La réalité virtuelle personnalisée sur les troubles de l'humeur en établissement d'hébergement pour personnes âgées dépendantes et unité de soin de longue durée : étude de cas chez un résident présentant des troubles cognitifs modérés

La maladie d'Alzheimer et les maladies apparentées entraînent des troubles de l'humeur et des troubles anxieux chez les résidents institutionnalisés. La thérapie par réminiscence a démontré un intérêt dans le traitement de ces symptômes. L'étude pilote randomisée « Réminiscences et Émotions » utilise la réalité virtuelle personnalisée pour diminuer les troubles de l'humeur des résidents. Les objectifs secondaires visent à évaluer l'acceptabilité du dispositif et la qualité de vie des résidents. Monsieur G. présente des troubles cognitifs modérés ainsi que des troubles de l'humeur. Il participe à dix séances de réalité virtuelle personnalisée pendant une période de six semaines. Les variables sont mesurées en amont et à la fin du protocole. Une analyse visuelle des scores illustre les résultats. Le dispositif de réalité virtuelle est accepté et toléré par le participant. Les scores aux échelles de l'humeur (dépression, apathie) et de l'anxiété diminuent. Aucune différence n'apparaît sur l'échelle de qualité de vie. Les interventions génèrent du plaisir et de la vivacité en lien avec l'émergence de souvenirs positifs. Il existe un intérêt de la thérapie par réminiscence en réalité virtuelle pour améliorer l'humeur du participant. Les futurs résultats permettront de conclure sur la méthode et son indication thérapeutique en institution gériatrique. The World Health Organization defined dementia as a syndrome in which there is deterioration in cognitive function beyond what might be expected from the usual consequences of biological aging. Currently, 55 million people live with Alzheimer's in the world. Unfortunately, there isn't any drug treatment to cure the degenerative disease although clinical trials are promising regarding the use of monoclonal antibodies. But, Alzheimer's disease and associated diseases lead to behavioral and psychological symptoms (anxiety, apathy, depression) which can be frequent in nursing homes. In the context of pandemic, these conditions are amplified because of the sanitary restrictions. Since the beginning of the sars-cov2 pandemic, residents have felt alone, sad and more anxious. Nowadays, non-drug interventions are recommended by health organizations for the treatment of behavioral and mood disorders in the elderly with cognitive disorders. Reminiscence therapy is a non drug intervention which has been shown to be effective in the treatment of mood disorders on elderly. Many nursing homes use this non pharmacological treatment for their residents. Some studies take interest in reminiscence and virtual reality. The use of new technologies is innovative in geriatric care and it can be used as a personalized support for reminiscence therapy. The "Bien Vieillir Nice 2030" Project of Nice's University Hospital supports this research on virtual reality and mood disorders in nursing homes/long term care unit. The objective of this study (University Hospital of Nice, CoBTeK France) is to evaluate the effects of personalized virtual reality on reduction of mood disorders in nursing homes residents with minors and moderates neurocognitive disorders. The secondary objectives are to assess the acceptability of the device, the emotional valence and the resident's quality of life. A single case study is presented to illustrate reminiscences and emotions protocol. Participants are randomized into two groups: neutral versus personalized. The neutral videos consist of unknown places like random streets or public gardens while the personalized videos are known places that mattered to the residents. Places are filmed with a camera GoPro Fusion 360°. The healthcare team and families are actively involved in the research protocol. Their help is invaluable in targeting memories related to the resident's life history. A clinical psychologist specializing in gerontology is in charge of the virtual reality sessions. The therapeutic alliance is central to our study. A humanistic method of person-centered approach allows communication with the resident to offer him to participate in the sessions. The sessions always start and end in the same way in order not to cause stress in the resident. The hardware is tested before the protocol starts, for familiarization purpose. Potential side effects related to virtual reality are identified using a cybermalaise questionnaire. The sessions are held in a sitting position for the participant's safety. In this paper, Mr. G, 92 years old benefits from personalized video according to his life story. He has moderate cognitive impairment as well as mood disorders. He received ten virtual reality sessions over a period of six weeks. The exposure time varies between five to ten minutes. We use an Oculus Rift S headset and a computer in partnership with C2Care. Variables were measured before and at the end of the protocol. We performed a visual analysis of the scores. The results indicated a decrease on mood rating scales scores (Geriatric Depression Scale, Apathy Inventory, Neuropsychiatric Inventory and Hamilton Depression Rating scale). The interventions produced pleasure and alertness in connection along with the emergence of positive memories. The headset was well tolerated by the participant, but we did not observe any effect on quality of life. There is an interest in the use of reminiscence therapy using virtual reality to improve participants' mood. Future results will allow us to conclude on the method and on its indication in nursing homes after the inclusion of 30 participants. [ABSTRACT FROM AUTHOR]