Linking Cognitive Functioning and Postural Balance Control Through Virtual Reality Environmental Manipulations

Overview

Journal Front Aging Neurosci

Specialty Geriatrics

Date 2022 Sep 19

PMID 36118684

Authors

Yu Imaoka

Laura Hauri

Andri Flury

Eling D de Bruin

Affiliations

Soon will be listed here.

Abstract

Background: Dementia is becoming a relevant problem worldwide. A simple screening at an early stage will be important to detect the risk of developing dementia. Vestibular dysfunction is likely to be associated with cognitive impairment. Since head-mounted display (HMD) virtual reality (VR) technology has the potential to activate the vestibular function, assessing postural sway with visual stimulation using HMD VR technology could be potentially useful for dementia screening.

Objective: The purpose of this study is to evaluate the effect of HMD-based VR visual stimuli on posture in older adults and the relationship between the stimulated body sway behaviors and cognitive performance.

Method: Using a cross-sectional study design, we investigated the effect of an optokinetic design-based room with stripes (OKR) VR environment oscillating forwards and backwards at 23/60Hz. Center of pressure (COP) displacement was measured in older adults aged 65 years and over in the OKR VR environment. The frequency response of COP was compared to the cognitive performance of the Montreal Cognitive Assessment (MoCA).

Results: 20 healthy older adults (70.4 ± 4.9 years; 27.2 ± 1.6 MoCA score) and 3 people with mild cognitive impairment (74.7 ± 4.0 years; 20.3 ± 2.1 MoCA score) were assessed. The results reveal that the oscillating OKR VR environment induced different postural sway in the anterior-posterior direction in the real world. Correlation analysis shows that the cognitive test score was associated with the frequency response of stimulated postural sway in the anterior-posterior direction (frequency Band 1 of 0-0.5Hz related to the visual and vestibular systems: = 0.45, = 0.03).

Conclusion: Outcomes would suggest that a potential link may emerge between cognition and posture when the HMD-based VR visual stimuli are applied. The simple screening of stimulated postural sway could explain cognitive functioning. Further studies are warranted to clarify the vestibular system and spatial cognitive function more specifically in the proposed assessment system.

Citing Articles

The Association Between Cognitive Domains and Postural Balance among Healthy Older Adults: A Systematic Review of Literature and Meta-Analysis.

Divandari N, Bird M, Vakili M, Jaberzadeh S Curr Neurol Neurosci Rep. 2023; 23(11):681-693.

PMID: 37856048 PMC: 10673728. DOI: 10.1007/s11910-023-01305-y.

References

Singh N, Taylor W, Madigan M, Nussbaum M . The spectral content of postural sway during quiet stance: influences of age, vision and somatosensory inputs. J Electromyogr Kinesiol. 2011; 22(1):131-6. DOI: 10.1016/j.jelekin.2011.10.007. View

Fife T, Tusa R, Furman J, Zee D, Frohman E, Baloh R . Assessment: vestibular testing techniques in adults and children: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2000; 55(10):1431-41. DOI: 10.1212/wnl.55.10.1431. View

Lacour M, Bernard-Demanze L, Dumitrescu M . Posture control, aging, and attention resources: models and posture-analysis methods. Neurophysiol Clin. 2008; 38(6):411-21. DOI: 10.1016/j.neucli.2008.09.005. View

Harun A, Oh E, Bigelow R, Studenski S, Agrawal Y . Vestibular Impairment in Dementia. Otol Neurotol. 2016; 37(8):1137-42. PMC: 5392114. DOI: 10.1097/MAO.0000000000001157. View

Kucharik M, Kosutzka Z, Pucik J, Hajduk M, Saling M . Processing moving visual scenes during upright stance in elderly patients with mild cognitive impairment. PeerJ. 2020; 8:e10363. PMC: 7680028. DOI: 10.7717/peerj.10363. View

Liu Y, Tan W, Chen C, Liu C, Yang J, Zhang Y . A Review of the Application of Virtual Reality Technology in the Diagnosis and Treatment of Cognitive Impairment. Front Aging Neurosci. 2019; 11:280. PMC: 6813180. DOI: 10.3389/fnagi.2019.00280. View

Sundermier L, Woollacott M, Jensen J, Moore S . Postural sensitivity to visual flow in aging adults with and without balance problems. J Gerontol A Biol Sci Med Sci. 1996; 51(2):M45-52. DOI: 10.1093/gerona/51a.2.m45. View

Bertolini G, Straumann D . Moving in a Moving World: A Review on Vestibular Motion Sickness. Front Neurol. 2016; 7:14. PMC: 4753518. DOI: 10.3389/fneur.2016.00014. View

Van Ooteghem K, Musselman K, Mansfield A, Gold D, Marcil M, Keren R . Key factors for the assessment of mobility in advanced dementia: A consensus approach. Alzheimers Dement (N Y). 2019; 5:409-419. PMC: 6726753. DOI: 10.1016/j.trci.2019.07.002. View

10.

Bahureksa L, Najafi B, Saleh A, Sabbagh M, Coon D, Mohler M . The Impact of Mild Cognitive Impairment on Gait and Balance: A Systematic Review and Meta-Analysis of Studies Using Instrumented Assessment. Gerontology. 2016; 63(1):67-83. PMC: 5107359. DOI: 10.1159/000445831. View

11.

Gago M, Yelshyna D, Bicho E, David Silva H, Rocha L, Lurdes Rodrigues M . Compensatory Postural Adjustments in an Oculus Virtual Reality Environment and the Risk of Falling in Alzheimer's Disease. Dement Geriatr Cogn Dis Extra. 2016; 6(2):252-67. PMC: 4959436. DOI: 10.1159/000447124. View

12.

Ivanenko Y, Gurfinkel V . Human Postural Control. Front Neurosci. 2018; 12:171. PMC: 5869197. DOI: 10.3389/fnins.2018.00171. View

13.

Degani A, Leonard C, Danna-Dos-Santos A . The effects of early stages of aging on postural sway: A multiple domain balance assessment using a force platform. J Biomech. 2017; 64:8-15. DOI: 10.1016/j.jbiomech.2017.08.029. View

14.

Imaoka Y, Flury A, de Bruin E . Assessing Saccadic Eye Movements With Head-Mounted Display Virtual Reality Technology. Front Psychiatry. 2020; 11:572938. PMC: 7527608. DOI: 10.3389/fpsyt.2020.572938. View

15.

. Global, regional, and national burden of Alzheimer's disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018; 18(1):88-106. PMC: 6291454. DOI: 10.1016/S1474-4422(18)30403-4. View

16.

Pavlou M . The use of optokinetic stimulation in vestibular rehabilitation. J Neurol Phys Ther. 2010; 34(2):105-10. DOI: 10.1097/NPT.0b013e3181dde6bf. View

17.

Imaoka Y, Saba N, Vanhoestenberghe A, de Bruin E . Triggering Postural Movements With Virtual Reality Technology in Healthy Young and Older Adults: A Cross-Sectional Validation Study for Early Dementia Screening. Front Med (Lausanne). 2020; 7:533675. PMC: 7701173. DOI: 10.3389/fmed.2020.533675. View

18.

Cogne M, Taillade M, NKaoua B, Tarruella A, Klinger E, Larrue F . The contribution of virtual reality to the diagnosis of spatial navigation disorders and to the study of the role of navigational aids: A systematic literature review. Ann Phys Rehabil Med. 2016; 60(3):164-176. DOI: 10.1016/j.rehab.2015.12.004. View

19.

Ashiri M, Lithgow B, Suleiman A, Blakley B, Mansouri B, Moussavi Z . Differences Between Physical vs. Virtual Evoked Vestibular Responses. Ann Biomed Eng. 2020; 48(4):1241-1255. DOI: 10.1007/s10439-019-02446-3. View

20.

Robinson L, Tang E, Taylor J . Dementia: timely diagnosis and early intervention. BMJ. 2015; 350:h3029. PMC: 4468575. DOI: 10.1136/bmj.h3029. View