Applicability of an immersive virtual reality system to assess egocentric orientation of older adults.

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.

ANTECEDENTES: A orientação espacial é um domínio cognitivo frequentemente comprometido em pacientes com doença de Alzheimer (DA) e pode ser uma das suas primeiras manifestações clínicas. Alguns estudos demonstraram que a integração alocêntrica com informações espaciais egocêntricas parece prejudicada nessa patologia. Não há um consenso sobre qual a melhor forma de avaliar a orientação espacial e os testes tradicionais carecem de validade ecológica; porém, recentemente, a realidade virtual (RV) proporcionou novas oportunidades para esta avaliação. OBJETIVOS: Analisar a aplicabilidade e estabilidade de uma tarefa virtual imersiva desenvolvida para avaliar a orientação espacial, o Spatial Orientation in Immersive Virtual Environment Maze Test (SOIVET-Maze) em idosos com e sem comprometimento cognitivo leve. MéTODOS: Quarenta e três idosos foram incluídos no estudo, 24 sem comprometimento cognitivo e 19 com comprometimento cognitivo leve. A aplicabilidade foi avaliada pelo Witmer and Singer Sense of Presence Questionnaire e um questionário para eventos adversos de cybersickness. Para avaliar a estabilidade, os participantes foram avaliados 2 vezes com intervalo de 7 a 14 dias, e o coeficiente de correlação intraclasse foi calculado entre as visitas. O teste t ou o teste de Mann-Whitney foi utilizado para comparar a aplicabilidade e estabilidade entre os grupos. RESULTADOS: Não houve diferença significativa entre os grupos quanto à aplicabilidade. Uma forte correlação entre o primeiro e o segundo dia de teste foi encontrada no grupo de comprometimento cognitivo leve. CONCLUSãO: A tarefa SOIVET-Maze apresentou excelente aplicabilidade e boa estabilidade, favorecendo sua aplicação clínica para avaliação da orientação espacial em idosos.

Applicability of an immersive virtual reality system to assess egocentric orientation of older adults / Aplicabilidade de um sistema de realidade virtual imersivo para avaliar a orientação egocêntrica de idosos

Abstract 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.

Resumo Antecedentes A orientação espacial é um domínio cognitivo frequentemente comprometido em pacientes com doença de Alzheimer (DA) e pode ser uma das suas primeiras manifestações clínicas. Alguns estudos demonstraram que a integração alocêntrica com informações espaciais egocêntricas parece prejudicada nessa patologia. Não há um consenso sobre qual a melhor forma de avaliar a orientação espacial e os testes tradicionais carecem de validade ecológica; porém, recentemente, a realidade virtual (RV) proporcionou novas oportunidades para esta avaliação. Objetivos Analisar a aplicabilidade e estabilidade de uma tarefa virtual imersiva desenvolvida para avaliar a orientação espacial, o Spatial Orientation in Immersive Virtual Environment Maze Test (SOIVET-Maze) em idosos com e sem comprometimento cognitivo leve. Métodos Quarenta e três idosos foram incluídos no estudo, 24 sem comprometimento cognitivo e 19 com comprometimento cognitivo leve. A aplicabilidade foi avaliada pelo Witmer and Singer Sense of Presence Questionnaire e um questionário para eventos adversos de cybersickness. Para avaliar a estabilidade, os participantes foram avaliados 2 vezes com intervalo de 7 a 14 dias, e o coeficiente de correlação intraclasse foi calculado entre as visitas. O teste t ou o teste de Mann-Whitney foi utilizado para comparar a aplicabilidade e estabilidade entre os grupos. Resultados Não houve diferença significativa entre os grupos quanto à aplicabilidade. Uma forte correlação entre o primeiro e o segundo dia de teste foi encontrada no grupo de comprometimento cognitivo leve. Conclusão A tarefa SOIVET-Maze apresentou excelente aplicabilidade e boa estabilidade, favorecendo sua aplicação clínica para avaliação da orientação espacial em idosos.

Applicability of an immersive virtual reality system for assessing route learning in older adults / Aplicabilidade de um sistema de realidade virtual imersivo para avaliação da aprendizagem de rotas em idosos

ABSTRACT. Spatial orientation is defined as the ability to find one's way around an environment, follow familiar routes, recognize places, and learn new routes. Spatial disorientation is one of the early symptoms of Alzheimer's disease (AD), and traditional cognitive evaluation lacks ecological validity. Therefore, new assessment methods are needed for the early identification of this cognitive impairment. Objective: This study aimed to compare the applicability and stability of an immersive virtual reality (VR) system developed to assess route learning between older adults with and without mild cognitive impairment (MCI). Methods: The study sample included 43 older adults: 22 without MCI and 23 with MCI. Applicability was assessed based on the recording of adverse events and the sense of presence reported through questionnaires. The Mann-Whitney U test was applied to compare the applicability of the Spatial Orientation in Immersive Virtual Environment Test (SOIVET)-Route task between older adults with and without MCI. Both short- and long-term stabilities of the task were evaluated using the intraclass correlation coefficient (ICC). Results: The mean age of participants was 71.4 years (SD=5.5). A minimum number of adverse events (mean=1.46; SD=2.11) and high levels of presence (mean=138.04; SD=14.80) were reported, and there was no difference between groups with and without MCI. A good to excellent correlation was found for short-term stability (CCI 0.78) and a reasonable correlation was found for long-term stability (CCI 0.58). Conclusions: The VR system was applicable for older adults and showed a good to excellent correlation for short-term stability.

RESUMO. Orientação espacial é a capacidade de encontrar um caminho em um ambiente, seguir rotas familiares, reconhecer lugares e aprender novas rotas. A desorientação espacial é um dos primeiros sintomas da doença de Alzheimer, e a avaliação cognitiva tradicional carece de validade ecológica. Diante disso, novos métodos de avaliação são necessários para a identificação precoce desse comprometimento cognitivo. Objetivo: Este estudo teve como objetivo comparar a aplicabilidade e a estabilidade de um sistema de realidade virtual imersivo desenvolvido para avaliar a aprendizagem de rotas entre idosos com e sem comprometimento cognitivo leve (CCL). Métodos: Participaram do estudo 43 idosos: 22 sem CCL e 23 com CCL. A aplicabilidade foi avaliada por meio do registro de eventos adversos e pela sensação de presença relatados. O teste de Mann-Whitney foi aplicado para comparar a aplicabilidade da tarefa SOIVET-Route entre idosos com e sem CCL. A estabilidade da tarefa em curto e longo prazo foi avaliada pelo coeficiente de correlação intraclasse (ICC). Resultados: A idade média dos participantes foi de 71,4 anos (desvio padrão — DP=5,5). Em relação à aplicabilidade, encontramos mínimo relato de sintomas adversos (média=1,46; DP=2,11) e altos níveis de sensação de presença (média 138,04; DP=14,80), e não houve diferença entre os grupos com e sem CCL. Ao analisarmos a estabilidade, encontramos de boa a excelente correlação em curto prazo (CCI=0,78) e uma correlação razoável em longo prazo (CCI=0,58). Conclusões: O sistema de realidade virtual foi aplicável em idosos e mostrou boa correlação na estabilidade de curto prazo.

Use of the Brazilian version of the Interpersonal Negotiation Strategies Interview (INSI) in a child and adolescent sample: a pilot study.

INTRODUCTION: Interpersonal negotiation skills (INS) comprise actions used to solve social situations between interacting individuals involving different needs or desires. These abilities are part of one's social competence and may be impaired in some psychiatric conditions. There are few validated psychometric tools for measuring INS in the literature. This pilot study aimed to investigate some basic psychometric properties of the Brazilian version of the Interpersonal Negotiation Strategies Interview (INSI) in children and adolescents. METHODS: We developed a new version of the INSI adapted to the Brazilian culture using eight different dilemmas in dyadic situations (with peers and adults), presented visually as drawings on cards. A group of psychologists and psychiatrists chose and adapted the dilemmas formerly proposed by the original version. The same scoring criteria as for the original instrument were used. A total of 20 children and adolescents were included in this pilot study. We investigated test reliability using measures of interrater reliability, test-retest, and internal consistency. The content validity of the INSI was also evaluated by comparison with scores from the Child Behavior Checklist-Revised (CBCL). RESULTS: Internal consistency and test-retest evaluations were acceptable (rater 1: α = 0.77; rater 2: α = 0.72); the reliability of the instrument was excellent (K = 0.078; intraclass correlation coefficient = 0.98; 95% confidence interval 0.97-0.99); and content validity was strongly significant (p < 0.001). CONCLUSIONS: Preliminary results suggest that this version of the INSI has good interrater reliability and internal consistency and constitutes a promising tool to assess social competence.

Use of the Brazilian version of the Interpersonal Negotiation Strategies Interview (INSI) in a child and adolescent sample: a pilot study

Abstract Introduction Interpersonal negotiation skills (INS) comprise actions used to solve social situations between interacting individuals involving different needs or desires. These abilities are part of one's social competence and may be impaired in some psychiatric conditions. There are few validated psychometric tools for measuring INS in the literature. This pilot study aimed to investigate some basic psychometric properties of the Brazilian version of the Interpersonal Negotiation Strategies Interview (INSI) in children and adolescents. Methods We developed a new version of the INSI adapted to the Brazilian culture using eight different dilemmas in dyadic situations (with peers and adults), presented visually as drawings on cards. A group of psychologists and psychiatrists chose and adapted the dilemmas formerly proposed by the original version. The same scoring criteria as for the original instrument were used. A total of 20 children and adolescents were included in this pilot study. We investigated test reliability using measures of interrater reliability, test-retest, and internal consistency. The content validity of the INSI was also evaluated by comparison with scores from the Child Behavior Checklist-Revised (CBCL). Results Internal consistency and test-retest evaluations were acceptable (rater 1: α = 0.77; rater 2: α = 0.72); the reliability of the instrument was excellent (K = 0.078; intraclass correlation coefficient = 0.98; 95% confidence interval 0.97-0.99); and content validity was strongly significant (p < 0.001). Conclusions Preliminary results suggest that this version of the INSI has good interrater reliability and internal consistency and constitutes a promising tool to assess social competence.

Spatial orientation tasks show moderate to high accuracy for the diagnosis of mild cognitive impairment: a systematic literature review.

Spatial disorientation has been observed in mild cognitive impairment (MCI) and is associated with a higher risk of progression to Alzheimer's disease (AD). However, there is no gold standard assessment for spatial orientation and paper-and-pencil tests lack ecological validity. Recently, there has been an increasing number of studies demonstrating the role of spatial disorientation as a cognitive marker of pathological decline, shedding new light on its importance for MCI. This systematic review aimed to investigate the accuracy of spatial orientation tasks for the diagnosis of MCI by comparison with cognitively healthy elderly. The search was conducted in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Web of Science, Scopus, Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO). Only original studies reporting spatial orientation assessment in MCI patients compared to a healthy control group were included. Studies were excluded if the MCI classification did not follow well described criteria and/or if accuracy results of spatial orientation assessment were not provided. Seven studies met the eligibility criteria, describing a variety of spatial orientation assessments including questionnaires, paper-and-pencil, office-based route learning, and computer-based and virtual reality tasks. Spatial orientation tasks demonstrated moderate to high accuracy in detecting elderly with MCI compared to cognitively healthy elderly, with areas under the curve (AUC) ranging from 0.77 to 0.99. However, important methodological issues were found in the selected studies which should be considered when interpreting results. Although the inclusion of spatial orientation assessments in MCI evaluations seems to have significant value, further studies are needed to clarify their true capacity to distinguish pathological from non-pathological aging.

Spatial orientation tasks show moderate to high accuracy for the diagnosis of mild cognitive impairment: a systematic literature review / Tarefas de orientação espacial têm acurácia moderada a alta para o diagnóstico de comprometimento cognitivo leve: uma revisão sistemática

Abstract Spatial disorientation has been observed in mild cognitive impairment (MCI) and is associated with a higher risk of progression to Alzheimer's disease (AD). However, there is no gold standard assessment for spatial orientation and paper-and-pencil tests lack ecological validity. Recently, there has been an increasing number of studies demonstrating the role of spatial disorientation as a cognitive marker of pathological decline, shedding new light on its importance for MCI. This systematic review aimed to investigate the accuracy of spatial orientation tasks for the diagnosis of MCI by comparison with cognitively healthy elderly. The search was conducted in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Web of Science, Scopus, Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO). Only original studies reporting spatial orientation assessment in MCI patients compared to a healthy control group were included. Studies were excluded if the MCI classification did not follow well described criteria and/or if accuracy results of spatial orientation assessment were not provided. Seven studies met the eligibility criteria, describing a variety of spatial orientation assessments including questionnaires, paper-and-pencil, office-based route learning, and computer-based and virtual reality tasks. Spatial orientation tasks demonstrated moderate to high accuracy in detecting elderly with MCI compared to cognitively healthy elderly, with areas under the curve (AUC) ranging from 0.77 to 0.99. However, important methodological issues were found in the selected studies which should be considered when interpreting results. Although the inclusion of spatial orientation assessments in MCI evaluations seems to have significant value, further studies are needed to clarify their true capacity to distinguish pathological from non-pathological aging.

RESUMO A ocorrência de desorientação espacial foi observada no comprometimento cognitivo leve (CCL) e está associada a um maior risco de progressão para a doença de Alzheimer (DA). No entanto, não há um padrão ouro para avaliação da orientação espacial e os testes em papel e caneta não apresentam validade ecológica. Recentemente, um número cada vez maior de estudos têm apontado o papel da desorientação espacial como um marcador cognitivo do declínio patológico, lançando uma nova luz sobre sua importância para o CCL. Esta revisão sistemática teve como objetivo investigar a acurácia de tarefas de orientação espacial para se estabelecer o diagnóstico de CCL entre idosos cognitivamente saudáveis. A pesquisa foi realizada através das bases de dados Medline/PubMed, Web of Science, Scopus, Embase, Lilacs e Scielo. Apenas artigos originais que reportassem avaliação da orientação espacial em idosos CCL comparados a um grupo controle saudável foram incluídos. Foram excluídos os estudos que não utilizassem a classificação de CCL segundo critérios bem descritos e/ou que não reportassem resultados de acurácia da avaliação da orientação espacial. Sete estudos atenderam aos critérios de elegibilidade, descrevendo uma variedade de formas de avaliação da orientação espacial, incluindo questionários, tarefas em papel e lápis, tarefas de aprendizado de rotas no escritório, tarefas baseadas em computador e com realidade virtual. As tarefas de orientação espacial demonstraram acurácia moderada a alta na detecção de CCL em comparação com idosos cognitivamente saudáveis, com áreas sob a curva (area under the curve — AUC) variando de 0,77 a 0,99. No entanto, um viés metodológico importante foi identificado nos estudos selecionados, o que deve ser levado em consideração na interpretação dos resultados. Apesar da inclusão da orientação espacial na avaliação cognitiva em CCL parecer ter um valor significativo, mais estudos são necessários para esclarecer sua verdadeira capacidade de distinguir o envelhecimento patológico do não patológico.

Two new virtual reality tasks for the assessment of spatial orientation: preliminary results of tolerability, sense of presence and usability / Duas novas tarefas de realidade virtual para avaliação da orientação espacial: resultados preliminares de tolerabilidade, sensação de presença e usabilidade

Abstract 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).

Resumo A orientação espacial é um domínio cognitivo freqüentemente comprometido na doença de Alzheimer e pode ser um dos primeiros sintomas manifestados. Objetivo: Este artigo descreve os resultados de tolerabilidade, sensação de presença e usabilidade de duas tarefas imersivas de realidade virtual para avaliação da orientação espacial, utilizando óculos de RV em adultos. Métodos: 31 adultos saudáveis, ​​recrutados entre estudantes universitários e da comunidade local, realizaram duas tarefas de realidade virtual imersiva para avaliação da orientação espacial: A tarefa SOIVET-Maze para avaliação da capacidade de transposição da orientação alocêntrica para egocêntrica e a tarefa SOIVET-Route para avaliação da memória espacial e reconhecimento de pontos de referência. Os participantes também responderam questionários sobre Sensação de Presença, Sintomas de cybersickness, Perfil de Uso de Tecnologia e Histórico de cinetose. Feedback espontâneo dos participantes foi utilizado como medida de usabilidade. Resultados: Todos os participantes conseguiram compreender as instruções da tarefa e como interagir com o sistema. Ambas tarefas parecem induzir forte sensação de presença, avaliada pelo Questionário de Presença de Witmer e Singer (M=128 e 143 para SOIVET-Maze e SOIVET-Route, respectivamente). A tarefa SOIVET-Route teve uma pequena vantagem numérica em relação à tarefa SOIVET-Maze na pontuação de tolerabilidade avaliada pelo Questionário de Cybersickness (M=4,19, SD=5,576 e M=3,52, SD=6,418 para SOIVET-Maze e SOIVET-Route respectivamente). Além disso, não houve desistências na SOIVET-Route devido a problemas de tolerabilidade, ao contrário da SOIVET-Maze, que teve dois drop-outs. No entanto, essa diferença não foi estatisticamente significativa (Z= -901, p=0,368, teste de postos sinalizados de Wilcoxon)

All that glitters is not gold: When motor and vocal tics in a child do not match Tourette syndrome: A case report / Nem tudo que reluz é ouro: quando tiques motores e vocais em uma criança não combinam com Síndrome de Tourette: relato de caso

ABSTRACT The atypical form of Pantothenate Kinase-Associated Neurodegeneration (PKAN) tends to present at around the age of 14 years, has a heterogeneous presentation with extrapyramidal symptoms, and approximately one third of patients exhibit psychiatric problems. This paper reports the case of a patient with apparent typical symptoms of Tourette syndrome. However, the severity and poor response to treatment led to further investigation and the diagnosis of PKAN as a secondary cause of Tourettism was reached.

RESUMO A forma atípica de PKAN costuma se apresentar por volta dos 14 anos de idade, possui uma sintomatologia heterogênea, com sintomas extrapiramidais e, em cerca de um terço dos pacientes, também com a manifestação de sintomas psiquiátricos. O presente artigo relata o caso de uma paciente com sintomatologia típica da Síndrome de Tourette à primeira vista. Entretanto, a gravidade do quadro e pouca resposta ao tratamento levaram a uma maior investigação e ao diagnóstico de PKAN como causa secundária do Tourettismo.

Dissociation of depression from apathy in traumatic brain injury: a case report / Dissociação de depressão e apatia em lesão encefálica traumática: um relato de caso

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.

Apesar de não se destacarem ao olhar clínico, as lesões do córtex pré-frontal acarretam grande prejuízo funcional e social aos pacientes. O córtex do cíngulo anterior está intimamente envolvido com o comportamento motivacional e o que se observa após um dano a esta região é a instalação de um estado apático. Este trabalho visa relatar o caso de um paciente com lesão traumática do lobo pré-frontal que apresentou uma síndrome depressiva associada a sintomas apáticos. Após tratamento adequado da depressão foi possível perceber intensa apatia, sequela irreversível do traumatismo crânio encefálico, que se constituiu como principal obstáculo ao retorno do estilo de vida e independência do paciente.