Cognition Assessment in Virtual Reality (CAVIR)-Spanish Version: Validation of a Novel Virtual Reality Test for...

There is a need for ecologically valid measures of real-life cognitive functioning. We investigated: (I) the sensitivity of the Cognition Assessment in Virtual Reality (CAVIR) test, which assesses daily-life cognitive skills in an immersive virtual reality kitchen scenario, to capture cognitive impairments in a Spanish sample of patients with bipolar disorder (BD) compared to healthy controls (HCs); (II) the convergent validity of CAVIR against standard neuropsychological tests and functional measures.

Patients with BD in full/partial remission (n = 40) and HCs (n = 40) completed the CAVIR-Spanish version and standard neuropsychological tests; the Hamilton Depression Rating Scale (HRDS-17), the Young Mania Rating Scale (YMRS), the Functioning Assessment Short-Test (FAST) and the Brief University of California Performance-based Skills Assessment (UPSA-B). Between-group comparisons of CAVIR global and subtask scores were conducted, together with correlation and linear regression analyses adjusting for age and mood symptoms.

CAVIR was sensitive to cognitive impairments in BD, with patients showing poorer performance than HCs on CAVIR global composite (BD = -1.09, 95% CI [-1.44, 0.74] vs. HCs = -0.19, 95% CI [-0.53, 0.15]) (F_(1,72) = 9.52, p = 0.003, ${\eta }_p^2$  = 0.12) and subtasks of sustained attention (BD = -1.25, 95% CI [-1.83, -0.70] vs. HCs = -0.14, 95% CI [-0.66, 0.37]) (F_(1,69) = 6.12, p = 0.016, ${\eta }_p^2$  = 0.08), processing speed (BD = -1.64, 95% CI [-2.11, -1.18] vs. HCs = -0.20, 95% CI [-0.66, 0.25]) (F_(1,68) = 13.67, p < 0.001, ${\eta }_p^2$  = 0.17) and working memory (BD = -0.91, 95% CI [-1.42, -0.41] vs. HCs = 0.05, 95% CI [-0.42, 0.52]) (F_(1,71) = 5.50, p = 0.022, ${\eta }_p^2$  = 0.07). The global CAVIR composite and subtasks scores were associated with standard global neurocognitive composite and domains, respectively (σ = 0.50-0.74, p < 0.001). The global CAVIR and all subtasks scores were associated with both observed/interview-based (FAST; σ = -0.29 to -0.55, p < 0.001) and performance-based (UPSA-B; σ = 0.29-0.49, p < 0.05) functional outcomes.

The CAVIR-Spanish version is a sensitive and valid instrument for measuring real-life cognitive skills in BD and may be implemented in clinical settings and treatment trials targeting cognition following further studies.