Virtual Reality Technology and Alzheimer's Disease

The use of virtual reality technology in the assessment, study of, and possible assistance in the rehabilitation of memory deficits associated with patients with Alzheimer disease.

Background

Alzheimer's disease is the common cause of dementia, and is particularly common in older people. Because it is the most common cause of dementia, Alzheimer's disease is commonly equated with the general term dementia. However, there are many other causes of dementia. Alzheimer's disease is therefore a specific form of dementia having very specific microscopic brain abnormalities.

Alzheimer disease is not merely a problem of memory. Additional mental and behavioral problems often affect people who have the disease, and may influence quality of life, caregivers, and the need for institutionalization.

Depression for example affects 20–30% of people who have Alzheimer’s, and about 20% have anxiety. Psychosis (often delusions of persecution) and agitation/aggression also often accompany this disease. Common symptoms and comorbidities include:

• Mental deterioration of organic or functional origin

• Loss of cognitive ability in a previously-unimpaired person, beyond what might be expected from normal aging. Areas particularly affected include memory, attention, judgement, language and problem solving.

• Loss (usually gradual) of mental abilities such as thinking, remembering, and reasoning. It is not a disease, but a group of symptoms that may accompany some diseases or conditions affecting the brain.

• Deteriorated mental state due to a disease process and the result from many disorders of the nervous system.

• Cognitive deficit or memory impairment due to progressive brain injury.

Distinguishing Alzheimer's disease from other causes of dementia is not always as easy and straightforward as defining these terms. In practice, people and their disorders of behaviour, or behaviours of concern are far more complex than the simple definitions sometimes provided.

Establishing patient history, abilities, the natural course of disorder development such as that involving short-term memory, speech and language, personality, decision-making and judgment, and others is often needed in the diagnosis of the disease. Routine diagnostic steps therefore include a careful history, mental status screening, laboratory and imaging studies, and neuropsychologic testing.

Differential diagnosis of Alzheimer's disease

It is sometimes difficult to differentiate dementia caused by Alzheimer's from delirium and in addition several features distinguish dementia from depression, but the two can coexist and the distinction may be uncertain.

Whilst prominent motor signs such as Gait disturbance is a characteristic feature of patients with vascular dementia - In contrast, the NINCDS-ADRDA criteria for Alzheimer's disease state that: `gait disturbance at the onset or very early in the course of the illness' makes the diagnosis of probable Alzheimer's disease uncertain or unlikely. However, clinical studies suggest that gait disturbance is not restricted to the later stages of Alzheimer's disease. Also, studies have identified abnormalities of gait and balance in patients with early Alzheimer's disease(1).

It had been thought that Dementias without prominent motor signs included Alzheimer's disease, frontotemporal dementia, and Creutzfeld-Jakob, and others and the clinical pattern of gait disturbance in patients with early Alzheimer's disease has attracted less attention to date.

Diagnosis

Differential diagnosis between the types of dementia and treatments available for Alzheimer's - while limited in their effectiveness usually have best patient outcomes when begun early in the course of the disease. Diagnosis and/or diagnostic tools include:

Taking medical history.

Physical examination including evaluations of hearing and sight, as well as blood pressure and pulse readings, etc.

Standard laboratory tests including blood and urine tests designed to help eliminate other possible conditions.

Neuropsychological testing including assessing memory, problem-solving, attention, vision-motor coordination and abstract thinking, such as performing simple calculations.

Brain-imaging or structural brain scan such as CT or MRI to help rule out brain tumors or blood as the reason for symptoms and more recently

The use of virtual reality

The use of virtual reality technology in the assessment, study of, and possible assistance in the rehabilitation of memory deficits associated with patients with Alzheimer disease.

Using virtual reality to simulate real-word environments and test patient’s ability to navigate these environments. Work has been carried out to compare previously described real-world navigation tests with a virtual reality version simulating the same navigational environment (2). Authors of this research work conclude that virtual navigation testing reveals deficits in aging and Alzheimer disease that are associated with potentially grave risks to patients and the community.

In another study in the United Kingdom (3), researchers’ aimed to examine the feasibility of virtual reality technology for use by people with dementia (PWD). Data was obtained directly from six PWD regarding their experiences with a virtual environment of a large outdoor park. A user-centered method was developed to assess:

(a) presence;
(b) user inputs;
(c) display quality;
(d) simulation fidelity; and
(e) overall system usability.

The extent to which PWD could perform four functional activities in the virtual enviroment was also investigated (e.g., mailing a letter). In addition, physical and psychological well-being of PWD while interacting with the virtual environment was assessed objectively by recording heart rate during the virtual reality sessions and subjectively with discrete questionnaire items and real-time prompts.

(1) Gait disturbance in Alzheimer's disease: a clinical studyS.T. O'Keeffe, H. Kazeem, R.M. Philpott, J.R. Playfer, M. Gosney, M. Lye July, 1996

(2) NEUROLOGY 2008;71:888-895
Detecting navigational deficits in cognitive aging and Alzheimer disease using virtual reality
Laura A. Cushman, PhD, Karen Stein and Charles J. Duffy, MD, PhD
From the Departments of Neurology, Brain and Cognitive Sciences, Neurobiology and Anatomy, Ophthalmology, and Psychiatry (L.A.C.) and Center for Visual Science, The University of Rochester Medical Center, Rochester, NY.

(3) Flynn D, van Schaik P, Blackman T, Femcott C, Hobbs B, Calderon C.
School of Social Sciences and Law, The University of Teesside, Middlesbrough, United Kingdom

Experiences That Are Quite Unreal

Sydney Morning Herald

Sunday June 28, 1992

By MONIQUE FARMER

Jack Dikian and Virtual Worlds

IT USUALLY takes years for a computer technology to go from the laboratory or R & D department to the mass market. Those lucky enough to experience a new technology in its infancy are generally only the well connected or the wealthy

An exhibition at the Powerhouse museum (Sydney) next month will allow the public to experience two exciting and quite recently developed technologies - virtual reality and the computerised transformation of images known as "morphing".

The exhibitions, called "Virtual Reality" and "Altered States", will run during the school holidays but the Powerhouse museum expects as many adults as children to attend.

The Powerhouse claims to be the first museum in the world to conduct an exhibition, albeit a temporary one, on virtual reality.

According to the museum's curator of mathematics and computing, Matthew Connell, the aim of the Powerhouse has always been to feature new technologies.

"We have a tradition of presenting new technologies to the Australian public," said Connell. "These are important technologies which will have enormous impact, and we want to be there from the very beginning."

The virtual-reality exhibition will be a hands-on experience - people wearing headsets and holding joysticks will interact in computerised "virtual"worlds.

There is a choice of two virtual-reality experiences - Dactyl Nightmare(prehistoric birds swoop on you from great heights as you avoid an opponent)and Capture the Flag (ambush your opponent and seize his flag before you get shot).

Each fantasy experience takes three minutes and about 120 people will be able to participate each day. The visuals of Dactyl Nightmare and Capture the Flag will be shown on television monitors for the benefit of those who, because of time limitations, aren't able to participate.

Connell is not thrilled by the content of the virtual-reality experiences, but says the most important thing is enabling people to experience the technology.

"Dactyl Nightmare and Capture the Flag are shoot-'em-up games - they're not as bad as some video games, but that was all that was available to us," he said. "We're more interested in showing people the technology than whether the content is ideal. For a permanent exhibition we'd present a much wider choice than video arcade narratives.

"A lot of people will be interested in virtual reality as a new experience, but we want to draw attention to the enormous potential of the technology: for example, the less-sensationalist possibilities in science, education, design," said Connell.

The Powerhouse was investigating the feasibility of a virtual-reality display and speaking to companies in the United States and Japan when it discovered a Melbourne company that had begun distributing virtual-reality systems.

The Virtual Reality Corporation, which formed earlier this year, has the only two commercial virtual-reality systems in Australia. They are aimed at the education market and were produced by W Industries in the United Kingdom -systems are already installed in some European and American clubs and retail stores.

The museum's director, Terence Measham, said the Powerhouse was keen to develop a permanent virtual-reality exhibition.

The other temporary exhibition, "Altered States", will focus on the popular technology "morphing", in which a computer seamlessly transforms one object on-screen into another. The technique was used in Michael Jackson's video clip Black and White, in the film Terminator 2, and is being used in some Australian television commercials.

The exhibition will feature two graphics simulations on Silicon Graphics workstations which are explored using a spaceball, or 3-D mouse. People will be able to fly over a fractal-generated landscape in a paper aeroplane, and walk through an architect's design of a building.

Jack Dikian, a futurist with Silicon Graphics, will be at the museum, conducting demonstrations and answering questions on computerised image transformation.

"We hope people gain an understanding of how interactive 3-D graphics can be used in the workplace, and that they develop an appreciation of what the technology can do for them," Dikian said.

He said that people seeing a simulation for the first time usually reacted with stunned silence. "Most people are struck by what they're seeing. You'd never expect to look down at a mountain as you fly over it. People often ask if they're watching a movie," he said.

"Virtual Reality" is on daily from next Saturday to Wednesday, July 8. It is recommended for children aged 10 and over. Bookings must be made in person on the day at the museum for a chance to participate. Twenty names will be drawn from a barrel each hour. "Altered States" is on daily from Monday, July 13, to Sunday, July 19, from 10 am to 4 pm.