Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-10T14:52:39.122Z Has data issue: false hasContentIssue false
  • English
  • Français

Virtual reality and mental health in older adults: a systematic review

Published online by Cambridge University Press:  24 March 2021

Miranda D. Skurla ,
Aniqa T. Rahman ,
Sarah Salcone ,
Liana Mathias ,
Bhumika Shah ,
Brent P. Forester  and
Ipsit V. Vahia
Miranda D. Skurla
Affiliation:
McLean Hospital, Belmont, MA, USA
Aniqa T. Rahman
Affiliation:
McLean Hospital, Belmont, MA, USA
Sarah Salcone
Affiliation:
University of South Alabama, Mobile, AL, USA
Liana Mathias
Affiliation:
University of Vermont College of Medicine, Burlington, VT, USA
Bhumika Shah
Affiliation:
DeSouza Foundation, Mumbai, India
Brent P. Forester
Affiliation:
McLean Hospital, Belmont, MA, USA Harvard Medical School, Boston, MA, USA
Ipsit V. Vahia*
Affiliation:
McLean Hospital, Belmont, MA, USA Harvard Medical School, Boston, MA, USA
*
Correspondence should be addressed to: Ipsit V. Vahia, McLean Hospital, 115 Mill Street, Belmont, MA02478, USA. Phone: (617) 855-3291; Fax: (617) 855-3246. Email: ivahia@mclean.harvard.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

Importance:

Virtual reality (VR) is a promising tool with the potential to enhance care of cognitive and affective disorders in the aging population. VR has been implemented in clinical settings with adolescents and children; however, it has been less studied in the geriatric population.

Objective:

The objective of this study is to determine the existing levels of evidence for VR use in clinical settings and identify areas where more evidence may guide translation of existing VR interventions for older adults.

Design and measurements:

We conducted a systematic review in PubMed and Web of Science in November 2019 for peer-reviewed journal articles on VR technology and its applications in older adults. We reviewed article content and extracted the number of study participants, study population, goal of the investigation, the level of evidence, and categorized articles based on the indication of the VR technology and the study population.

Results:

The database search yielded 1554 total results, and 55 articles were included in the final synthesis. The most represented study design was cross-sectional, and the most common study population was subjects with cognitive impairment. Articles fell into three categories for VR Indication: Testing, Training, and Screening. There was a wide variety of VR environments used across studies.

Conclusions:

Existing evidence offers support for VR as a screening and training tool for cognitive impairment in older adults. VR-based tasks demonstrated validity comparable to some paper-based assessments of cognition, though more work is needed to refine diagnostic specificity. The variety of VR environments used shows a need for standardization before comparisons can be made across VR simulations. Future studies should address key issues such as usability, data privacy, and confidentiality. Since most literature was generated from high-income countries (HICs), it remains unclear how this may be translated to other parts of the world.

Keywords

Virtual realityVRagingcognitionmoodtechnologygeriatrics
Type
Review Article
Information
International Psychogeriatrics , Volume 34 , Issue 2: Issue Theme: Technology, Virtual Reality, and Other Promising Interventions for Older Adults , February 2022 , pp. 143 - 155
Copyright
© International Psychogeriatric Association 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Miranda Skurla and Aniqa Rahman are co-first authors of this manuscript

References

Ali Mirza, R. and Yaqoob, I. (2018). Effects of combined aerobic and virtual reality-based cognitive training on 76 years old diabetic male with mild cognitive impairment. Journal of the College of Physicians and Surgeons Pakistan, 28, S210–S212. doi: 10.29271/jcpsp.2018.09.S210.CrossRefGoogle Scholar
Allain, P. et al. (2014). Detecting everyday action deficits in Alzheimer’s disease using a nonimmersive virtual reality kitchen. Journal of the International Neuropsychological Society, 20, 468–477. doi: 10.1017/S1355617714000344.CrossRefGoogle ScholarPubMed
Allison, S. L. et al. (2016). Spatial Navigation in Preclinical Alzheimer’s Disease. Journal of Alzheimer’s Disease : JAD, 52, 77–90.10.3233/JAD-150855CrossRefGoogle ScholarPubMed
Amaefule, C. O. et al. (2020). Effect of Spatial Disorientation in a virtual environment on gait and vital features in patients with dementia: Pilot Single-Blind Randomized Control Trial. JMIR Serious Games, 8, e18455. doi: 10.2196/18455.CrossRefGoogle Scholar
Anderson, P. L. et al. (2013). Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 81, 751–760. doi: 10.1037/a0033559.CrossRefGoogle ScholarPubMed
Anderson-Hanley, C. et al. (2012). Exergaming and older adult cognition. American Journal of Preventive Medicine, 42, 109–119. doi: 10.1016/j.amepre.2011.10.016.CrossRefGoogle ScholarPubMed
Anderson-Hanley, C. et al. (2018). The Aerobic and Cognitive Exercise Study (ACES) for community-dwelling older adults with or at-risk for mild cognitive impairment (MCI): neuropsychological, neurobiological and neuroimaging outcomes of a randomized clinical trial (report). Frontiers in Aging Neuroscience, 10.10.3389/fnagi.2018.00076CrossRefGoogle Scholar
Anderson-Hanley, C. et al. (2018). The interactive Physical and Cognitive Exercise System (iPACESTM): effects of a 3-month in-home pilot clinical trial for mild cognitive impairment and caregivers. Clinical Interventions in Aging, 13, 1565–1577.10.2147/CIA.S160756CrossRefGoogle Scholar
Appel, L. et al. (2020). Older adults with cognitive and/or physical impairments can benefit from immersive virtual reality experiences: a feasibility study. Frontiers in Medicine, 6, 329. doi: 10.3389/fmed.2019.00329.CrossRefGoogle ScholarPubMed
Aruanno, B. and Garzotto, F. (2019). MemHolo: mixed reality experiences for subjects with Alzheimer’s disease. Multimedia Tools and Applications, 78, 13517–13537. doi: 10.1007/s11042-018-7089-8.CrossRefGoogle Scholar
Brimelow, R. E., Dawe, B. and Dissanayaka, N. (2020). Preliminary Research: Virtual Reality in Residential Aged Care to Reduce Apathy and Improve Mood. Cyberpsychology, Behavior, and Social Networking, 23, 165–170. doi: 10.1089/cyber.2019.0286.CrossRefGoogle Scholar
Burdea, G. et al. (2015). Feasibility study of the BrightBrainer TM integrative cognitive rehabilitation system for elderly with dementia. Disability and Rehabilitation: Assistive Technology, 10, 421–432. doi: 10.3109/17483107.2014.900575.Google Scholar
Caffò, A. O. et al. (2012)Reorientation deficits are associated with amnestic mild cognitive impairment. American Journal of Alzheimer’s Disease & Other Dementias, 27, 321–330. doi: 10.1177/1533317512452035.CrossRefGoogle ScholarPubMed
Chan, C. L. F. et al. (2009). Effect of the adapted virtual reality cognitive training program among Chinese older adults with chronic schizophrenia: a pilot study. International Journal of Geriatric Psychiatry, n/a-n/a. doi: 10.1002/gps.2403.CrossRefGoogle Scholar
Che Me, R., Gramegna, S. M. and Biamonti, A. (2015). Virtual Reality in Assessing the Supportive Environment that Promotes Navigability of Persons with Alzheimer’s disease. Studies in Health Technology and Informatics, 217, 951–956.Google ScholarPubMed
Cogné, M. et al. (2018). Are visual cues helpful for virtual spatial navigation and spatial memory in patients with mild cognitive impairment or Alzheimer’s disease? Neuropsychology, 32, 385–400. doi: 10.1037/neu0000435.CrossRefGoogle ScholarPubMed
Corriveau Lecavalier, N. et al. (2020). Use of immersive virtual reality to assess episodic memory: a validation study in older adults. Neuropsychological Rehabilitation, 30, 462–480. doi: 10.1080/09602011.2018.1477684.CrossRefGoogle ScholarPubMed
Coyle, H., Traynor, V. and Solowij, N. (2015). Computerized and virtual reality cognitive training for individuals at high risk of cognitive decline: systematic review of the literature. The American Journal of Geriatric Psychiatry, 23, 335–359. doi: 10.1016/j.jagp.2014.04.009.CrossRefGoogle ScholarPubMed
Cushman, L. A., Stein, K. and Duffy, C. J. (2008). Detecting navigational deficits in cognitive aging and Alzheimer disease using virtual reality. Neurology, 71, 888–895. doi: 10.1212/01.wnl.0000326262.67613.fe.CrossRefGoogle ScholarPubMed
Davis, R. and Ohman, J. (2016). Wayfinding in ageing and Alzheimer’s disease within a virtual senior residence: study protocol. Journal of Advanced Nursing, 72, 1677–1688. doi: 10.1111/jan.12945.CrossRefGoogle ScholarPubMed
Davis, R., Ohman, J. M. and Weisbeck, C. (2017). Salient Cues and Wayfinding in Alzheimer’s Disease Within a Virtual Senior Residence. Environment and Behavior, 49, 1038–1065.10.1177/0013916516677341CrossRefGoogle ScholarPubMed
Davison, S. M. C., Deeprose, C. and Terbeck, S. (2018). A comparison of immersive virtual reality with traditional neuropsychological measures in the assessment of executive functions. Acta Neuropsychiatrica, 30, 79–89. doi: 10.1017/neu.2017.14.CrossRefGoogle ScholarPubMed
Didehbani, N. et al. (2016). Virtual Reality Social Cognition Training for children with high functioning autism. Computers in Human Behavior, 62, 703–711. doi: 10.1016/j.chb.2016.04.033.CrossRefGoogle Scholar
Doniger, G. M. et al. (2018). Virtual reality-based cognitive-motor training for middle-aged adults at high Alzheimer’s disease risk: a randomized controlled trial. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 4, 118–129. doi: 10.1016/j.trci.2018.02.005.Google ScholarPubMed
Eldridge, S. M. et al. (2016). Defining feasibility and pilot studies in preparation for randomised controlled trials: development of a conceptual framework. PLOS ONE, 11, e0150205. doi: 10.1371/journal.pone.0150205.CrossRefGoogle ScholarPubMed
Falconer, C. J. et al. (2016). Embodying self-compassion within virtual reality and its effects on patients with depression. BJPsych Open, 2, 74–80. doi: 10.1192/bjpo.bp.115.002147.CrossRefGoogle ScholarPubMed
Fasilis, Th. et al. (2018). A pilot study and brief overview of rehabilitation via virtual environment in patients suffering from dementia. Psychiatriki, 29, 42–51. doi: 10.22365/jpsych.2018.291.42.CrossRefGoogle ScholarPubMed
Fernandez Montenegro, J. M. and Argyriou, V. (2017). Cognitive evaluation for the diagnosis of Alzheimer’s disease based on Turing Test and Virtual Environments. Physiology & Behavior, 173, 42–51. doi: 10.1016/j.physbeh.2017.01.034.CrossRefGoogle Scholar
Foloppe, D. A. et al. (2018). The potential of virtual reality-based training to enhance the functional autonomy of Alzheimer’s disease patients in cooking activities: a single case study. Neuropsychological Rehabilitation, 28, 709–733. doi: 10.1080/09602011.2015.1094394.CrossRefGoogle ScholarPubMed
Freeman, D. et al. (2017). Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychological Medicine, 47, 2393–2400. doi: 10.1017/S003329171700040X.CrossRefGoogle ScholarPubMed
Gamito, P. et al. (2010). PTSD elderly war veterans: a clinical controlled pilot study. Cyberpsychology, Behavior, and Social Networking, 13, 43–48.10.1089/cyber.2009.0237CrossRefGoogle ScholarPubMed
García-Betances, R. I. et al. (2015). Using virtual reality for cognitive training of the elderly. American Journal of Alzheimer’s Disease & Other Dementias, 30, 49–54. doi: 10.1177/1533317514545866.CrossRefGoogle ScholarPubMed
Hsieh, C.-C. et al. (2018). The effectiveness of a virtual reality-based Tai Chi exercise on cognitive and physical function in older adults with cognitive impairment. Dementia and Geriatric Cognitive Disorders, 46, 358–370.10.1159/000494659CrossRefGoogle ScholarPubMed
Hwang, J. and Lee, S. (2017). The effect of virtual reality program on the cognitive function and balance of the people with mild cognitive impairment. Journal of Physical Therapy Science, 29, 1283–1286. doi: 10.1589/jpts.29.1283.CrossRefGoogle ScholarPubMed
Lesk, V. et al. (2014). Using a virtual environment to assess cognition in the elderly. Virtual Reality, 18, 271–279.10.1007/s10055-014-0252-2CrossRefGoogle Scholar
Levy, F. et al. (2016). Fear of falling: efficacy of virtual reality associated with serious games in elderly people. Neuropsychiatric Disease and Treatment, 877. doi: 10.2147/NDT.S97809.CrossRefGoogle ScholarPubMed
Liao, Y.-Y. et al. (2019). Effects of virtual reality-based physical and cognitive training on executive function and dual-task gait performance in older adults with mild cognitive impairment: a randomized control trial. Frontiers in Aging Neuroscience, 11, 162. doi: 10.3389/fnagi.2019.00162.CrossRefGoogle ScholarPubMed
Liao, Y.-Y. et al. (2020). Using virtual reality-based training to improve cognitive function, instrumental activities of daily living and neural efficiency in older adults with mild cognitive impairment. European Journal of Physical and Rehabilitation Medicine, 56. doi: 10.23736/S1973-9087.19.05899-4.CrossRefGoogle ScholarPubMed
Man, D. W. K., Chung, J. C. C. and Lee, G. Y. Y. (2012). Evaluation of a virtual reality-based memory training programme for Hong Kong Chinese older adults with questionable dementia: a pilot study: MCI training using virtual reality. International Journal of Geriatric Psychiatry, 27, 513–520. doi: 10.1002/gps.2746.CrossRefGoogle Scholar
Man, D. W. K., Poon, W. S. and Lam, C. (2013). The effectiveness of artificial intelligent 3-D virtual reality vocational problem-solving training in enhancing employment opportunities for people with traumatic brain injury. Brain Injury, 27, 1016–1025. doi: 10.3109/02699052.2013.794969.CrossRefGoogle ScholarPubMed
Manera, V. et al. (2016). A Feasibility study with image-based rendered virtual reality in patients with mild cognitive impairment and dementia. PLOS ONE. Edited by L. Chao, 11, e0151487. doi: 10.1371/journal.pone.0151487.CrossRefGoogle ScholarPubMed
McEwen, D. et al. (2014). Two-week virtual reality training for dementia: single case feasibility study. Journal of Rehabilitation Research and Development, 51, 1069–1076. doi: 10.1682/JRRD.2013.10.0231.CrossRefGoogle ScholarPubMed
Mendez, M. F., Joshi, A. and Jimenez, E. (2015). Virtual reality for the assessment of frontotemporal dementia, a feasibility study. Disability and Rehabilitation: Assistive Technology, 10, 160–164. doi: 10.3109/17483107.2014.889230.Google ScholarPubMed
Mohammadi, A., Kargar, M. and Hesami, E. (2018). Using virtual reality to distinguish subjects with multiple- but not single-domain amnestic mild cognitive impairment from normal elderly subjects. Psychogeriatrics, 18, 132–142.10.1111/psyg.12301CrossRefGoogle Scholar
Moher, D. et al. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine, 6, e1000097. doi: 10.1371/journal.pmed.1000097.CrossRefGoogle ScholarPubMed
Monteiro-Junior, R. S. et al. (2017). Virtual Reality–Based Physical Exercise With Exergames (PhysEx) Improves Mental and Physical Health of Institutionalized Older Adults. Journal of the American Medical Directors Association, 18, 454.e1–454.e9. doi: 10.1016/j.jamda.2017.01.001.CrossRefGoogle ScholarPubMed
Morganti, F., Stefanini, S. and Riva, G. (2013). From allo- to egocentric spatial ability in early Alzheimer’s disease: a study with virtual reality spatial tasks. Cognitive Neuroscience, 4, 171–180. doi: 10.1080/17588928.2013.854762.CrossRefGoogle ScholarPubMed
Moyle, W. et al. (2018). Effectiveness of a virtual reality forest on people with dementia: a mixed methods pilot study. The Gerontologist, 58, 478–487. doi: 10.1093/geront/gnw270.CrossRefGoogle ScholarPubMed
Mrakic-Sposta, S. et al. (2018). Effects of combined physical and cognitive virtual reality-based training on cognitive impairment and oxidative stress in MCI patients: a pilot study. Frontiers in Aging Neuroscience, 10, 282. doi: 10.3389/fnagi.2018.00282.CrossRefGoogle ScholarPubMed
O’Connor, M.-F., Arizmendi, B. J. and Kaszniak, A. W. (2014). Virtually supportive: a feasibility pilot study of an online support group for dementia caregivers in a 3D virtual environment. Journal of Aging Studies, 30, 87–93. doi: 10.1016/j.jaging.2014.03.001.CrossRefGoogle Scholar
Opriş, D. et al. (2012). Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis: Virtual Reality Exposure Therapy. Depression and Anxiety, 29, 85–93. doi: 10.1002/da.20910.CrossRefGoogle ScholarPubMed
Optale, G. et al. (2010). Controlling memory impairment in elderly adults using virtual reality memory training: a randomized controlled pilot study. Neurorehabilitation and Neural Repair, 24, 348–357. doi: 10.1177/1545968309353328.CrossRefGoogle ScholarPubMed
Park, E. et al. (2019). Effects of a mixed reality-based cognitive training system compared to a conventional computer-assisted cognitive training system on mild cognitive impairment: a pilot study. Cognitive and Behavioral Neurology, 32, 7.10.1097/WNN.0000000000000197CrossRefGoogle ScholarPubMed
Park, J.-H. (2020). Effects of virtual reality-based spatial cognitive training on hippocampal function of older adults with mild cognitive impairment. International Psychogeriatrics, 1–7. doi: 10.1017/S1041610220001131.CrossRefGoogle ScholarPubMed
Park, J.-H. et al. (2020). Feasibility and tolerability of a culture-based virtual reality (VR) training program in patients with mild cognitive impairment: a randomized controlled pilot study. International Journal of Environmental Research and Public Health, 9.Google ScholarPubMed
Park, J.-S., Jung, Y.-J. and Lee, G. (2020). Virtual reality-based cognitive–motor rehabilitation in older adults with mild cognitive impairment: a randomized controlled study on motivation and cognitive function, 9.10.3390/healthcare8030335CrossRefGoogle Scholar
Parsons, T. D. and Barnett, M. (2017). validity of a newly developed measure of memory: feasibility study of the virtual environment grocery store. Journal of Alzheimer’s Disease. Edited by J. Robillard, 59, 1227–1235. doi: 10.3233/JAD-170295.CrossRefGoogle ScholarPubMed
Phillips, B. et al. (2009). Oxford Centre for Evidence-based Medicine: Levels of Evidence (March 2009), Oxford Centre for Evidence-based Medicine. Available at: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009 Google Scholar
Plancher, G. et al. (2012). Using virtual reality to characterize episodic memory profiles in amnestic mild cognitive impairment and Alzheimer’s disease: influence of active and passive encoding. Neuropsychologia, 50, 592–602. doi: 10.1016/j.neuropsychologia.2011.12.013.CrossRefGoogle ScholarPubMed
Ready, D. J. et al. (2010). Comparing virtual reality exposure therapy to present-centered therapy with 11 U.S. Vietnam veterans with PTSD. Cyberpsychology, Behavior, and Social Networking, 13, 49–54. doi: 10.1089/cyber.2009.0239.CrossRefGoogle ScholarPubMed
Repetto, C. et al. (2016). Virtual reality as an embodied tool to enhance episodic memory in elderly. Frontiers in Psychology, 7. doi: 10.3389/fpsyg.2016.01839.Google ScholarPubMed
Sauzéon, H. et al. (2016). Everyday-like memory for objects in ageing and Alzheimer’s disease assessed in a visually complex environment: the role of executive functioning and episodic memory. Journal of Neuropsychology, 10, 33–58. doi: 10.1111/jnp.12055.CrossRefGoogle Scholar
Saylor, K. (2020). Research Guides: Nursing: Hierarchy of Evidence Resources. Available at: https://guides.lib.umich.edu/nursing/evidence; accessed 24 April 2020Google Scholar
Seo, K. et al. (2017). Virtual daily living test to screen for mild cognitive impairment using kinematic movement analysis. PLOS ONE. Edited by K. Chen, 12, e0181883. doi: 10.1371/journal.pone.0181883.CrossRefGoogle ScholarPubMed
Serino, S. et al. (2014). Assessing the mental frame syncing in the elderly: a virtual reality protocol. Studies in Health Technology and Informatics, 199, 153–157.Google ScholarPubMed
Serino, S. et al. (2017). A novel virtual reality-based training protocol for the enhancement of the “Mental Frame Syncing” in individuals with Alzheimer’s disease: a development-of-concept trial. Frontiers in Aging Neuroscience, 9, 240. doi: 10.3389/fnagi.2017.00240.CrossRefGoogle ScholarPubMed
Serino, S. et al. (2018). Disentangling the contribution of spatial reference frames to executive functioning in healthy and pathological aging: an experimental study with virtual reality. Sensors, 18, 1783. doi: 10.3390/s18061783.CrossRefGoogle ScholarPubMed
Tarnanas, I. et al. (2013). Ecological validity of virtual reality daily living activities screening for early dementia: longitudinal study. JMIR Serious Games, 1, e1. doi: 10.2196/games.2778.CrossRefGoogle ScholarPubMed
Tarnanas, I. et al. (2014a). Can a novel computerized cognitive screening test provide additional information for early detection of Alzheimer’s disease? Alzheimer’s & Dementia, 10, 790–798. doi: 10.1016/j.jalz.2014.01.002.CrossRefGoogle ScholarPubMed
Tarnanas, I. et al. (2015). Reliability of a novel serious game using dual-task gait profiles to early characterize aMCI. Frontiers in Aging Neuroscience, 7, 50–50.10.3389/fnagi.2015.00050CrossRefGoogle ScholarPubMed
Tarnanas, I., Laskaris, N. and Tsolaki, M. (2012). On the comparison of VR-responses, as performance measures in prospective memory, with auditory P300 responses in MCI detection. Studies in Health Technology and Informatics, 181, 156.Google ScholarPubMed
Tarnanas, I., Tsolakis, A. and Tsolaki, M. (2014). Assessing virtual reality environments as cognitive stimulation method for patients with MCI. In: Brooks, A. L., Brahnam, S. and Jain, L. C. (Eds.), Technologies of Inclusive Well-Being (pp 39–74). Berlin, Heidelberg: Springer.10.1007/978-3-642-45432-5_4CrossRefGoogle Scholar
Thapa, N. et al. (2020). The effect of a virtual reality-based intervention program on cognition in older adults with mild cognitive impairment: a randomized control trial. Journal of Clinical Medicine, 9, 1283. doi: 10.3390/jcm9051283.CrossRefGoogle ScholarPubMed
Thiese, M. S. (2014). Observational and interventional study design types; an overview. Biochemia Medica, 24, 199–210. doi: 10.11613/BM.2014.022.CrossRefGoogle ScholarPubMed
Tippett, W. J. et al. (2009). Visually navigating a virtual world with real-world impairments: a study of visually and spatially guided performance in individuals with mild cognitive impairments. Journal of Clinical and Experimental Neuropsychology, 31, 447–454.10.1080/13803390802251360CrossRefGoogle ScholarPubMed
Torpil, B. et al. (2020). The Effectiveness of a virtual reality-based intervention on cognitive functions in older adults with mild cognitive impairment: a single-blind, RANDOMIZED CONTROLLED TRIAL. Games for Health Journal, g4h.2020.0086. doi: 10.1089/g4h.2020.0086.Google ScholarPubMed
Vahia, I. V. et al. (2017). Use of tablet devices in the management of agitation among inpatients with dementia: an open-label study. The American Journal of Geriatric Psychiatry, 25, 860–864. doi: 10.1016/j.jagp.2016.07.011.CrossRefGoogle Scholar
Wall, K. et al. (2018). The Enhanced Interactive Physical and Cognitive Exercise System (iPACESTM v2.0): Pilot Clinical Trial of an In-Home iPad-Based Neuro-Exergame for Mild Cognitive Impairment (MCI). Journal of Clinical Medicine, 7, 249.10.3390/jcm7090249CrossRefGoogle Scholar
Weniger, G. et al. (2011). Egocentric and allocentric memory as assessed by virtual reality in individuals with amnestic mild cognitive impairment. Neuropsychologia, 49, 518–527. doi: 10.1016/j.neuropsychologia.2010.12.031.CrossRefGoogle ScholarPubMed
Werner, P. et al. (2009). Use of the virtual action planning supermarket for the diagnosis of mild cognitive impairment. Dementia and Geriatric Cognitive Disorders, 27, 301–309.10.1159/000204915CrossRefGoogle Scholar
Wilhelm, F. H. et al. (2005). Mechanisms of virtual reality exposure therapy: the role of the behavioral activation and behavioral inhibition systems. Applied Psychophysiology and Biofeedback, 30, 271–284. doi: 10.1007/s10484-005-6383-1.CrossRefGoogle ScholarPubMed
Yamaguchi, T. et al. (2012). A dual-modal virtual reality kitchen for (Re)Learning of everyday cooking activities in alzheimer’s disease. Presence: Teleoperators and Virtual Environments, 21, 43–57. doi: 10.1162/PRES_a_00080.CrossRefGoogle Scholar
Zakzanis, K. K. et al. (2009). Age and dementia related differences in spatial navigation within an immersive virtual environment. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, 15, CR140–CR150.Google ScholarPubMed
Zygouris, S. et al. (2015). Can a virtual reality cognitive training application fulfill a dual role? Using the virtual supermarket cognitive training application as a screening tool for mild cognitive impairment. Journal Of Alzheimers Disease, 44, 1333–1347.10.3233/JAD-141260CrossRefGoogle ScholarPubMed
Zygouris, S. et al. (2017). A Preliminary Study on the Feasibility of Using a virtual reality cognitive training application for remote detection of mild cognitive impairment. Journal of Alzheimer’s Disease. Edited by C. de Jager, 56, 619–627. doi: 10.3233/JAD-160518.CrossRefGoogle Scholar
Zygouris, S. et al. (2020). Detection of mild cognitive impairment in an at-risk Group of Older Adults: Can a Novel Self-Administered Serious Game-Based Screening Test Improve Diagnostic Accuracy? Journal of Alzheimer’s Disease, 78, 405–412. doi: 10.3233/JAD-200880.CrossRefGoogle Scholar