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      A Feasibility Study with Image-Based Rendered Virtual Reality in Patients with Mild Cognitive Impairment and Dementia

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          Abstract

          Virtual Reality (VR) has emerged as a promising tool in many domains of therapy and rehabilitation, and has recently attracted the attention of researchers and clinicians working with elderly people with MCI, Alzheimer’s disease and related disorders. Here we present a study testing the feasibility of using highly realistic image-based rendered VR with patients with MCI and dementia. We designed an attentional task to train selective and sustained attention, and we tested a VR and a paper version of this task in a single-session within-subjects design. Results showed that participants with MCI and dementia reported to be highly satisfied and interested in the task, and they reported high feelings of security, low discomfort, anxiety and fatigue. In addition, participants reported a preference for the VR condition compared to the paper condition, even if the task was more difficult. Interestingly, apathetic participants showed a preference for the VR condition stronger than that of non-apathetic participants. These findings suggest that VR-based training can be considered as an interesting tool to improve adherence to cognitive training in elderly people with cognitive impairment.

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          Effectiveness of an attention-training program.

          Attention Process Training (APT), a hierarchical, multilevel treatment program, was designed to remediate attention deficits in brain-injured persons. The program incorporates current theories in the experimental attention literature. Four brain-injured subjects, varying widely in both etiology of injury and time post onset, underwent intensive cognitive remediation including 5 to 10 weeks of specific attention training. Results are displayed using a single subject multiple baseline across behaviors design. All four subjects demonstrated significant gains in attention following the initiation of attention training. Remediation of another cognitive function (visual processing) was not associated with alterations in attention behavior. The merits of a process-specific approach to cognitive rehabilitation are discussed.
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            ‘Kitchen and cooking,’ a serious game for mild cognitive impairment and Alzheimer’s disease: a pilot study

            Recently there has been a growing interest in employing serious games (SGs) for the assessment and rehabilitation of elderly people with mild cognitive impairment (MCI), Alzheimer’s disease (AD), and related disorders. In the present study we examined the acceptability of ‘Kitchen and cooking’ – a SG developed in the context of the EU project VERVE (http://www.verveconsortium.eu/) – in these populations. In this game a cooking plot is employed to assess and stimulate executive functions (such as planning abilities) and praxis. The game is installed on a tablet, to be flexibly employed at home and in nursing homes. Twenty one elderly participants (9 MCI and 12 AD, including 14 outpatients and 7 patients living in nursing homes, as well as 11 apathetic and 10 non-apathetic) took part in a 1-month trail, including a clinical and neuropsychological assessment, and 4-week training where the participants were free to play as long as they wanted on a personal tablet. During the training, participants met once a week with a clinician in order to fill in self-report questionnaires assessing their overall game experience (including acceptability, motivation, and perceived emotions). The results of the self reports and of the data concerning game performance (e.g., time spent playing, number of errors, etc) confirm the overall acceptability of Kitchen and cooking for both patients with MCI and patients with AD and related disorders, and the utility to employ it for training purposes. Interestingly, the results confirm that the game is adapted also to apathetic patients.
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              Cognitive training changes hippocampal function in mild cognitive impairment: a pilot study.

              A randomized pilot experiment examined the neural substrates of response to cognitive training in participants with mild cognitive impairment (MCI). Participants performed exercises previously demonstrated to improve verbal memory and an active control group performed other computer activities. An auditory-verbal fMRI task was conducted before and after the two-month training program. Verbal memory scores improved significantly and left hippocampal activation increased significantly in the experimental group (gains in 5 of 6 participants) relative to the control group (reductions in all 6 participants). Results suggest that the hippocampus in MCI may retain sufficient neuroplasticity to benefit from cognitive training.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 March 2016
                2016
                : 11
                : 3
                : e0151487
                Affiliations
                [1 ]EA CoBTeK / IA, University of Nice Sophia Antipolis, Nice, France
                [2 ]Institut National de Recherche en Informatique et en Automatique, Sophia Antipolis, France
                [3 ]Centre Mémoire de Ressources et de Recherche, CHU de Nice, Nice, France
                [4 ]Disney Research Los Angeles, Los Angeles, California, United States of America
                [5 ]Trinity College Dublin, Dublin, Ireland
                University of California, San Francisco, UNITED STATES
                Author notes

                Competing Interests: Co-author Jan Ondrej is employed by Disney Research Los Angeles. There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

                Conceived and designed the experiments: VM EC JB RG RD JO GD PR. Performed the experiments: VM EC JB RD PR. Analyzed the data: VM EC PR. Contributed reagents/materials/analysis tools: EC RG GD JO. Wrote the paper: VM EC JB RG RD JO GD PR.

                Article
                PONE-D-15-34908
                10.1371/journal.pone.0151487
                4798753
                26990298
                1f2bb83b-59df-424d-b129-94cd5d970656
                © 2016 Manera et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 10 August 2015
                : 29 February 2016
                Page count
                Figures: 4, Tables: 2, Pages: 14
                Funding
                This study was supported by a grant from the FP7 European Commission Seventh Framework Programme VERVE project (Vanquishing fear and apathy through e-inclusion: http://www.verveconsortium.com/), by the Innovation Alzheimer Association, and by the Lions district Provence-Alpes Côte d’azur. The study has been realized in the ecological room of the Edmond et Lily Safra center at the Institut Claude Pompidou. Disney Research Los Angeles provided support in the form of salaries for authors [JO], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.
                Categories
                Research Article
                Engineering and Technology
                Human Factors Engineering
                Man-Computer Interface
                Virtual Reality
                Computer and Information Sciences
                Computer Architecture
                User Interfaces
                Virtual Reality
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Neuroscience
                Cognitive Neurology
                Cognitive Impairment
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                Neuroscience
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                Cognitive Neurology
                Cognitive Impairment
                Medicine and Health Sciences
                Neurology
                Cognitive Neurology
                Cognitive Impairment
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Dementia
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                Neurology
                Dementia
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                Dementia
                Alzheimer Disease
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                Neurology
                Dementia
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                Cognition
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                Memory
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