Tracking the trail: Using VR to explore cognitive-motor function in Parkinson's disease

Cognitive impairments in Parkinson's disease (PD) often emerge alongside motor symptoms, yet most clinical assessments examine these domains separately. This mixed-design study explores the utility of a virtual reality-based Color Trails Test (VR-CTT) as an integrated, immersive tool to assess motor-cognitive interaction in PD. Twenty-three individuals with PD (ON medication) and twenty-three age- and education-matched healthy controls completed both the standard pen-and-paper CTT and the VR-CTT, which preserves the same cognitive demands while introducing an upper-limb motor component through full-arm reaching to virtual targets. As expected, individuals with PD were slower and less accurate across both formats. However, we observed only moderate-to-low correlations between completion times in the two CTTs, thus suggesting that the VR-CTT may capture distinct and ecologically valid aspects of motor-cognitive performance. Indeed, kinematic analysis revealed longer head-hand coordination delays and reduced maximal execution velocities in PD, pointing to subtle, yet specific motor difficulties during cognitive tasks. Beyond confirming feasibility, these results highlight the VR-CTT's potential as a novel tool for identifying motor-cognitive dysfunction and informing targeted rehabilitation strategies. Its immersive nature and multi-competency format position it as a promising intervention platform for cognitive-motor training in PD and related disorders.