Evaluation of a cognition-sensitive spatial virtual reality game for Alzheimer's disease

Spatial impairment characterizes Alzheimer's disease (AD) from its earliest stages. We present the design and preliminary evaluation of "Barn Ruins," a serious virtual reality (VR) wayfinding game for early-stage AD. Barn Ruins is tailored to the cognitive abilities of this population, featuring simple controls and error-based scoring system. Ten younger adults, ten cognitively healthy older adults, and ten age-matched individuals with AD participated in this study. They underwent cognitive assessments using the Montreal Cognitive Assessment (MoCA) and the Montgomery-Åsberg Depression Rating Scale (MADRS) before gameplay. The game involves navigating a virtual environment to find a target room, with increasing levels of difficulty. This study aimed to confirm the cognitive sensitivity of the Barn Ruins' spatial learning score by studying its relationship with Montreal Cognitive Assessment (MoCA) scores. MoCA scores and spatial learning scores had a correlation coefficient of 0.755 (p < 0.001). Logistic regression further revealed that higher spatial learning scores significantly predicted lower odds of cognitive impairment (OR = 0.495, 95% CI [0.274, 0.746], p < 0.005). The initial results suggest that the game is effective in differentiating performance among participant groups. This research demonstrates the potential of the Barn Ruins game as an innovative tool for assessing spatial navigation in AD, highlighting areas for future validation and investigation as a training tool.