1. Introduction
NDC, EG-DC, cognitive impairment, dementia, neurocognitive disorder
DEGENERATIVE, SHOP
Hospital San Raffaele, Cassino (FR), 03043 Cassino, Italy.Virtual reality has gained attention as an effective tool for cognitive, motor, and daily activity rehabilitation in patients with major neurocognitive disorder (M-NCD). The first objective of this study was to check for differences between M-NCD caused by degenerative and non-degenerative conditions (DC and NDC, respectively) in terms of relearning four functional living skills (FLSs), by means of a non-immersive virtual reality training (VRT). The second purpose was to verify whether spontaneous transfer from the virtual environment to the real environment occurred. Four FLS apps were developed in our institute (Information, Suitcase, Medicine, and Supermarket). A nonrandomized interventional study was carried out, comparing experimental and control groups (EG and CG, respectively). The study included three phases: in vivo test at T1; VRT at T2 only for EG; in vivo test at T3. During the in vivo test, the four FLSs were assessed in their natural environments. Both EG-DC and EG-NDC significantly improved in all of the VRT variable scores (the EG-NDC group seemed to show better outcomes than the EG-DC group). Moderate-to-high satisfaction with the VRT was reported. EG-DC and EG-NDC also enhanced their performances in the in vivo test. No statistically significant differences between them were found. CG-DC and CG-NDC improved only in the execution time of Information in the in vivo test. These findings confirm the ecological validity of VRT for FLSs.Major neurocognitive disorder (M-NCD) [VR has gained attention as an effective tool for cognitive, motor, and daily activity rehabilitation in patients with M-NCDs or in the prodromal conditions of dementia. It seems to produce positive effects in a short time, as well as to enhance brain neuroplasticity [VR consists of a three-dimensional (3D) computer simulation of a real environment. It allows users to feel “to be there” and to interact with and within the specific simulated place. Three types of immersive systems have been described: low-immersion, in which the patient interacts with the simulated environment through a PC monitor (touchscreen or keyboard and mouse), with or without additional sounds; semi-immersive, using more complex interactive devices (such as haptic gloves and balance platforms); and full-immersion, generally using head-mounted displays connected with any computer or video source, or the cave automatic virtual environment, which projects images on the wall, floor, or ceiling. The full-immersion systems also integrate sensory stimuli that make the simulated environment even more realistic [VR applications need to meet specific needs, especially those for motor and cognitive rehabilitation. They can be personalized according to the strengths and weaknesses of the patients. A recent review showed positive effects on memory, global cognition, and balance in people with mild cognitive impairment or dementia [Some authors have emphasized that the interventions for people with dementia should be guided by the effort to maintain FLSs for as long as possible [The objective of the present study was to compare the effectiveness of low-immersion VR training, focused on four FLSs (namely, to provide information, to take medicines, to prepare a suitcase, and to shop at the supermarket), in patients with M-NCDs with different etiologies, i.e., degenerative or non-degenerative conditions (DC and NDC, respectively). In a previous study [