VR Navigation Task Outperforms Cognitive Tests in Identifying Alzheimer's Disease

A virtual reality (VR) tool identified early Alzheimer’s disease more accurately than existing cognitive tests, according to research from the University of Cambridge.

The findings, published in the journal Brain, came from patients who participated in a VR navigation task. The test had a higher diagnostic sensitivity and specificity for differentiating biomarker positive versus negative patients, with an area under the curve of 0.9. The cognitive tests had an area under the curve of 0.57.

Patients with mild cognitive impairments who had positive cerebrospinal fluid markers, which indicated the presence of Alzheimer’s disease, performed worse than those with negative biomarkers.

“These results suggest a VR test of navigation may be better at identifying early Alzheimer’s disease than tests we use at present in clinic and in research studies,” said study lead Dennis Chan, Ph.D., from the clinical neurosciences department at the University of Cambridge.

The research team, led by Chan, recruited 45 patients with mild cognitive impairment. Those patients typically have an impaired memory, which can indicate early Alzheimer’s. But it can also be caused by other conditions, such as anxiety and even normal aging.

Establishing the cause of mild cognitive impairment is necessary to determine whether affected individuals are at risk of developing dementia in the future.

The researchers’ primary objective was to see if the performance of the task on the entorhinal cortex function differentiated mild cognitive impairment patients at increased risk of developing dementia. The team also had several secondary objectives:

• To determine whether manipulation of environmental conditions would affect path integration performance
• To determine whether the task performance correlated with entorhinal cortex volumes
• To determine whether the task exhibited greater classification accuracy than current cognitive tests considered to have high diagnostic sensitivity and specificity for early Alzheimer’s disease

The researchers took samples of cerebrospinal fluid to look for biomarkers of underlying Alzheimer’s disease in the patients — and 12 tested positive. The team recruited 41 age-matched healthy controls for comparison.

For the navigation task, participants walked an L-shaped path to three locations marked by inverted cones at head height. Each cone disappeared after the participant reached it, and then the next cone in sequence appeared. Audio prompted participants toward the next cone. When the participant reached the third cone, a message asked the individual to walk back to the location of the first cone by memory.

Patients with mild cognitive impairment performed worse on the navigation task than the healthy controls.

“We know that Alzheimer’s affects the brain long before symptoms become apparent,” Chan said. “We’re getting to the point where everyday tech can be used to spot the warning signs of the disease well before we become aware of them.”

Chan suggested that VR can help clinical trials for future drugs aimed at slowing down or halting the progression of Alzheimer’s disease.

He also said that app-based approaches have the potential to diagnose the disease at minimal extra cost, in a way that’s scalable beyond brain scanning and other current diagnostic approaches.

Chan is working with Cecilia Mascolo, Ph.D., professor of mobile systems at the University of Cambridge, to develop apps that would run on smartphones and smartwatches. The apps will be designed to track changes in other activities such as sleep and communication.

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