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IntroductionThe evaluation of memory is a crucial aspect of both cognitive research and clinical applications, as it offers valuable insights into an individual’s cognitive wellbeing and performance. Conventional neuropsychological assessments represent the established method for assessing different aspects of memory. Recent technological advancements, specifically in the field of virtual reality (VR), have introduced novel methods for evaluating memory.ObjectiveThis systematic review aims to examine the current state of memory assessment using VR technologies, assessing the degree of convergence and divergence between VR-based memory assessments and conventional neuropsychological tests.MethodA systematic review of the literature was conducted searching PubMed, PsycINFO, Web of Science databases, leading to the incorporation of 24 studies. Studies were grouped according to the examined memory domain (episodic, prospective, spatial domain). Convergence and divergence validity were examined for each, and information on software and hardware features was collected.ResultsThis review demonstrates a notable alignment between VR-based memory assessments and conventional neuropsychological tests. Moreover, VR tasks have shown to exhibit associations with executive functions and overall cognitive performance. The inclusion of various ecological contexts, such as residential environments, commercial establishments, and simulated scenarios, serves to augment the ecological validity of memory evaluations conducted in VR.DiscussionThe findings indicate that VR assessments demonstrate a functional perspective by effectively capturing the dynamic relationship between memory, executive functions, and overall cognitive performance. Nevertheless, it is imperative to acknowledge and tackle certain constraints that may hinder the widespread adoption and utilization of VR tasks. These limitations encompass factors such as restricted accessibility to VR tasks and the presence of heterogeneity in VR hardware and software. The dynamic and ever-changing nature of VR technology presents a range of potential avenues for future investigation and utilization in the domain of memory evaluation.

The present perspective introduces a novel psychometric tool designed to enhance the evaluation of alexithymia. Alexithymia, a condition marked by difficulties in recognizing and expressing emotions, along with a propensity to direct attention outside rather than toward one’s own interior experiences, is commonly investigated through self-report questionnaires. These instruments assume that individuals have sufficient self-awareness and abstraction capabilities, which restricts the understanding of the underlying mechanisms of emotional recognition in individuals who do not possess these capacities. To address this lack, emerging technologies like virtual reality (VR) and 360° videos facilitate the recreation of immersive contexts, enabling subjects to engage with scenarios even remotely. Our innovative tool employs spherical video technology to recreate social and non-social scenarios that elicit emotions. Psychophysiological measures are collected during video observation; then, questions are asked to investigate how the subject consciously processes the emotions they experienced. This multimodal approach aims to capture both implicit and explicit emotion processing, providing a comprehensive assessment. Overall, the proposed psychometric tool offers the potential for a more nuanced understanding of alexithymic traits and their real-life impact, empowering clinicians to tailor treatment processes to individual needs based on a richer set of information.

Completing cognitive and motor tasks simultaneously requires a high level of cognitive control in terms of executive processes and attentional abilities. Most of the daily activities require a dual-task performance. While walking, for example, it may be necessary to adapt gait to obstacles of the environment or simply participate in a conversation; all these activities involve more than one ability at the same time. This parallel performance may be critical in the cognitive or motor load, especially for patients with neurological diseases such as Parkinsonian Syndromes. Patients are often characterized by a crucial impairment in performing both tasks concurrently, showing a decrease in attention skills and executive functions, thus leading to increased negative outcomes. In this scenario, the accurate assessment of the components involved in dual-task performance is crucial, and providing an early specific training program appears to be essential. The objective of this protocol is to assess cognitive and motor components involved in dual-task performance and create a training program based on ecological activities focusing on executive and motor functions. Thus, we will employ Virtual Reality to provide semi-immersive, multisensory, ecological, standardized, and realistic experiences for rehabilitative purposes in patients with Parkinsonian Syndromes, considering its high prevalence in aging and the incidence of motor and cognitive dysfunctions in this population. Moreover, we propose to integrate the great amount of different data provided by dual-task and Virtual Reality system, using machine learning techniques. These integrations may increase the treatment's reliability in terms of better prognostic indexes and individualized training.

Virtual Reality is an effective technique for eliciting emotions. It provides immersive and ecologically valid emotional experiences while maintaining experimental control. Recently, novel VR forms like 360° videos have been used successfully for emotion elicitation. Some preliminary databases of 360° videos for emotion elicitation have been proposed, but they tapped mainly into an emotional dimensional approach and did not include a concurrent physiological assessment of an emotional profile. This study expands on these databases by combining dimensional and discrete approaches to validate a new set of 360° emotion-inducing images. Twenty-six participants viewed 46 immersive images, and their emotional reactions were measured using self-reporting, psychophysiological signals, and eye tracking. The IAVRS database can successfully elicit a wide range of emotional responses, including both positive and negative valence, as well as different levels of arousal. Results reveal an important correspondence between the discrete and dimensional models of emotions. Furthermore, the images that exhibit convergence between the dimensional and discrete emotional models are particularly impactful regarding arousal and valence values. The IAVRS database provides insights into potential relationships between physiological parameters and emotional responses. This preliminary investigation highlights the complexity of emotional elicitation processes and their physiological correlates, suggesting the need for further research to deepen our understanding.

Traditional neuropsychological evaluations are usually carried out using psychometric paper and pencil tests. Nevertheless, there is a continuous discussion concerning their efficacy to capture life-like abilities. The introduction of new technologies, such as Virtual Reality (VR) and 360° spherical photos and videos, has improved the ecological validity of the neuropsychological assessment. The possibility of simulating realistic environments and situations allows clinicians to evaluate patients in realistic activities. Moreover, 360° photos and videos seem to provide higher levels of graphical realism and technical user-friendliness compared to standard VR, regardless of their limitations in terms of interactivity. We developed a novel 360° tool, ObReco-2 (Object Recognition version 2), for the assessment of visual memory which simulates a daily situation in a virtual house. More precisely, patients are asked to memorize some objects that need to be moved for a relocation. After this phase, they are asked to recall them after 15 min and later to recognize them in the same environment. Here we present a first study about the usability of ObReco-2, and a second one exploring its clinical efficacy and updated usability data. We focused on Free Recall and Recognition scores, comparing the performances obtained by the participants in the standard and the 360° test. The preliminary results support the use of 360° technology for enhancing the ecological value of standard memory assessment tests.

Aging may be associated with conditions characterized by motor and cognitive alterations, which could have a detrimental impact on daily life. Although motors and cognitive aspects have always been treated as separate entities, recent literature highlights their relationship, stressing a strong association between locomotion and executive functions. Thus, designing interventions targeting the risks deriving from both components’ impairments is crucial: the dual-task represents a starting point. Although its role in targeting and decreasing difficulties in aging is well known, most interventions are focused on a single domain, proposing a vertical model in which patients emerge only for a single aspect per time during assessment and rehabilitation. In this perspective, we propose a view of the individual as a whole between mind and body, suggesting a multicomponent and multidomain approach that could integrate different domains at the same time retracing lifelike situations. Virtual Reality, thanks to the possibility to develop daily environments with engaging challenges for patients, as well as to manage different devices to collect multiple data, provides the optimal scenario in which the integration could occur. Artificial Intelligence, otherwise, offers the best methodologies to integrate a great amount of various data to create a predictive model and identify appropriate and individualized interventions. Based on these assumptions the present perspective aims to propose the development of a new approach to an integrated, multimethod, multidimensional training in order to enhance cognition and physical aspects based on behavioral data, incorporating consolidated technologies in an innovative approach to neurology.

Cognitive frailty is defined as a clinical condition characterized by both physical frailty and cognitive impairment, without reaching the criteria for dementia. The major goal of rehabilitation intervention is to assist patients in performing ordinary personal duties without the assistance of another person, or at the very least to remove the need for additional support, using adaptive approaches and facilities. In this regard, home-based rehabilitation allows patients to continue an intervention begun in a hospital setting while also ensuring support and assistance when access to healthcare systems is limited, such as during the present pandemic situation. We thus present Brain m-App, a tablet-based application designed for home-based cognitive rehabilitation of frail subjects, addressing spatial memory, attention, and executive functions. This app exploits the potential of 360° videos which are well-suited to home-based rehabilitation. The Brain m-app is made up of 10 days of activities that include a variety of exercises. The activities were chosen based on those patients used to do during their clinical practice in the hospital with the aim to improve their independence and autonomy in daily tasks. The preliminary usability test, which was conducted on five older people, revealed a sufficient level of usability, however, the sample size was modest. Results from the clinical study with 10 patients, revealed that Brain m-App improved especially executive functions and memory performances.

BackgroundLiving in the time of the COVID-19 means experiencing not only a global health emergency but also extreme psychological stress with potential emotional side effects such as sadness, grief, irritability, and mood swings. Crucially, lockdown and confinement measures isolate people who become the first and the only ones in charge of their own mental health: people are left alone facing a novel and potentially lethal situation, and, at the same time, they need to develop adaptive strategies to face it, at home. In this view, easy-to-use, inexpensive, and scientifically validated self-help solutions aiming to reduce the psychological burden of coronavirus are extremely necessary.AimsThis pragmatic trial aims to provide the evidence that a weekly self-help virtual reality (VR) protocol can help overcome the psychological burden of the Coronavirus by relieving anxiety, improving well-being, and reinforcing social connectedness. The protocol will be based on the “Secret Garden” 360 VR video online (www.covidfeelgood.com) which simulates a natural environment aiming to promote relaxation and self-reflection. Three hundred sixty–degree or spherical videos allow the user to control the viewing direction. In this way, the user can explore the content from any angle like a panorama and experience presence and immersion. The “Secret Garden” video is combined with daily exercises that are designed to be experienced with another person (not necessarily physically together), to facilitate a process of critical examination and eventual revision of core assumptions and beliefs related to personal identity, relationships, and goals.MethodsThis is a multicentric, pragmatic pilot randomized controlled trial involving individuals who experienced the COVID-19 pandemic and underwent a lockdown and quarantine procedures. The trial is approved by the Ethics Committee of the Istituto Auxologico Italiano. Each research group in all the countries joining the pragmatic trial, aims at enrolling at least 30 individuals in the experimental group experiencing the self-help protocol, and 30 in the control group, over a period of 3 months to verify the feasibility of the intervention.ConclusionThe goal of this protocol is for VR to become the “surgical mask” of mental health treatment. Although surgical masks do not provide the wearer with a reliable level of protection against the coronavirus compared with FFP2 or FFP3 masks, surgical masks are very effective in protecting others from the wearer’s respiratory emissions. The goal of the VR protocol is the same: not necessarily to solve complex mental health problems but rather to improve well-being and preserve social connectedness through the beneficial social effects generated by positive emotions.

Mild cognitive impairment (MCI) refers to a subtle, general cognitive decline with a detrimental impact on elderlies' independent living and quality of life. Without a timely diagnosis, this condition can evolve into dementia over time, hence the crucial need for early detection, prevention, and rehabilitation. For this purpose, current neuropsychological interventions have been integrated with (i) virtual reality, which immerses the user in a controlled, ecological, and safe environment (so far, both virtual reality-based cognitive and motor rehabilitation have revealed promising positive outcomes); and (ii) non-invasive brain stimulation, i.e., transcranial magnetic or electric brain stimulation, which has emerged as a promising cognitive treatment for MCI and Alzheimer's dementia. To date, these two methods have been employed separately; only a few studies (limited to motor rehabilitation) have suggested their integration. The present paper suggests to extend this integration to cognitive rehabilitation as well as to provide a multimodal stimulation that could enhance cognitive training, resulting in a more efficient rehabilitation.

The aim of this perspective is to propose and discuss the integration of transcranial magnetic stimulation (TMS) over the dorsolateral prefrontal cortex with virtual reality (VR) food exposure for therapeutic interventions for food addiction. “Food addiction” is a dysfunctional eating pattern which is typically observed in eating disorders (ED) such as bulimia nervosa and binge eating disorder. Food addiction has been compared to substance use disorder due to the necessity of consuming a substance (food) and the presence of a dependence behavior. In recent years, VR has been applied in the treatment of ED because it triggers psychological and physiological responses through food exposure in place of real stimuli. Virtual reality-Cue exposure therapy has been proven as a valid technique for regulating anxiety and food craving in ED. More, TMS has been proven to modulate circuits and networks implicated in neuropsychiatric disorders and is effective in treating addiction such as nicotine craving and consumption and cocaine use disorder. The combination of a simulative technology and a neurostimulation would presumably provide better improvement compared to a single intervention because it implies the presence of both cognitive and neuropsychological techniques. The possible advantage of this approach will be discussed in the perspective.