VR Motor-cognitive Training for Older People With Cognitive Frailty

Overview

Cognitive frailty is a clinical syndrome in which cognitive impairment (e.g., poor memory, visuospatial function) and physical frailty (e.g., slowness, poor muscle strength, physical inactivity) co-exist. It is prevalent in community-dwelling older people. The progressive decline of cognitive and physical functions restricts older people from participating in activities (e.g., social get-togethers). Reduced participation further jeopardizes their life-space mobility (e.g., ability to travel to areas far away from home). Therefore, those with cognitive frailty are at risk of developing dementia and becoming dependent. Simultaneous motor-cognitive training is more effective at promoting optimal functioning in older people than motor or cognitive training alone. Gaming is effective at promoting the motivation to participate. The contents of games in the market are unrelated to the context or daily living of the elderly. Currently, available training is non-simultaneous. This makes the training less transferable to the daily life of the elderly and reduces its effects. Virtual reality (VR) technology can provide a virtual space that mimics the real environment. This allows clients to participate in daily activities in a virtual space. Older people can be trained to improve their cognitive and physical skills in a painless, fun way. However, the effect and feasibility of employing simultaneous motor-cognitive training launching on a VR platform mimicking the daily living environment in older people with cognitive frailty is poorly known. Following the findings from the previous proof-of-concept test (registration number: NCT04467216), we proceed to implement the study to 400 participants from six different elderly centres between the period of March 2021 and December 2022.

Full Title of Study: “Virtual Reality Motor-cognitive Training for Older People With Cognitive Frailty: The Implementation of the Prototype”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Outcomes Assessor)
  • Study Primary Completion Date: May 31, 2021

Detailed Description

In the intervention, VR will be employed to simulate a daily living environment familiar to older people. Participants will wear a commercially available head-mounted VR system with hand-held controllers to experience the participation of daily activities in a virtual environment. Simultaneous physical and cognitive training will be embedded in the training system to promote optimal function. Participants will attend physical training in a sitting position through cycling on an ergometer and moving the hand-held controllers. Motion sensors built into the VR system and ergometer will track these movements to control everyday tasks in the virtual environment (e.g., moving around the city). Simultaneously, participants will undergo cognitive training by participating in various tasks demanding cognitive functions, such as visual-spatial (e.g., wayfinding) and problem-solving (e.g., wallet loss) functions. Gamification will be employed to promote the motivation to participate. All training activities will be gamified by blending in fun elements, such as difficulty-levelling, competition, and e-tokens. Co-participation is allowed to promote interpersonal interactions. The prototype enables real-time co-viewing among participants. Other elderly centre members and the activity facilitators can share the view of the participants in the game on either a large-screen monitor or a tablet computer, allowing them to simultaneously discuss and share about their gaming experiences.

Interventions

  • Device: Virtual Reality Motor-Cognitive Training System
    • Immersive VR training system tailor-made for the daily living experiences in the Hong Kong context to provide interactive experiences for older people in Hong Kong. The VR training system is designed as a game with 16 progressive levels (anticipating intervention group participants to complete 2 levels per week for 8 weeks) which aim to train their motor and cognitive functions.

Arms, Groups and Cohorts

  • Experimental: Intervention group
    • This arm will undertake VR simultaneous motor-cognitive training in 30 minutes session, twice a week for 8 weeks.
  • No Intervention: Control group
    • This arm will not be given any kind of treatment and will act as a passive control group.

Clinical Trial Outcome Measures

Primary Measures

  • Global cognitive function
    • Time Frame: Change is being assessed at “baseline” (T0) and “immediately after the completion” (T1), being 8 weeks apart
    • Score on the Montreal Cognitive Assessment Hong Kong Version (HK-MoCA), ranging from 0 to 30.
  • Frailty
    • Time Frame: Change is being assessed at “baseline” (T0) and “immediately after the completion” (T1), being 8 weeks apart
    • Score on the Fried Frailty Phenotype, ranging from 0 to 5

Secondary Measures

  • Inhibition of cognitive interference
    • Time Frame: Change is being assessed at “baseline” (T0) and “immediately after the completion” (T1), being 8 weeks apart
    • Stroop Color-Word Test (SCWT) Global Index score, calculated by I=CW-((W+C)/2)
  • Executive function
    • Time Frame: Change is being assessed at “baseline” (T0) and “immediately after the completion” (T1), being 8 weeks apart
    • Time taken to complete the trail making test (TMA & TMB), ranges from 0 to 300 seconds (when maximum time is reached)
  • Verbal and visuo-spatial short-term memory
    • Time Frame: Change is being assessed at “baseline” (T0) and “immediately after the completion” (T1), being 8 weeks apart
    • Score on the Digit Span Test, ranges from 0 to 9
  • Walking speed
    • Time Frame: Change is being assessed at “baseline” (T0) and “immediately after the completion” (T1), being 8 weeks apart
    • Timed up and go test (seconds)
  • Hand grip strength
    • Time Frame: Change is being assessed at “baseline” (T0) and “immediately after the completion” (T1), being 8 weeks apart
    • Hand grip strength by dynamometer (kg)

Participating in This Clinical Trial

Inclusion Criteria

  • Age ≥ 60 years, – Self-reported or informant-reported cognitive complaints – Objective cognitive impairment, as defined by a Clinical Dementia Rating of 0.5 and a Montreal Cognitive Assessment (MoCA) score of <25 – Preservation of one's independence, as defined by the Lawton's Instrumental Activity of Daily Living score of >14 – No diagnosed dementia, as observed in the medical record – Physical frailty from being pre-frail to frail, as defined by a Fried Frailty Index (FFI) score of 1-5. Exclusion Criteria:

  • Participants who have impaired mobility, as defined by Modified Functional Ambulatory Classification (MFAC) < Category 7 (i.e., Outdoor walker), – or probable dementia, i.e., MoCA < 17 or clinical dementia rating ≥ 1.

Gender Eligibility: All

Minimum Age: 60 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • The Hong Kong Polytechnic University
  • Collaborator
    • Pok Oi Hospital
  • Provider of Information About this Clinical Study
    • Principal Investigator: Dr Rick Kwan, Assistant Professor – The Hong Kong Polytechnic University
  • Overall Official(s)
    • Rick Kwan, Dr, Principal Investigator, The Hong Kong Polytechnic University
  • Overall Contact(s)
    • Rick Kwan, Dr, (852) 2766, rick.kwan@polyu.edu.hk

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