Using Virtual Reality to Assess Spatial Cognition in Subjective Cognitive Decline and Mild Cognitive Impairment due to Alzheimer’s Disease

Abstract Background Spatial navigation impairment (SNI) is prevalent in people with Alzheimer’s disease (AD) continuum and may appear in the initial clinical stage. To detect this deficit in people at risk may not only help to prevent getting lost or missing incidents, but also provide a useful clinical feature for diagnosis. Traditional assessments for SNI include questionnaires, paper pencil and maze tests, or video games. Although a real‐world setting is more valid, direct, and accurate, it has many unexpected conditions such as weather, obstacles, or accidents. Thanks to technology, virtual reality (VR) is a new way to assess SNI. Method We used PJVR to test spatial navigation ability in cognitively unimpaired (CU), subjective cognitive decline (SCD) and mild cognitive impairment due to AD (MCI‐AD). The PJVR is the VR version (Vive Pro Eye Head‐mounted Display, HTC) of the PJ device, which was developed by Pai and Jan and has been successfully verified its power to discriminate each other among CU, MCI, and mild AD. With a map provided and using joysticks or handles, participants were requested to reach five points in a 660‐meter path on our university campus. Linear deviation in meters in each point was treated as the variable for comparison. A pre‐test training course was given to facilitate the procedure. Result 118 subjects signed informed consent and 87 (73.7%) completed the trials, including 18 CU, 41 SCD and 28 MCI‐AD. Fourteen, or 11.9%, of all participants failed the trials due to cybersickness. The averaged linear deviations of the CU, SCD and MCI‐AD were 36.1 (38.2), mean (S.D.), 40.8 (44.4), and 93.7 (46.8) meters respectively (p<0.000). The linear deviation of the PJVR of the participants was correlated with the Questionnaire on Everyday Navigation Abilities (p<0.001), indicating a good real‐world validity. Conclusion Although the rate of cybersickness is higher as compared with the reports from Western countries, most of the participants completed the trials. The PJVR is feasible to assess spatial cognition and able to discriminate CU/SCD from MCI‐AD. To simplify PJVR to be practical is important to welcome the era of digital cognitive assessment.