Virtual reality ‘more effective’ at detecting Alzheimer’s than current tests, University of Cambridge research finds

A navigation test using virtual reality (VR) could detect Alzheimer’s disease more accurately than the best cognitive tests currently used, research from the University of Cambridge suggests.

VR could even be used to help clinical trials of new drugs designed to tackle the disease, which affects more than 525,000 in the UK.

The research builds on the discovery of what amounts to the brain’s own satellite navigation system.

Professor John O’Keefe, of UCL, was jointly awards the Nobel Prize in Physiology or Medicine in 2014 for “discoveries of cells that constitute a positioning system in the brain”.

Key to this is a region of the brain called the entorhinal cortex, which is one of the first regions damaged in Alzheimer’s disease.

This could explain why one of the first symptoms of the disease is getting lost.

Dr Dennis Chan, who was Prof O’Keefe’s PhD student, led a team of scientists at the Department of Clinical Neurosciences at the University of Cambridge, working in collaboration with Prof Neil Burgess at UCL to develop and trial a VR navigation test in patients at risk of developing dementia.

Patients wearing VR headsets try the navigation tests while walking in a simulated environment - a task that requires the entorhinal cortex to be functioning properly.

Some 45 patients from Cambridge University Hospitals mild cognitive impairment (MCI) and memory clinic were recruited.

MCI can be an indication of early Alzheimer’s, but can also be caused by other conditions such as anxiety or normal ageing.

Establishing the cause of MCI is key in determining whether patients are at risk of developing dementia.

Cerebrospinal fluid (CSF) samples were taken from the patients to look for biomarkers of Alzheimer’s, with 12 testing positive.

All of the MCI patients performed worse than 41 age-matched healthy people who were recruited for control purposes.

The 12 with positive Alzheimer’s biomarkers performed worst of all.

The VR test was better at differentiating between all the existing tests currently considered the gold standard for the diagnosis of early Alzheimer’s.

Dr Chan said: “These results suggest a VR test of navigation may be better at identifying early Alzheimer’s disease than tests we use at present in clinic and in research studies.”

The first stage of drug trials currently involves testing in animals - usually mouse models of the disease. Scientists study their effect on mice given navigation tests such as a water maze, where they have to learn the location of hiddens platforms beneath the opaque surface of water.

If effective, the drugs are then trialled in humans, but using memory tests involving words and pictures.

The lack of comparable tests is, however, a problem for clinical trials.

Dr China said: “The brain cells underpinning navigation are similar in rodents and humans, so testing navigation may allow us to overcome this roadblock in Alzheimer’s drug trials and help translate basic science discoveries into clinical use.

“We’ve wanted to do this for years, but it’s only now that VR technology has evolved to the point that we can readily undertake this research in patients.”

Working with Prof Cecilia Mascolo at Cambridge’s Centre for Mobile, Wearable Systems and Augmented Intelligence, Dr Chan hopes to develop smartphone and smartwatch apps detecting and monitoring the progression of Alzheimer’s.

The apps would look for changes in navigation, and other everyday activities such as sleep and communication.

“We know that Alzheimer’s affects the brain long before symptoms become apparent. We’re getting to the point where everyday tech can be used to spot the warning signs of the disease well before we become aware of them,” said Dr Chan.

“We live in a world where mobile devices are almost ubiquitous, and so app-based approaches have the potential to diagnose Alzheimer’s disease at minimal extra cost and at a scale way beyond that of brain scanning and other current diagnostic approaches.”

The VR research was funded by the Medical Research Council and the Cambridge NIHR Biomedical Research Centre.

The app-based research is funded by the Wellcome, the European Research Council and the Alan Turing Institute.