A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> Virtual environments (VEs), offering a new human-computer interaction paradigm, have attracted much attention in clinical psychology, especially in the treatment of phobias. However, a possible new application of VR in psychology is as assessment tool: VEs can be considered as an highly sophisticated form of adaptive testing. This chapter describes the context of current psychological assessment and underlines possible advantages of a VR based assessment tool. The chapter also details the characteristics of BIVRS, Body Image Virtual Reality Scale, an assessment tool designed to assess cognitive and affective components of body image. It consists of a non-immersive 3D graphical interface through which the patient is able to choose between 9 figures of different size which vary in size from underweight to overweight. The software was developed in two architectures, the first (A) running on a single user desktop computer equipped with a standard virtual reality development software and the second (B) splitted into a server (B1) accessible via Internet and actually running the same virtual ambient as in (A) and a VRML client (B2) so that anyone can access the application. <s> BIB001 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> For the last 10 years a number of papers have been written that discuss human factors issues associated with virtual reality (VR). The nature of these papers has gradually evolved from speculation and anecdotal report to empirical research. Despite developments in VR technology, some participants still experience health and safety problems associated with VR use-termed VR-induced symptoms and effects (VRISE). The key concern from the literature is VR-induced sickness, experienced by a large proportion of VR participants, but for the majority these effects are mild and subside quickly. This paper makes a number of recommendations regarding the future direction of research into health and safety implications of VR, including the need to take into account the way in which VR is being used when conducting empirical research: first, to ensure that studies consider both effects and their consequences; second, to ensure that empirical trials reflect the actual likely context of VR use; third, to consider interactions between effects; and finally, to consider ways in which effects can be managed. <s> BIB002 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> Virtual reality (VR) has recently emerged as a potentially effective way to provide general and specialty health care services, and appears poised to enter mainstream psychotherapy delivery. Because VR could be part of the future of clinical psychology, it is critical to all psychotherapists that it be defined broadly. To ensure appropriate development of VR applications, clinicians must have a clear understanding of the opportunities and challenges it will provide in professional practice. This review outlines the current state of clinical research relevant to the development of virtual environments for use in psychotherapy. In particular, the paper focuses its analysis on both actual applications of VR in clinical psychology and how different clinical perspectives can use this approach to improve the process of therapeutic change. <s> BIB003 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> The increasing use of virtual reality (VR) simulators in surgical training makes it imperative that definitive studies be performed to assess their training effectiveness. Indeed, in this paper we report the meta-analysis of the efficacy of virtual reality simulators in: 1) the transference of skills from the simulator training environment to the operating room, and 2) their ability to discriminate between the experience levels of their users. The task completion time and the error score were the two study outcomes collated and analyzed in this meta-analysis. Sixteen studies were identified from a computer-based literature search (1996-2004). The meta-analysis of the random effects model (because of the heterogeneity of the data) revealed that training on virtual reality simulators did lessen the time taken to complete a given surgical task as well as clearly differentiate between the experienced and the novice trainees. Meta-analytic studies such as the one reported here would be very helpful in the planning and setting up of surgical training programs and for the establishment of reference `learning curves' for a specific simulator and surgical task. If any such programs already exist, they can then indicate the improvements to be made in the simulator used, such as providing for more variety in their case scenarios based on the state and/or rate of learning of the trainee <s> BIB004 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> BACKGROUND ::: Several virtual reality (VR) applications for the understanding, assessment and treatment of mental health problems have been developed in the last 10 years. The purpose of this review is to outline the current state of virtual reality research in the treatment of mental health problems. ::: ::: ::: METHODS ::: PubMed and PsycINFO were searched for all articles containing the words "virtual reality". In addition a manual search of the references contained in the papers resulting from this search was conducted and relevant periodicals were searched. Studies reporting the results of treatment utilizing VR in the mental health field and involving at least one patient were identified. ::: ::: ::: RESULTS ::: More than 50 studies using VR were identified, the majority of which were case studies. Seventeen employed a between groups design: 4 involved patients with fear of flying; 3 involved patients with fear of heights; 3 involved patients with social phobia/public speaking anxiety; 2 involved people with spider phobia; 2 involved patients with agoraphobia; 2 involved patients with body image disturbance and 1 involved obese patients. There are both advantages in terms of delivery and disadvantages in terms of side effects to using VR. Although virtual reality based therapy appears to be superior to no treatment the effectiveness of VR therapy over traditional therapeutic approaches is not supported by the research currently available. ::: ::: ::: CONCLUSIONS ::: There is a lack of good quality research on the effectiveness of VR therapy. Before clinicians will be able to make effective use of this emerging technology greater emphasis must be placed on controlled trials with clinically identified populations. <s> BIB005 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> Abstract Virtual reality (VR) systems are used in a variety of applications within industry, education, public and domestic settings. Research assessing reported symptoms and side effects of using VR systems indicates that these factors combine to influence user experiences of virtual reality induced symptoms and effects (VRISE). Three experiments were conducted to assess prevalence and severity of sickness symptoms experienced in each of four VR display conditions; head mounted display (HMD), desktop, projection screen and reality theatre, with controlled examination of two additional aspects of viewing (active vs. passive viewing and light vs. dark conditions). Results indicate 60–70% participants experience an increase in symptoms pre–post exposure for HMD, projection screen and reality theatre viewing and found higher reported symptoms in HMD compared with desktop viewing (nausea symptoms) and in HMD compared with reality theatre viewing (nausea, oculomotor and disorientation symptoms). No effect of lighting condition was found. Higher levels of symptoms were reported in passive viewing compared to active control over movement in the VE. However, the most notable finding was that of high inter- and intra-participant variability. As this supports other findings of individual susceptibility to VRISE, recommendations are offered concerning design and use of VR systems in order to minimise VRISE. <s> BIB006 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> The availability of virtual environments on the Web is fostering new applications of virtual reality in several fields, including some therapeutical applications. We present an application of virtual reality applied to the tele-rehabilitation of patients with traumatic brain injury and stroke. Our system, based on X3D and Ajax3D technologies, enhances the possibility of making tele-rehabilitation exercises aimed at the recovery of the neurological disease. The system, called Nu!RehaVR, has been designed to integrate the activity carried out on a tele-rehabilitation system, Nu!Reha (Nu!Reha is a trademark of Pragma Engineering srl. See http://www.nureha.eu) desk, with the activities performed in the virtual worlds, through some rehabilitation exercises in contexts incompatible with the patients’ impairments (not able to move or forced in static positions because of therapies, etc.). The architecture of Nu!RehaVR and the environments associated to two exercises, “Utilising an elevator to reach a given floor” and “Crossing a road using a traffic light”, are illustrated. These exercises can be considered as prototypes of a series of tele-rehabilitation exercises which help to stimulate the patients performing actions in relatively dangerous scenarios. The system is designed to allow the remote monitoring and assessment of the patient’s activities by the medical staff at the hospital using the communication facilities of the tele-rehabilitation system. <s> BIB007 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> This paper reviews the concept of presence in immersive virtual environments, the sense of being there signalled by people acting and responding realistically to virtual situations and events. We argue that presence is a unique phenomenon that must be distinguished from the degree of engagement, involvement in the portrayed environment. We argue that there are three necessary conditions for presence: the (a) consistent low latency sensorimotor loop between sensory data and proprioception; (b) statistical plausibility: images must be statistically plausible in relation to the probability distribution of images over natural scenes. A constraint on this plausibility is the level of immersion; (c) behaviour-response correlations: Presence may be enhanced and maintained over time by appropriate correlations between the state and behaviour of participants and responses within the environment, correlations that show appropriate responses to the activity of the participants. We conclude with a discussion of methods for assessing whether presence occurs, and in particular recommend the approach of comparison with ground truth and give some examples of this. <s> BIB008 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> Background ::: Virtual reality (VR) simulators and Web-based instructional videos are valuable supplemental training resources in surgical programs, but it is unclear how to optimally integrate them into minimally invasive surgical training. <s> BIB009 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <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> BIB010 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> This chapter discusses the applications and solutions of emerging Virtual Reality (VR) and video games technologies in the healthcare sector, e.g. physical therapy for motor rehabilitation, exposure therapy for psychological phobias, and pain relief. Section 2 reviews state-of-the-art interactive devices used in current VR systems and high-end games such as sensor-based and camera-based tracking devices, data gloves, and haptic force feedback devices. Section 3 investigates recent advances and key concepts in games technology, including dynamic simulation, flow theory, adaptive games, and their possible implementation in serious games for healthcare. Various serious games are described in this section: some were designed and developed for specific healthcare purposes, e.g. BreakAway (2009)’s Free Dive, HopeLab (2006)’s Re-Mission, and Ma et al. (2007)’s VR game series, others were utilising off-the-shelf games such as Nintendo Wii sports for physiotherapy. A couple of experiments of using VR systems and games for stroke rehabilitation are highlighted in section 4 as examples to showcase the benefits and impacts of these technologies to conventional clinic practice. Finally, section 5 points some future directions of applying emerging games technologies in healthcare, such as augmented reality, Wii-mote motion control system, and even full body motion capture and controller free games technology demonstrated recently on E3 2009 which have great potentials to treat motor disorders, combat obesity, and other healthcare applications. <s> BIB011 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> The compatibility of virtual reality systems with brain imaging techniques and their use for animal research have aided the widespread adoption of virtual reality environments in both experimental and therapeutic domains. Here the authors review advances in virtual reality technology and its applications. <s> BIB012 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> Virtual reality exposure therapy has been proposed as a viable alternative in the treatment of anxiety disorders, including social anxiety disorder. Therapists could benefit from extensive control of anxiety eliciting stimuli during virtual exposure. Two stimuli controls are studied in this study: the social dialogue situation, and the dialogue feedback responses (negative or positive) between a human and a virtual character. In the first study, 16 participants were exposed in three virtual reality scenarios: a neutral virtual world, blind date scenario, and job interview scenario. Results showed a significant difference between the three virtual scenarios in the level of self-reported anxiety and heart rate. In the second study, 24 participants were exposed to a job interview scenario in a virtual environment where the ratio between negative and positive dialogue feedback responses of a virtual character was systematically varied on-the-fly. Results yielded that within a dialogue the more positive dialogue feedback resulted in less self-reported anxiety, lower heart rate, and longer answers, while more negative dialogue feedback of the virtual character resulted in the opposite. The correlations between on the one hand the dialogue stressor ratio and on the other hand the means of SUD score, heart rate and audio length in the eight dialogue conditions showed a strong relationship: r(6)?=?0.91, p?=?0.002; r(6)?=?0.76, p?=?0.028 and r(6)?=?-0.94, p?=?0.001 respectively. Furthermore, more anticipatory anxiety reported before exposure was found to coincide with more self-reported anxiety, and shorter answers during the virtual exposure. These results demonstrate that social dialogues in a virtual environment can be effectively manipulated for therapeutic purposes. <s> BIB013 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> Abstract Randomized controlled trials (RCTs) support the effectiveness of virtual reality exposure therapy (VRET) for anxiety disorders; however, the overall quality of the VRET RCT literature base has yet to be evaluated. This study reviewed 27 VRET RCTs and the degree of adherence to 8 RCT research design criteria derived from existing standards. Adherence to the study quality criteria was generally low as the articles met an average 2.85 criteria (SD = 1.56). None of the studies met more than six quality criteria. Study quality did not predict effect size; however, a reduction in effect size magnitude was observed for studies with larger sample sizes when comparing VRET to non-active control groups. VRET may be an effective method of treatment but caution should be exercised in interpreting the existing body of literature supporting VRET relative to existing standards of care. The need for well-designed VRET research is discussed. <s> BIB014 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> The aim of this research effort is to identify feeling-of-presence and metacognitive amplifiers over existing well-established VRET treatment methods. Patient real time projection in virtual environments during stimuli exposure and electroencephalographyi¾?EEG report sharing are among the techniques, which have been used to achieve the desired result. Initialized from theoretical inferences, is moving towards a proof-of-concept prototype, which has been developed as a realization of the proposed method. The evaluation of the prototype made possible with an expert team of 28 therapists testing the fear of public speaking and fear of flying case studies. <s> BIB015 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> Objectives. To identify the virtual reality (VR) interventions used for the lower extremity rehabilitation in stroke population and to explain their underlying training mechanisms using Social Cognitive (SCT) and Motor Learning (MLT) theoretical frameworks. Methods. Medline, Embase, Cinahl, and Cochrane databases were searched up to July 11, 2013. Randomized controlled trials that included a VR intervention for lower extremity rehabilitation in stroke population were included. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality of the included studies. The underlying training mechanisms involved in each VR intervention were explained according to the principles of SCT (vicarious learning, performance accomplishment, and verbal persuasion) and MLT (focus of attention, order and predictability of practice, augmented feedback, and feedback fading). Results. Eleven studies were included. PEDro scores varied from 3 to 7/10. All studies but one showed significant improvement in outcomes in favour of the VR group (P < 0.05). Ten VR interventions followed the principle of performance accomplishment. All the eleven VR interventions directed subject's attention externally, whereas nine provided training in an unpredictable and variable fashion. Conclusions. The results of this review suggest that VR applications used for lower extremity rehabilitation in stroke population predominantly mediate learning through providing a task-oriented and graduated learning under a variable and unpredictable practice. <s> BIB016 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> BACKGROUND ::: The objective of this analysis was to systematically review the evidence for virtual reality (VR) therapy in an adult post-stroke population in both custom built virtual environments (VE) and commercially available gaming systems (CG). ::: ::: ::: METHODS ::: MEDLINE, CINAHL, EMBASE, ERIC, PSYCInfo, DARE, PEDro, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were systematically searched from the earliest available date until April 4, 2013. Controlled trials that compared VR to conventional therapy were included. Population criteria included adults (>18) post-stroke, excluding children, cerebral palsy, and other neurological disorders. Included studies were reported in English. Quality of studies was assessed with the Physiotherapy Evidence Database Scale (PEDro). ::: ::: ::: RESULTS ::: Twenty-six studies met the inclusion criteria. For body function outcomes, there was a significant benefit of VR therapy compared to conventional therapy controls, G = 0.48, 95% CI = [0.27, 0.70], and no significant difference between VE and CG interventions (P = 0.38). For activity outcomes, there was a significant benefit of VR therapy, G = 0.58, 95% CI = [0.32, 0.85], and no significant difference between VE and CG interventions (P = 0.66). For participation outcomes, the overall effect size was G = 0.56, 95% CI = [0.02, 1.10]. All participation outcomes came from VE studies. ::: ::: ::: DISCUSSION ::: VR rehabilitation moderately improves outcomes compared to conventional therapy in adults post-stroke. Current CG interventions have been too few and too small to assess potential benefits of CG. Future research in this area should aim to clearly define conventional therapy, report on participation measures, consider motivational components of therapy, and investigate commercially available systems in larger RCTs. ::: ::: ::: TRIAL REGISTRATION ::: Prospero CRD42013004338. <s> BIB017 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> Stroke is the leading cause of serious, long-term disability in the United States. Impairment of upper extremity function is a common outcome following stroke, often to the detriment of lifestyle and employment opportunities. While the upper extremity is a natural target for therapy, treatment may be hampered by limitations in baseline capability as lack of success may discourage arm and hand use. We developeda virtual reality (VR) system in order to encourage repetitive task practice. This system combined an assistive glove with a novel VR environment. A set of exercises for this system was developed to encourage specific movements. Six stroke survivors with chronic upper extremity hemiparesis volunteered to participate in a pilot study in which they completed 18 one-hour training sessions with the VR system. Performance with the system was recorded across the 18 training sessions. Clinical evaluations of motor control were conducted at three time points: prior to initiation of training, following the end of training, and 1 month later. Subjects displayed significant improvement on performance of the virtual tasks over the course of the training, although for the clinical outcome measures only lateral pinch showed significant improvement. Future expansion to multi-user virtual environments may extend the benefits of this system for stroke survivors with hemiparesis by furthering engagement in the rehabilitation exercises. <s> BIB018 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> This paper reviews the move from virtual reality exposure-based therapy (VRET) to augmented reality exposure-based therapy (ARET). Unlike virtual reality (VR), which entails a complete virtual environment (VE), augmented reality (AR) limits itself to producing certain virtual elements to then merge them into the view of the physical world. Although the general public may only have become aware of AR in the last few years, AR type applications have been around since beginning of the 20th century. Since, then, technological developments have enabled an ever increasing level of seamless integration of virtual and physical elements into one view. Like VR, AR allows the exposure to stimuli which, due to various reasons, may not be suitable for real-life scenarios. As such, AR has proven itself to be a medium through which individuals suffering from specific phobia can be exposed “safely” to the object(s) of their fear, without the costs associated with programming complete virtual environments. Thus, ARET can offer an efficacious alternative to some less advantageous exposure-based therapies. Above and beyond presenting what has been accomplished in ARET, this paper also raises some ARET related issues, and proposes potential avenues to be followed. These include the definition of an AR related term, the type of measures to be used to qualify the user’s experience in an augmented reality environment (ARE), the development of alternative geospatial referencing systems, as well as the potential use of ARET to treat social phobia. Overall, it may be said that the use of ARET, although promising, is still in its infancy but that, given a continued cooperation between clinical and technical teams, ARET has the potential of going well beyond the treatment of small animal phobia. <s> BIB019 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> 20 participants with persecutory delusions and 20 controls entereda virtual underground train containing neutral characters. Under these circumstances, peoplewith persecutory delusions reported similar levels of paranoia as non-clinical participants.The transcripts of a post-virtual reality interview of the ﬁrst 10 participants in each groupwere analysed. <s> BIB020 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <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 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> There is a pressing demand for improving the quality and efficacy of health care and social support services needed by the world’s growing elderly population, especially by those affected by mild cognitive impairment (MCI) and Alzheimer’s disease (AD)-type early-stage dementia. Meeting that demand can significantly benefit from the deployment of innovative, computer-based applications capable of addressing specific needs, particularly in the area of cognitive impairment mitigation and rehabilitation. In that context, we present here our perspective viewpoint on the use of virtual reality (VR) tools for cognitive rehabilitation training, intended to assist medical personnel, health care workers, and other caregivers in improving the quality of daily life activities of people with MCI and AD. We discuss some effective design criteria and developmental strategies and suggest some possibly useful protocols and procedures. The particular innovative supportive advantages offered by the immersive interactive cha... <s> BIB022 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> Abstract Perspective taking is the ability to imagine what a scene looks like from a different viewpoint, which has been reported to be impaired in Alzheimer's disease (AD). This study compared overhead and first-person view perspective taking abilities in patients with mild cognitive impairment (MCI) and AD. A newly developed Arena Perspective Taking Task (APTT), using an environment of a circular arena, was used to compare 23 AD patients and 38 amnestic MCI patients with 18 healthy controls. The results were contrasted with a published perspective taking test (Standardized Road-Map Test of Direction Sense, RMTDS). The AD group was impaired in both overhead and first-person view APTT versions, but the impairment in the overhead view version applied specifically to women. Patients with aMCI were impaired in the first-person view but not in the overhead view version. Substantial sexual differences were found in the overhead but not in the first-person view APTT version. The RMTDS resembled both APTT versions: patients with aMCI were impaired in this test and also women in both patient groups were less accurate than men. Using the receiver operating characteristic analysis, the highest predictive power for MCI and AD patients diagnosis versus controls was observed for their success rate in the first-person view version. The results suggest distinction between overhead and first-person view perspective taking in the impairment of aMCI patients and the sex differences. The first-person view perspective taking is a potentially important candidate psychological marker for AD. <s> BIB023 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> Abstract There is a growing empirical evidence that virtual reality (VR) is valuable for education, training, entertaining and medical rehabilitation due to its capacity to represent real-life events and situations. However, the neural mechanisms underlying behavioral confounds in VR environments are still poorly understood. In two experiments, we examined the effect of fully immersive 3D stereoscopic presentations and less immersive 2D VR environments on brain functions and behavioral outcomes. In Experiment 1 we examined behavioral and neural underpinnings of spatial navigation tasks using electroencephalography (EEG). In Experiment 2, we examined EEG correlates of postural stability and balance. Our major findings showed that fully immersive 3D VR induced a higher subjective sense of presence along with enhanced success rate of spatial navigation compared to 2D. In Experiment 1 power of frontal midline EEG (FM-theta) was significantly higher during the encoding phase of route presentation in the 3D VR. In Experiment 2, the 3D VR resulted in greater postural instability and modulation of EEG patterns as a function of 3D versus 2D environments. The findings support the inference that the fully immersive 3D enriched-environment requires allocation of more brain and sensory resources for cognitive/motor control during both tasks than 2D presentations. This is further evidence that 3D VR tasks using EEG may be a promising approach for performance enhancement and potential applications in clinical/rehabilitation settings. <s> BIB024 </s> A Succinct Overview of Virtual Reality Technology Use in Alzheimer’s Disease <s>  <s> The occurrence of visually induced motion sickness has been frequently linked to the sensation of illusory self-motion (so-called vection), however, the precise nature of this relationship is still not fully understood. To date, it is still a matter of debate whether or not vection is a necessary prerequisite for visually induced motion sickness (VIMS). That is, can there be visually induced motion sickness without any sensation of self-motion? In this paper, we will describe the possible nature of this relationship, review the literature that may speak to this relationship (including theoretical accounts of vection and VIMS), and offer suggestions with respect to operationally defining and reporting these phenomena in future. <s> BIB025
are characteristic examples of current VR applications in psychotherapy BIB020 BIB003 BIB005 BIB013 BIB014 BIB015  Fornells-Ambrojo et al., 2015) . Other helpful medical uses of VR are surgical training, post-stroke intervention, musculoskeletal recovery, pain mitigation, etc. BIB004 BIB007 BIB009 BIB016 BIB017   BIB018 . Emerging VR applications today address the challenge of diagnosis and cognitive training of mild cognitive impairment (MCI) and dementia patients, concentrating on navigation and orientation, face recognition, cognitive functionality, and other instrumental activities of daily living (IADL) BIB021 . VR exposes cognitively impaired patients to computer-generated VEs providing a sensation of "presence" or "being there, " for the patient to interact with in a multisensory fashion through quasinaturalistic real-life-like stimuli. Using several perception aspects of psychophysics, mainly visual, tactile, and kinesthetic perceptual sensations, VR offers the possibility of performing activities, tasks, and tests in a VE adaptable to various characteristics and needs of individual patients BIB001 BIB019 BIB022 . A characteristic of VR, very helpful for Alzheimer's disease (AD) applications, is the high interaction level that is possible to achieve in a safe VE. Depending on the specific type of VE, patients may interact from egocentric or allocentric points of view BIB010 . The role of egocentric and allocentric abilities in AD have been recently reviewed by  . The devices and stimuli used determine the level of interaction. A growing number of devices is available today for interaction (e.g., joysticks, gloves, surfaces, etc.), as well as for stimuli presentation in VEs [e.g., screens, 3D head-mounted displays (HMDs), audio headsets, speakers, etc.]. BIB008 described the concept of the level of immersion offered by a VR system by referring to the "fidelity" to realworld sensory experience offered by the system's displays and tracking in all sensory modalities. Some features of VR systems are most significant when characterizing the immersion level BIB008 BIB011 BIB019 . They may be reduced to four main types: (a) number of stimulated senses, (b) quantity and level of interactions, (c) synthetic stimuli fidelity, and (d) system's ability to isolate the user from external stimuli. Based on the above considerations, three basic levels of system immersion may be defined: (1) non-immersive; (2) semiimmersive; and (3) fully-immersive. In a non-immersive system, the patient interacts with the VE using conventional graphic workstations (PC monitor, keyboard, and mouse)  BIB011 . Virtual tasks played as serious videogames even when displayed on 2D screens are considered for the purpose of this review as "non-immersive" VR, irrespective of the perspective used to look at the scene, whether be it an overhead view or a first-person view, commonly referred to as survey and route perspectives BIB023 . Other more dedicated devices, such as joysticks or gamepads may substitute the mouse. A semi-immersive VR system typically consists of more sophisticated graphics, with larger flat surface displays to present the visual VE BIB011 . A fully-immersive VE might consist of huge surrounding projection surfaces, or preferably of 3D displays, such as HMDs, that virtually place the patient inside the VE for the highest level of immersion  BIB019 . Immersion plays a crucial role on the subjective sense of "presence. " "Presence" refers to the experience of felling "being there, " that is, how well the VE truly represents a real-world situation, instead of being a simple video viewing experience. "Presence" is strongly related to immersion, since increasing the immersion level induces a higher intensity of the subjective sense of "presence" experienced by the patient BIB024 . The sense of presence intensity experienced by the patients while performing the required tasks, substantially affects the ensuing behavioral responses BIB024 . A detailed comparative study of the effect of fully-immersive 3D stereoscopic VEs versus less immersive 2D presentations on brain functions and subsequent behavioral outcomes in VR experiments has been recently published by BIB024 . Health and safety implications of VR use must be taken into serious consideration BIB002 , especially when intended for AD patients. Cyber-sickness, a visually induced motion sickness (VIMS) reaction BIB025 that could arise during or after immersion in a VE depending on the level of immersability, should be a matter of concern in clinical settings BIB012 . The possible occurrence and intensity of virtual reality induced sickness symptoms and effects (VRISE) appears to be dependent upon the level of immersion. Experiments have been conducted to comparatively evaluate VRISE in four VR immersion conditions: HMD, PC display, projection screen, and reality theater. In general, higher prevalence of VRISE was found the more immersive the environment is, although a high subject variability was also found BIB006 . This mini-review does not pretend to be an exhaustive account of all existing applications of VR for AD, rather, it only aims to illustrate, through representative state of the art examples of the most significant types of VR applications, the advantages of using VR for developing a new class of tools in support of the diagnostic assessment of and cognitive training in AD.