A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Abstract The current study sought to evaluate a novel kind of interactive computer-based cognitive training (ICT) in Alzheimer’s disease (AD). AD patients (N = 9), age- and gender-matched patients with a major depressive episode (N = 9), and healthy control subjects (N = 10) were trained to use an ICT program that relates to activities of daily living (ADL). Digital photographs of a shopping route were implemented in a close-to-reality simulation on a computer touch-screen. The task was to find a predefined shopping route, to buy three items, and to answer correctly 10 multiple-choice questions addressing knowledge related to the virtual tasks. Training performance was rated using the number of mistakes (wrong way), time needed for the tasks, number of correct multiple-choice answers, and of repeat of instruction. Compared to normal controls and depressed patients, AD patients performed significantly worse with regard to all variables. Within a 4-week training period including 12 sessions, however, substantial training gains were observed, including a significant reduction of mistakes. Training effects were sustained until follow-up 3 weeks later. The performance of the depressed patients and the normal controls improved as well, with no difference between the two groups. Self-reported effects revealed that the training was well perceived. Thus, the task performance of AD patients improved substantially and subjects appeared to have liked this approach to ICT. New interactive media, therefore, may yield interesting opportunities for rehabilitation and (psycho)therapeutic interventions. <s> BIB001 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Spatial disorientation and learning problems belong to the integral symptoms of Alzheimer's disease (AD). A circular arena for human subjects (2.9 m diameter, 3 m high) was equipped with a computerized tracking system, similar to that used in animals. We studied navigation in 11 subjects diagnosed with early stages of Alzheimer's disease (AD), 27 subjects with subjective problems with memory or concentration, and 10 controls. The task was to locate one or several unmarked goals using the arena geometry, starting position and/or cues on the arena wall. Navigation in a real version and a computer map view version of the tests yielded similar results. The AD group was severely impaired relative to controls in navigation to one hidden goal in eight rotated positions. The impairment was largest when only the cues on the wall could be used for orientation. Also, the AD group recalled worse than controls the order of six sequentially presented locations, though they recalled similarly to controls the positions of the locations. The group with subjective problems was not impaired in any of the tests. Our results document the spatial navigation and non-verbal episodic memory impairment in the AD. Similar results in real and map view computer tests support the use of computer tests in diagnosis of cognitive disturbances. <s> BIB002 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> The cognitive processes supporting spatial navigation are considered in the context of a patient (CF) with possible very early Alzheimer's disease who presents with topographical disorientation. Her verbal memory and her recognition memory for unknown buildings, landmarks and outdoor scenes was intact, although she showed an impairment in face processing. By contrast, her navigational ability, quantitatively assessed within a small virtual reality (VR) town, was significantly impaired. Interestingly, she showed a selective impairment in a VR object-location memory test whenever her viewpoint was shifted between presentation and test, but not when tested from the same viewpoint. We suggest that a specific impairment in locating objects relative to the environment rather than relative to the perceived viewpoint (i.e. allocentric rather than egocentric spatial memory) underlies her topographical disorientation. We discuss the likely neural bases of this deficit in the light of related studies in humans and animals, focusing on the hippocampus and related areas. The specificity of our test indicates a new way of assessing topographical disorientation, with possible application to the assessment of progressive dementias such as Alzheimer's disease. <s> BIB003 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Patients with Alzheimer's disease (AD) frequently have difficulties with spatial orientation in their day-to-day life. Although AD is typically preceded by amnestic mild cognitive impairment (MCI), spatial navigation has not yet been studied in MCI. Sixty-five patients were divided into five groups: probable AD (n = 21); MCI, further classified as amnestic MCI single domain (n = 11); amnestic MCI multiple domain (n = 18), or nonamnestic MCI (n = 7), and subjective memory complaints (n = 8). These patients, together with a group of healthy control subjects (n = 26), were tested by using a four-subtests task that required them to locate an invisible goal inside a circular arena. Each subtest began with an overhead view of the arena showed on a computer monitor. This was followed by a real navigation inside of the actual space, an enclosed arena 2.9 m in diameter. Depending on the subtest, the subjects could use the starting position and/or cues on the wall for navigation. The subtests thus were focused on allocentric and egocentric navigation. The AD group and amnestic MCI multiple-domain group were impaired in all subtests. The amnestic MCI single-domain group was impaired significantly in subtests focused on allocentric orientation and at the beginning of the real space egocentric subtest, suggesting impaired memory for allocentric and real space configurations. Our results suggest that spatial navigation impairment occurs early in the development of AD and can be used for monitoring of the disease progression or for evaluation of presymptomiatic AD. <s> BIB004 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Background:Older adults get lost, in many cases because of recognized or incipient Alzheimer disease (AD). In either case, getting lost can be a threat to individual and public safety, as well as to personal autonomy and quality of life. Here we compare our previously described real-world navigation test with a virtual reality (VR) version simulating the same navigational environment. Methods:Quantifying real-world navigational performance is difficult and time-consuming. VR testing is a promising alternative, but it has not been compared with closely corresponding real-world testing in aging and AD. We have studied navigation using both real-world and virtual environments in the same subjects: young normal controls (YNCs, n = 35), older normal controls (ONCs, n = 26), patients with mild cognitive impairment (MCI, n = 12), and patients with early AD (EAD, n = 14). Results:We found close correlations between real-world and virtual navigational deficits that increased across groups from YNC to ONC, to MCI, and to EAD. Analyses of subtest performance showed similar profiles of impairment in real-world and virtual testing in all four subject groups. The ONC, MCI, and EAD subjects all showed greatest difficulty in self-orientation and scene localization tests. MCI and EAD patients also showed impaired verbal recall about both test environments. Conclusions:Virtual environment testing provides a valid assessment of navigational skills. Aging and Alzheimer disease (AD) share the same patterns of difficulty in associating visual scenes and locations, which is complicated in AD by the accompanying loss of verbally mediated navigational capacities. We conclude that virtual navigation testing reveals deficits in aging and AD that are associated with potentially grave risks to our patients and the community. GLOSSARYAD = Alzheimer disease; EAD = early Alzheimer disease; MCI = mild cognitive impairment; MMSE = Mini-Mental State Examination; ONC = older normal control; std. wt. = standardized weight; THSD = Tukey honestly significant difference; VR = virtual reality; YNC = young normal control. <s> BIB005 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> ABSTRACT Using virtual reality (VR), we examined the barriers to and facilitators of functioning outdoors in persons with dementia (PwD) and investigated the generalizability of findings in VR to the real world. An existing town center was modeled in VR. PwD took part in both real-world and VR walks. Based on the results, the model was redesigned and then tested again. Performance on the walks improved, and potentially beneficial adaptations to outdoor environments were identified, but limitations of VR as a representation of the real world were also identified. We conclude that VR models, together with a rigorous behavioral testing method, can be a useful tool for the evaluation of outdoor environments and for identifying improvements for PwD. <s> BIB006 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Immersive virtual reality (VR) is an innovative tool that can allow study of human spatial navigation in a realistic but controlled environment. The purpose of this study was to examine age- and Alzheinrer's disease-related differences in route learning and memory using VR. The spatial memory task took place in a VR environment set up on a Computer Workstation. Participants were immersed by putting video unit goggles over their eyes using a Head Mounted. Participants were shown a path within a virtual city, and then had to navigate it as quickly and accurately as possible. They were granted four learning trials on this path. An interference path was then presented before asking participants to re-navigate the first route at short and long delays. Finally, participants were tested for recognition of the city's buildings and objects. Young adults were consistently quicker and more accurate in their path navigation than older participants whilst those patients with Alzheimer's Disease made more mistakes on the recognition task in particular, being more likely to mistakenly affirm having seen an element in the city when it was in fact a foil. Our study would suggest that spatial navigation is susceptible to the effects of aging and Alzheimer's Disease. The potential applications ofVR to the study of spatial navigation is seemingly important in that it may help place the science of neuropsychology on firmer scientific grounds in terms of its validity to real world function and dysfunction. <s> BIB007 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Background. Memory decline is a prevalent aspect of aging but may also be the first sign of cognitive pathology. Virtual reality (VR) using immersion and interaction may provide new approaches to the treatment of memory deficits in elderly individuals. Objective. The authors implemented a VR training intervention to try to lessen cognitive decline and improve memory functions. Methods. The authors randomly assigned 36 elderly residents of a rest care facility (median age 80 years) who were impaired on the Verbal Story Recall Test either to the experimental group (EG) or the control group (CG). The EG underwent 6 months of VR memory training (VRMT) that involved auditory stimulation and VR experiences in path finding. The initial training phase lasted 3 months (3 auditory and 3 VR sessions every 2 weeks), and there was a booster training phase during the following 3 months (1 auditory and 1 VR session per week). The CG underwent equivalent face-to-face training sessions using music therapy. Both groups par... <s> BIB008 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Abstract Present evidence suggests that medial temporal cortices subserve allocentric representation and memory, whereas egocentric representation and memory also depends on parietal association cortices and the striatum. Virtual reality environments have a major advantage for the assessment of spatial navigation and memory formation, as computer-simulated first-person environments can simulate navigation in a large-scale space. Twenty-nine patients with amnestic MCI (aMCI) were compared with 29 healthy matched controls on two virtual reality tasks affording to learn a virtual park (allocentric memory) and a virtual maze (egocentric memory). Participants further received a neuropsychological investigation and MRI volumetry at the time of the assessment. Results indicate that aMCI patients had significantly reduced size of the hippocampus bilaterally and the right-sided precuneus and inferior parietal cortex. aMCI patients were severely impaired learning the virtual park and the virtual maze. Smaller volumes of the right-sided precuneus were related to worse performance on the virtual maze. Participants with striatal lacunar lesions committed more errors than participants without such lesions on the virtual maze but not on the virtual park. aMCI patients later converting to dementia (n = 15) had significantly smaller hippocampal size when compared with non-converters (n = 14). However, both groups did not differ on virtual reality task performance. Our study clearly demonstrates the feasibility of virtual reality technology to study spatial memory deficits of persons with aMCI. Future studies should try to design spatial virtual reality tasks being specific enough to predict conversion from MCI to dementia and conversion from normal to MCI. <s> BIB009 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> In advanced countries throughout the world, the population of Alzheimer's Disease(AD) patients has been gradually increasing with the aging of the society. As a result, it has become an important research topic how to diagnose AD early and give necessary treatment and training to AD patients, especially those with mild cognitive impairment(MCI), whose executive functions such as response inhibition, cognitive flexibility, attention switching and planning may display evident disorder and impairment. Unlike traditional paper tests and subjective assessments by the patient's relatives, this study adopts virtual reality(VR) technology to develop a novel diagnosis & assessment system, which uses head mounted display(HMD), game technology and sensors to generate an interactive and panoramic scenario—a virtual convenience store—for assessment of executive functions and memory. A variety of tasks of multi-layered difficulty-level hierarchy, such as memorizing a shopping list, looking for certain goods, and checking out, has been designed for customized and adaptive assessment, training, and treatment of MD. In the meantime, the study also records test-takers' performance data (including path and central-vision movement) in the process of all tasks for the development of a novel diagnosis & assessment method. Moreover, test-takers' technology acceptance is measured for assessing the elderly's subjective perception of new technology and discussing the topic of human-machine interaction. In the study, tests on 2 healthy adults have been completed, the system's functionality has been preliminarily verified, and test-takers' subjective perception of the system has been investigated. <s> BIB010 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Recent studies have shown that people with mild cognitive impairment (MCI) may convert to Alzheimer's disease (AD) over time although not all MCI cases progress to dementia. The diagnosis of MCI is important to allow prompt treatment and disease management before the neurons degenerate to a stage beyond repair. Hence, the ability to obtain a method of identifying MCI is of great importance. VREAD is a quick, easy and friendly tool that was developed with an aim to investigate cognitive functioning in a group of healthy elderly and those with MCI. It focuses on the task of following a route, since Topographical Disorientation (TD) is common in AD. The results shows that this novel simulation was able to predict with about 90% overall accuracy using weighting function proposed to discriminate between MCI and healthy elderly. <s> BIB011 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Cognitive deficits in older adults attributable to Alzheimer's disease (AD) pathology are featured early on by hippocampal impairment. Among these individuals, deterioration in spatial navigation, manifested by poor hippocampus-dependent allocentric navigation, may occur well before the clinical onset of dementia. Our aim was to determine whether allocentric spatial navigation impairment would be proportional to right hippocampal volume loss irrespective of general brain atrophy. We also contrasted the respective spatial navigation scores of the real-space human Morris water maze with its corresponding 2D computer version. We included 42 cognitively impaired patients with either amnestic mild cognitive impairment (n = 23) or mild and moderate AD (n = 19), and 14 cognitively intact older controls. All participants underwent 1.5T MRI brain scanning with subsequent automatic measurement of the total brain and hippocampal (right and left) volumes. Allocentric spatial navigation was tested in the real-space version of the human Morris water maze and in its corresponding computer version. Participants used two navigational cues to locate an invisible goal independent of the start position. We found that smaller right hippocampal volume was associated with poorer navigation performance in both the real-space (β = −0.62, P 0.59) subjects. The respective real-space and virtual scores strongly correlated with each other. Our findings indicate that the right hippocampus plays a critical role in allocentric navigation, particularly when cognitive impairment is present. <s> BIB012 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Episodic memory impairment is a hallmark for early diagnosis of Alzheimer9s disease. Most actual tests used to diagnose Alzheimer9s disease do not assess the spatiotemporal properties of episodic memory and lead to false-positive or -negative diagnosis. We used a newly developed, nonverbal navigation test for Human, based on the objective experimental testing of a spatiotemporal experience, to differentially Alzheimer9s disease at the mild stage ( N = 16 patients) from frontotemporal lobar degeneration ( N = 11 patients) and normal aging ( N = 24 subjects). Comparing navigation parameters and standard neuropsychological tests, temporal order memory appeared to have the highest predictive power for mild Alzheimer9s disease diagnosis versus frontotemporal lobar degeneration and normal aging. This test was also nonredundant with classical neuropsychological tests. As a conclusion, our results suggest that temporal order memory tested in a spatial navigation task may provide a selective behavioral marker of Alzheimer9s disease. <s> BIB013 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Cognitive control is defined by a set of neural processes that allow us to interact with our complex environment in a goal-directed manner. Humans regularly challenge these control processes when attempting to simultaneously accomplish multiple goals (multitasking), generating interference as the result of fundamental information processing limitations. It is clear that multitasking behaviour has become ubiquitous in today's technologically dense world, and substantial evidence has accrued regarding multitasking difficulties and cognitive control deficits in our ageing population. Here we show that multitasking performance, as assessed with a custom-designed three-dimensional video game (NeuroRacer), exhibits a linear age-related decline from 20 to 79 years of age. By playing an adaptive version of NeuroRacer in multitasking training mode, older adults (60 to 85 years old) reduced multitasking costs compared to both an active control group and a no-contact control group, attaining levels beyond those achieved by untrained 20-year-old participants, with gains persisting for 6 months. Furthermore, age-related deficits in neural signatures of cognitive control, as measured with electroencephalography, were remediated by multitasking training (enhanced midline frontal theta power and frontal-posterior theta coherence). Critically, this training resulted in performance benefits that extended to untrained cognitive control abilities (enhanced sustained attention and working memory), with an increase in midline frontal theta power predicting the training-induced boost in sustained attention and preservation of multitasking improvement 6 months later. These findings highlight the robust plasticity of the prefrontal cognitive control system in the ageing brain, and provide the first evidence, to our knowledge, of how a custom-designed video game can be used to assess cognitive abilities across the lifespan, evaluate underlying neural mechanisms, and serve as a powerful tool for cognitive enhancement. <s> BIB014 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Virtual reality use in cognitive rehabilitation of advanced dementia has been sparse. Three residents of a Dementia Ward participated in a feasibility study of the BrightArm™ system. They played custom games targeting several cognitive domains including short-term and working memory. Clinician observation revealed a positive effect on emotive state, with technology well accepted by all participants. <s> BIB015 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> None of the previous studies on aging have tested the influence of action with respect to the degree of interaction with the environment (active or passive navigation) and the source of itinerary choice (self or externally imposed), on episodic memory encoding. The aim of this pilot study was to explore the influence of these factors on feature binding (the association between what, where and when) in episodic memory and on the subjective sense of remembering. Navigation in a virtual city was performed by 64 young and 64 older adults in one of four modes of exploration: (1) passive condition where participants were immersed as passengers of a virtual car (no interaction, no itinerary control), (2) itinerary control (the subject chose the itinerary, but did not drive the car), (3) low or (4) high navigation control (the subject just moved the car on rails or drove the car with a steering wheel and a gas pedal on a fixed itinerary, respectively). The task was to memorize as many events encountered in the virtual environment as possible along with their factual (what), spatial (where), and temporal (when) details, and then to perform immediate and delayed memory tests. An age-related decline was evidenced for immediate and delayed feature binding. Compared to passive and high navigation conditions, and regardless of age groups, feature binding was enhanced by low navigation and itinerary control conditions. The subjective sense of remembering was boosted by the itinerary control in older adults. Memory performance following high navigation was specifically linked to variability in executive functions. The present findings suggest that the decision of the itinerary is beneficial to boost episodic memory in aging, although it does not eliminate age-related deficits. Active navigation can also enhance episodic memory when it is not too demanding for subjects' cognitive resources. <s> BIB016 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Author contributions ::: ::: Dr Jun-Young Lee conceived the study, acquired, and interpreted the data. Ms Sooyeon Kho and Ms Hye Bin Yoo analyzed the data and edited the article. Ms Soowon Park made major revisions to the Introduction section. Dr Jung-Seok Choi and Jun Soo Kwon acquired the patients and their clinical reports. The corresponding authors Dr Kyung Ryeol Cha and Dr Hee-Yeon Jung designed the research and the experiments. All authors made substantial contributions to conception and design of the paper, acquisition of data, or analysis and interpretation of data, and drafted the article or revised it for critically important content. ::: ::: ::: ::: Disclosure ::: ::: The authors report no conflict of interest in this work. No competing financial interests exist. <s> BIB017 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Abstract Background Virtual reality testing of everyday activities is a novel type of computerized assessment that measures cognitive, executive, and motor performance as a screening tool for early dementia. This study used a virtual reality day-out task (VR-DOT) environment to evaluate its predictive value in patients with mild cognitive impairment (MCI). Methods One hundred thirty-four patients with MCI were selected and compared with 75 healthy control subjects. Participants received an initial assessment that included VR-DOT, a neuropsychological evaluation, magnetic resonance imaging (MRI) scan, and event-related potentials (ERPs). After 12 months, participants were assessed again with MRI, ERP, VR-DOT, and neuropsychological tests. Results At the end of the study, we differentiated two subgroups of patients with MCI according to their clinical evolution from baseline to follow-up: 56 MCI progressors and 78 MCI nonprogressors. VR-DOT performance profiles correlated strongly with existing predictive biomarkers, especially the ERP and MRI biomarkers of cortical thickness. Conclusions Compared with ERP, MRI, or neuropsychological tests alone, the VR-DOT could provide additional predictive information in a low-cost, computerized, and noninvasive way. <s> BIB018 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> Alzheimer’s disease (AD) causes impairments affecting instrumental activities of daily living (IADL). Transdisciplinary research in neuropsychology and virtual reality has fostered the development of ecologically valid virtual tools for the assessment of IADL, using simulations of real life activities. Few studies have examined the benefits of this approach in AD patients. Our aim was to examine the utility of a non-immersive virtual coffee task (NI-VCT) for assessment of IADL in these patients. We focus on the assessment results obtained from a group of 24 AD patients on a task designed to assess their ability to prepare a virtual cup of coffee, using a virtual coffee machine. We compared performance on the virtual task to an identical daily living task involving the actual preparation of a cup of coffee, as well as to global cognitive, executive, and caregiver-reported IADL functioning. Relative to 32 comparable, healthy elderly (HE) controls, AD patients performed worse than HE controls on all tasks. Correlation analyses revealed that NI-VCT measures were related to all other neuropsychological measures. Moreover, regression analyses demonstrated that performance on the NI-VCT predicted actual task performance and caregiver-reported IADL functioning. Our results provide initial support for the utility of our virtual kitchen for assessment of IADL in AD patients. ( JINS , 2014, 20 , 1–10) <s> BIB019 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> 뀀ഀȠ 뀀ഀȠ Silvia SerinoGiuseppe Riva 뀀ഀȠ 뀀ഀȠ 뀀ഀȠ 뀀ഀȠ 뀀ഀȠ 뀀ഀȠ 뀀ഀȠ Abstract This experiment is aimed at understanding how egocentric experiences, allocentric viewpoint-dependent representations, and allocentric viewpoint-independent representations interact when encoding and retrieving a spatial environment. Although several cognitive theories have highlighted the interaction between reference frames, it is less clear about the role of a real-time presentation of allocentric viewpoint-dependent representation on the spatial organization of information. Sixty participants were asked to navigate in two virtual cities to memorize the position of one hidden object. Half of the participants had the possibility to visualize the virtual city with an inter- active aerial view. Then, they were required to find the position of the object in three different experimental con- ditions (''retrieval with an interactive aerial view'' vs. ''retrieval on a map'' vs. ''retrieval without an interactive aerial view''). Results revealed that participants were sig- nificantly more precise in retrieving the position of the object when immersed in an egocentric experience with the interactive aerial view. The retrieval of spatial information is facilitated by the presence of the interactive aerial view of the city, since it provides a real-time allocentric view- point-dependent representation. More participants with high preference for using cardinal points tend to be more accurate when they were asked to retrieve the position of the object on the map. As suggested by the mental frame syncing hypothesis, the presence of an allocentric 뀀ഀȠ 뀀ഀȠ 뀀ഀȠoduction <s> BIB020 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s> Focal Aspects <s> IntroductionThere is a growing body of evidence that subtle deficits in instrumental activities of daily living (IADL) may be present in mild cognitive impairment (MCI). However, it is not clear if there are IADL domains that are consistently affected across patients with MCI. In this systematic review, therefore, we aimed to summarize research results regarding the performance of MCI patients in specific IADL (sub)domains compared with persons who are cognitively normal and/or patients with dementia.MethodsThe databases PsycINFO, PubMed and Web of Science were searched for relevant literature in December 2013. Publications from 1999 onward were considered for inclusion. Altogether, 497 articles were retrieved. Reference lists of selected articles were searched for potentially relevant articles. After screening the abstracts of these 497 articles, 37 articles were included in this review.ResultsIn 35 studies, IADL deficits (such as problems with medication intake, telephone use, keeping appointments, finding things at home and using everyday technology) were documented in patients with MCI. Financial capacity in patients with MCI was affected in the majority of studies. Effect sizes for group differences between patients with MCI and healthy controls were predominantly moderate to large. Performance-based instruments showed slight advantages (in terms of effect sizes) in detecting group differences in IADL functioning between patients with MCI, patients with Alzheimer’s disease and healthy controls.ConclusionIADL requiring higher neuropsychological functioning seem to be most severely affected in patients with MCI. A reliable identification of such deficits is necessary, as patients with MCI with IADL deficits seem to have a higher risk of converting to dementia than patients with MCI without IADL deficits. The use of assessment tools specifically designed and validated for patients with MCI is therefore strongly recommended. Furthermore, the development of performance-based assessment instruments should be intensified, as they allow a valid and reliable assessment of subtle IADL deficits in MCI, even if a proxy is not available. Another important point to consider when designing new scales is the inclusion of technology-associated IADL. Novel instruments for clinical practice should be time-efficient and easy to administer. <s> BIB021
Recent research has focused on certain specific aspects of AD cognitive impairment features that are generally deemed to be most relevant for VR diagnostic and training purposes. For the sake of the present mini-review, they may be roughly summarized as follows: (1) attention BIB002 BIB014 ; (2) executive functions BIB010  ; (3) memory, comprising: non-verbal episodic memory, allocentric and egocentric spatial memory, temporal order memory, prospective memory, short-term, and working memory, etc. BIB002 BIB003 BIB008 BIB009 ; BIB011 BIB010 BIB015  BIB016 BIB017 BIB020 ; (4) orientation, specifically: allothetic, visuospatial, wayfinding, spatial navigation, topographical disorientation, etc. BIB002 BIB003 BIB004  BIB005 BIB007 BIB012 ; and also (5) executive functions and IADL BIB001 BIB006  BIB010  BIB018 BIB019 BIB021 . The justification of the importance of these specific cognitive aspects of AD may be found in the cited references. Some approaches look at more than one of the above mentioned aspects for better assessment. Examples of this combined focus are: BIB002 (2012), likewise, a combination of more than one aspect may be used for more effective training tools  BIB014 . Frequently, memory and attention are combined with navigation, because navigational impairment is a common manifestation of AD that implies disorders of spatial cognition, spatial memory, and orientation. For example, BIB013 assessed temporal order memory, as acquired through active navigation (spatiotemporal navigation), to design a sensitive behavioral non-verbal marker of mild AD. BIB017 evaluated spatial memory in amnestic MCI (aMCI) patients from results of a virtual route learning environment-labeled virtual radial arm maze (VRAM).