With mild cognitive impairment, there's still time to learn new habits for coping with day‑to‑day life.
Forgetting to pick up clothes from the dry cleaner. Struggling to retrieve the name of your new dentist. Not recalling how to properly use a COVID‑19 mask. About 15 to 20% of people aged 65 or older suffer from symptoms such as these, which can be signs of mild cognitive impairment (MCI).
While MCI does not affect the ability to function independently, the buildup of episodes can create anxiety and stress. It can also be a precursor to dementia and Alzheimer's disease, which are irreversible. Fortunately, people with this condition can still learn new ways to memorize and handle daily activities, and the tools they acquire at this early stage can stay with them as problems increase.
An emerging non‑pharmaceutical intervention‑cognitive training‑helps older adults cope by developing memory‑boosting strategies. Conceived 15 years ago by Sylvie Belleville, professor at the Université de Montréal and Scientific Director of the Research Centre of the Institut universitaire de gériatrie de Montréal (CRIUGM), this "MEMO" program has generated neural changes that help those with MCI manage their cognitive challenges.
"The brains of people with mild cognitive problems remain plastic, or malleable," explains Belleville, who also holds the Canada Research Chair in Cognitive Neuroscience of Aging and Brain Plasticity. "This means they still have the capacity to learn new ways to memorize elements that they need to help them handle their daily activities." That presents opportunities for teaching them to cope better with everyday life.
VR adds realism to memory training
Since paying attention is key to memorization, MEMO focusses on teaching study subjects techniques for both memorizing and focussing. While the program was initially limited to in‑person training by clinicians, a multi‑level web version allows broader access. At the research centre, program participants go through pen‑and‑paper exercises based on lists and images that they can take home with them for additional practice.
"Our test subjects reported that, while they did practice the strategies taught in class when they got home, they did not see a great impact on their daily activities such as improving their financial management," adds Belleville. "This was understandable, because the classroom conditions in which the training is delivered are very different from those in real life and it's difficult to transpose what they learned." For example, classrooms are quiet and controlled, whereas grocery stores can be noisy and full of distractions.
In response to requests from program participants to see more realistic exercises, Belleville and her team turned to the National Research Council of Canada (NRC) to develop a virtual reality (VR) version of MEMO. This immerses participants in 3D settings such as grocery stores, apartments and social situations. The platform also allows researchers to track everything that happens before, during and after various exercises.
"This collaboration was a remarkable fit, since I had developed some expertise in VR along with memory training," she says. "Combined with the NRC's lengthy experience in creating VR platforms, we can produce top‑quality training modules."
According to Anne Cabral, Research Officer at the NRC's Medical Devices Research Centre, the multidisciplinary VR team has deep roots in both the medical and engineering fields. "Over the years, we have developed VR software, sensors and other basics, so we don't have to build platforms from scratch," she says. "Having comprehensive knowledge of the constraints, limitations and requirements related to the medical field makes it easier and faster for us to provide clients with whole packages tailored to their needs."
For the MEMO project, Cabral's team also does content creation, adapts interactivity levels to program participants, and identifies and safeguards objective measurements. To ensure the usability and efficiency of the VR software, the NRC and CRIUGM teams are in continuous contact. By offering a versatile and responsive research and development approach, the NRC team ensures that the application will meet new needs and constraints that arise throughout the project. These include adapting the program for use in a VR context without a trainer.
Seeing a real future
The goal of the 5‑year project is to improve the daily lives of those afflicted with MCI by making MEMO available to people living in remote areas or hampered by reduced mobility. In time, they will be able to access the VR modules through cellphones, iPads and other devices.
Belleville points out that the high‑quality tools developed by the NRC are "beautiful and very close to reality." The new generation of VR helmet is light and comfortable, and the NRC's software presents a more realistic virtual world than ever. This is having an enormous effect on helping participants transpose their experiences from virtual to real life.