In Singapore, one in 10 people aged 60 years and older may have dementia. The condition occurs when the brain is damaged by stroke or diseases like Alzheimer's, causing memory loss and difficulties with thinking, problem-solving or language.
As part of a new immersive virtual-reality (VR) study designed in Singapore to detect mild cognitive impairment in seniors, participants have to wear a special eyewear to complete tasks such as pressing the correct button on a virtual list panel and keying in the correct sum of money to buy fruit.
The first study in the series, called Re@ch, was developed by SingHealth Polyclinics (SHP) and Duke-NUS Medical School (Duke-NUS) in 2018, in collaboration with an Institute of Technical Education (ITE) Technology team from ITE College West.
A total of 60 senior patients aged between 65 and 85 were assessed at AHP’s Outram Polyclinic in the Phase 1 study completed in April last year. Nine in 10 found the test a positive experience. SHP’s Associate Professor Tan Ngiap Chuan said Phase 1 of the study has shown the feasibility and acceptability of using VR to screen for cognitive impairment in seniors. The virtual environment of 13 daily scenarios from the home to the supermarket allows the research team to assess the seniors’ cognitive skills better.
There are at present several screening tools, the most popular being the Mini-Mental State Examination (MMSE), which is the most widely applied test for dementia screening, and the Montreal Cognitive Assessment (MoCA), which is considered the best alternative to the MMSE. Both tests are conducted using paper and pencil and are administered to patients by healthcare workers.
Experts say one of the challenges in such self-reporting questionnaire-based assessments is that these may not be adequate in reviewing a person's performance of activities in daily life, known as "executive functions" - such as planning, focusing and remembering instructions. Executive functions are one of the six domains of cognition, with the others being complex attention (such as multitasking), memory, language, perceptual motor (how the brain and eyes speak to each other) and social cognition (such as decreased inhibitions).
All the enrolled senior patients in the first phase of the VR study were of acceptable mental capacity and were first screened via the MoCA test. Those with MoCA scores of 26 or higher out of 30 were identified as being "cognitively intact", while the rest who scored less than 26 were classified as having some degree of cognitive impairment. Out of the 60 patients, close to 40 per cent scored less than 26. Both groups then took the VR test to determine if there were any differences in their performance. Each participant had 15 to 20 minutes to complete the test. They were assessed on the ability to complete at last seven tasks correctly, the number of attempts at each task and the proportion of tasks performed correctly.
In general, the scores for each VR task performed were higher for the cognitively intact individuals than those with cognitive impairment.
A person with suspected early cognitive decline will be the target user of the Phase 2 study, which began last month and aims to assess close to 200 patients aged 35 years and older. A/Prof Tan said the results will be reviewed before the system is implemented for routine screening.
"It is still premature to indicate a timeline as more research needs to be done to validate the system before it can be rolled out into clinical practice," he says.
"Ultimately, the goal is to leverage emerging technology to portray realistic settings in the early detection of dementia in at-risk individuals and to prepare caregivers to support their loved ones."
Two seniors who took part in the first phase of the VR study said it was a fun experience.
Retired nurse Seah Ai Choo, 70, says initially she was slightly apprehensive about using the VR tool. "However, my worries were unfounded as the experience was fantastic, although the bulky eyewear did cause some mild discomfort as it pressed on my nose," says Madam Seah with a laugh.
Retiree Francis Toh, 76, who used to work in the food and beverage industry, says: "It was fun and easy to use and I felt I was really performing the actions in that virtual environment."