Objective: Spatial disorientation is common in Alzheimer’s disease (AD), Mild Cognitive Impairment (MCI), and preclinical individuals with AD biomarkers. However, traditional neuropsychological tests lack ecological validity for the assessment of spatial orientation and to date, there is still no gold standard. The current study aimed to determine the validity and accuracy of two virtual reality tasks for the assessment of spatial orientation.Methods: We adapted two spatial orientation tasks to immersive virtual environments: a “survey to route” task in which participants had to transfer information from a map to their body position within a maze [Spatial Orientation in Immersive Virtual Environment Test (SOIVET) Maze], and an allocentric-type, route learning task, with well-established topographic landmarks (SOIVET Route). A total of 19 MCI patients and 29 cognitively healthy older adults aged 61–92 participated in this study. Regular neuropsychological assessments were used for correlation analysis and participant performances were compared between groups. Receiver Operating Characteristic (ROC) curve analysis was performed for accuracy.Results: The SOIVET Maze correlated with measures of visuoperception, mental rotation, and planning, and was not related to age, educational level, or technology use profile. The SOIVET Route immediate correlated with measures of mental rotation, memory, and visuoconstruction, and was influenced only by education. Both tasks significantly differentiated MCI and control groups, and demonstrated moderate accuracy for the MCI diagnosis.Conclusion: Traditional neuropsychological assessment presents limitations and immersive environments allow for the reproduction of complex cognitive processes. The two immersive virtual reality tasks are valid tools for the assessment of spatial orientation and should be considered for cognitive assessments of older adults.

Spatial disorientation, defined as a defect in the ability to establish relations among positions, directions, movements of objects, and points in space, has been frequently reported in AD, commonly being one of the earliest symptoms^4,5,6,7. Several studies have also demonstrated spatial disorientation in MCI patients, with a prevalence as high as 41.4%^8,9,10,11. Changes in hippocampal volume or metabolism, considered particularly important predictors of conversion from MCI to AD, are known to mediate spatial orientation skills^9,12,13,14. It has been hypothesized that spatial disorientation in MCI patients could reflect an underlying neurodegenerative process in key areas for AD pathology, which would justify its inclusion in regular cognitive evaluation^5,11,15,16.

Spatial orientation is a cognitive domain frequently impaired in Alzheimer's Disease and can be one of its earliest symptoms. Objective: This paper describes the results of tolerability, sense of presence and usability of two immersive virtual reality tasks for the assessment of spatial orientation, using VR headset in adults. Methods: 31 healthy adults recruited from university and the local community performed two experimental immersive virtual reality tasks of spatial orientation: the SOIVET-Maze for the assessment of allocentric to egocentric spatial abilities and the SOIVET-Route for the assessment of spatial memory and landmark recognition. Participants completed questionnaires about sense of presence, cybersickness symptoms, technology use profile and motion sickness history. Usability measures were assessed by spontaneous feedback from participants. Results: All participants were able to understand the task instructions and how to interact with the system. Both tasks seemed to induce a strong sense of presence, as assessed by the Witmer and Singer Presence Questionnaires (M=128 and 143 for SOIVET-Maze and SOIVET-Route, respectively). The SOIVET-Route had a small numeric advantage over the SOIVET-Maze tolerability scores assessed by the Cybersickness Questionnaire (M=4.19, SD=5.576 and M=3.52, SD=6.418 for SOIVET-Maze and SOIVET-Route respectively). Also, there were no drop-outs on the SOIVET-Route due to tolerability issues, unlike the SOIVET-Maze, which had two drop-outs. However, this difference was not statistically significant (Z= -.901, p= 0.368, Wilcoxon signed-rank test).

There is growing recognition that much of human behavior is governed by the presence of classically conditioned cues. The Pavlovian-to-Instrumental Transfer (PIT) paradigm offers a way to measure the effects of classically conditioned stimuli on behavior. In the current study, a novel behavioral task, an adaptation of the PIT framework, was developed for use in conjunction with an fMRI classical conditioning task. Twenty-four healthy young adults completed (1) instrumental training, (2) Pavlovian conditioning, and (3) a Transfer test. During instrumental training, participants learned to apply force to a handgrip to win money from slot machines pictured on a computer screen. During Pavlovian conditioning, slot machines appeared with one of two abstract symbols (cues), one symbol was predictive of monetary reward. During the Transfer test, participants again applied force to a handgrip to win money. This time, the slot machines were presented with the Pavlovian cues, but with the outcomes hidden. The results indicated increased effort on the instrumental task, i.e. higher response frequency and greater force, in the presence of the reward-predicting cue. Our findings add to the growing number of studies demonstrating PIT effects in humans. This new paradigm is effective in measuring the effects of a conditioned stimulus on behavioral activation.

Although not evident clinically, lesions to the prefrontal cortex cause great social and functional impairment to patients. The anterior cingulate cortex is intimately involved with motivational behavior and after injury to this area the onset of an apathetic state can be observed. This paper describes the case of a patient with traumatic brain injury to the prefrontal lobe presenting with a depressive syndrome associated with apathetic symptoms. After appropriate treatment for depression, intense apathy was revealed, an irreversible sequelae of the traumatic brain injury, constituting the main barrier to the patient's return of lifestyle and independence.

Background Spatial orientation is a cognitive domain frequently compromised in patients with Alzheimer disease (AD) and may be one of its first clinical manifestations. Some studies have shown that allocentric integration with egocentric spatial information seems to be impaired in this pathology. There is no consensus on how best to assess spatial orientation and traditional tests lack ecological validity, but, recently, virtual reality (VR) has provided new opportunities for this assessment. Objectives To analyze the applicability and stability of an immersive virtual task developed to assess spatial orientation, the Spatial Orientation in Immersive Virtual Environment Maze Test (SOIVET-Maze) in older adults with and without mild cognitive impairment. Methods Forty-three older adults were included in the study, 24 without cognitive impairment and 19 with mild cognitive impairment. Applicability was assessed by the Witmer and Singer Sense of Presence Questionnaire and a questionnaire for adverse events of cybersickness. To assess stability, participants were assessed twice with an interval of 7 to 14 days, and the intraclass correlation coefficient was calculated between visits. The t test or the Mann-Whitney test was used to compare applicability and stability between groups. Results There was no significant difference between the groups regarding applicability. A strong correlation between the first and second day of testing was found in the mild cognitive impairment group. Conclusion The SOIVET-Maze task showed excellent applicability and good stability, favoring its clinical application for the evaluation of spatial orientation in older adults.