better.

Moreover, younger participants completed the CAVIRE assessment much quicker than older comparators. Group 1 participants had significantly shorter completion times than groups 3 and 4 for all domains. The only exception was social cognition, in which groups 1 and 3 completed at similar speed.

Group 2 was also significantly faster than groups 3 and 4 across all domains. Completion times did not differ between groups 3 and 4.

Need to improve

“Performing tasks such as preparing a toast, bringing along an umbrella in the context of a rainy day, crossing a road with signal from traffic lights, and settling payment by selecting the correct currency notes are reflective of day-to-day executive functions,” the researchers said. “Such activities of daily living are difficult to assess without direct and objective observations in a clinical setting.”

VR systems can help in this regard and with assessing social cognition, too, they added.

“The conventional paper-and-pencil cognitive assessments have limitations in evaluating social cognition,” the researchers said. “The study results suggest the potential of VR to screen for deficits in social cognition based on the performance score and completion time in people of different age groups.”

However, the present study also underlined the limitations of using VR systems as cognitive assessment tools, particularly for older patients. The age-dependent variations in performance and completion times could reflect genuine changes in cognitive function, or they could suggest a need to further improve VR systems and data analysis.

“Users of this system should be cognizant of the differences in the performance scores and completion time between the younger and older participants, with the most significant demarcation around the age of 55 years old,” the researchers said.

“Further refinements to the VR segments and scoring matrix are needed to reduce the wide dispersion of the scores and completion time,” they added.