VR Games: The New Diagnostic Standard for Testing Neurocognitive Decline

From telehealth to decentralized clinical trials, we are experiencing an industrial shift from in-person primary care to embracing digital health care enablement. Specifically, digital advancement continues to expedite the diagnosis and treatment of cognitive health, which is an area of healthcare that is becoming more important than ever before. The Centers for Disease Control and Prevention (CDC) has reported that one in every nine individuals is dealing with some manner of cognitive decline; and by 2050, an estimated 115 million people worldwide will have a form of cognitive impairment. Based on the current needs, the forecasted market outlook for neurocognitive assessment and diagnosis is projected to grow from $3.2 billion in 2020 to $11.4 billion by 2025, at a compounded annual growth rate (CAGR) of 29.3%.

As Gen X, Y, Z and alpha mature, so will their need to leverage technology instead of the current archaic methods of cognitive testing. In the area of cognitive health, we are seeing a greater focus on virtual reality (VR) to test the effectiveness of drugs on cognitive function and for types of therapy. With far-reaching benefits like reduced time of efficacy, acceptance by patients and minimal side effects, it is not a far reach to say that we will see this novel approach become a norm in routine physical-mental health scans.

Cognitive Health: Current Testing & How VR Can Help

To understand how VR can be a useful therapy, let’s break down how cognitive health is defined and tested today. Cognitive decline is a normal response to the aging of neurons and reduced brain activities that occur naturally in every individual at some point in their life. On the other hand, cognitive impairment – such as Dementia, Alzheimer’s, Parkinson’s and Huntington’s disease – could be a result of diseases, damage or abnormal cognitive decline. Individuals suffering from cognitive decline or impairment disorder are unable to perform routine tasks, such as meal preparation, medication adherence and language understanding, which will ultimately require additional dedicated care.

Currently, neurocognitive disorders, like Dementia or Alzheimer’s, are identified using CT scans, head MRIs, PET scans and/or an EEG. These scans are expensive, time-consuming, invasive and in many instances, inconclusive of the type of cognitive decline an individual may be experiencing. Additionally, for many individuals, visiting a clinical environment can be stressful and negatively affect cognitive assessments.

To avoid stigmatization and to motivate patient participation in neurocognitive testing, game-like applications, such as EPAM’s Inner Focus Platform, can be useful. That’s because effective VR cognitive assessments are sensitive, specific and are designed to assess key domains – like memory, attention span, emotional and social cognition, executive functions and psychomotor speed. Neurocognitive diagnosis performed using VR games can be efficient, non-invasive, executed at a reduced cost and would not have any associated age restrictions (unlike some of the typical diagnostic options). In addition to being effective for children dealing with ADHD, autism or dyslexia, this type of testing can also detect neurocognitive decline at an early stage or adults suffering from Dementia or Alzheimer’s.

The use of VR in cognitive games keeps individuals engaged through various virtual physical activities and mentally challenging tasks. While an individual is engaged in cognitive activities, the tool collects metrics – like movement and response time, focus range and memory status – to evaluate the effectiveness of an administered drug or therapeutic regime.

Overcoming Challenges

Diagnosis of neurocognitive decline or disorders, as well as treatment using VR games, is an innovative discovery tool that can be engaged by the patient from any location. Currently, the idea is being used as part of several ongoing clinical trials to test the effectiveness of VR intervention in people suffering from cognitive impairment. However, before VR cognitive games become part of routine treatment, some limitations need to be addressed:

Cognitive Testing Challenges

1. Intellectual property (IP): Many cognitive test designs have been subjected to IP regulations, limiting accessibility to a wider population.
2. Scoring inconsistency: Different cognitive tests use different metrics to calculate a score, which has the potential to result in an inaccurate diagnosis. A universal scoring matrix is required to accurately determine and diagnose the level of the decline of neurocognitive function.
3. Sensory impairment: Current cognitive assessments are not designed to address the needs of individuals with sensory impairment (vision or hearing loss). An impact on the cognitive score was observed in individuals with mild sensory impairment, who took the cognitive assessment.

VR Challenges

1. Training: The administration of VR games as a therapy would require training before use. Easy and comprehensible training is needed to understand how the solution can be used successfully.
2. Motion sickness: A common disadvantage of VR has been motion sickness. This impacts performance during cognitive testing and makes the VR experience unpleasant.
3. Cybersickness: Applications designed to encompass a room can become challenging for patients with limited mobility (strong drug side effects, disabilities, etc.) as these patients need to use the system in a seated position.

Despite these challenges, cognitive assessments are becoming a new reality and are being used by both private and public institutions to support the wellbeing of their patients and employees. The use of VR cognitive games can enhance diagnostic capabilities by providing new ways to:

• Test for visuospatial reasoning in 3D, which are key indicators of neurocognitive decline
• Develop dual tasks to test for multiple cognitive disorders
• Use non-invasive imaging methods from wearable devices that can provide body/brain imaging
• Treat and rehabilitate patients
• Provide a relaxed, anxiety-free environment for increased engagement
• Streamline cloud storage to provide patients with self-administration capabilities.

These dedicated applications and VR assessments will play a vital role in the early detection and diagnosis of cognitive decline and the design of personalized cognitive treatment regimens. We look forward to continuing to partner with companies who are advancing diagnostic tools through technology innovation to bring these platforms to life.