Effectiveness of TeleVR App in Cognitive Decline and MCI Patients

This clinical trial aims to assess the effectiveness of a telerehabilitation program combined with a virtual reality (VR) app in enhancing cognitive performance and social skills in individuals with Subjective Cognitive Decline (SCD) and Mild Cognitive Impairment (MCI).

Study Rationale SCD and MCI are considered critical stages in identifying individuals at risk for dementia. Both conditions are associated with cognitive and social impairments, as well as neurophysiological changes observable through advanced neuroimaging and EEG markers. While traditional cognitive rehabilitation has shown benefits, emerging evidence suggests that telerehabilitation combined with VR may offer enhanced outcomes through its interactive, engaging, and scalable nature.

Primary Objective Evaluate the potential efficacy of a telerehabilitation plus VR intervention in improving cognitive performance and social cognition skills in patients with SCD and MCI.

Secondary Objectives Assess neurophysiological changes (EEG and MRI biomarkers) following the intervention.

Evaluate gait patterns and eye movement parameters. Investigate the usability and patient compliance of the VR app-based intervention.

Study Design Type: Randomized Clinical Trial (RCT) Duration: 6 weeks intervention, with follow-up assessments at baseline (T0), post-intervention (T1), and 3 months after intervention (T2).

Population: Individuals aged 40-80 with SCD or MCI (AD and PD subtypes).

Intervention Groups:

Experimental Group (EG): Participants will use two non-immersive VR apps ("NeuroNation" and "The Sims Mobile") on smartphones/tablets for cognitive and socio-emotional skill training. Training will occur 3 times per week, 30 minutes per session, guided remotely by therapists.

Active Control Group (aCG): Participants will follow a traditional cognitive rehabilitation program using paper-based exercises targeting cognitive domains.

Assessment Tools:

Neuropsychological Assessment: MMSE, MoCA, FAB, Stroop Test, RAVLT, Trail Making Test (TMT-A/B), and more.

Neurophysiological Assessment: EEG and MRI scans for brain activity and structural analysis.

Gait Analysis: Timed Up and Go (TUG) Test with BTS G-WALK®. Eye Movement Analysis: Using an eye-tracking system for fixation, saccades, antisaccades, and smooth pursuit eye movements.

Usability Assessment: System Usability Scale (SUS).

Expected Outcomes:

Improved cognitive and social cognition performance in the experimental group compared to the control group.

Observable changes in EEG and MRI biomarkers correlating with cognitive improvements.

Enhanced usability and acceptance of VR-based telerehabilitation tools among participants.

Significance of the Study:

This trial seeks to bridge the gap between traditional cognitive rehabilitation and innovative, scalable, and cost-effective digital health interventions. Positive outcomes could establish telerehabilitation with VR as a standard intervention for cognitive and social rehabilitation in at-risk populations.

The study adheres to ethical principles outlined in the Declaration of Helsinki, and informed consent will be obtained from all participants before enrollment

Inclusion criteria

• Subjects diagnosed with MCI (AD and PD) according to the criteria of the National Institute on Aging-Alzheimer's Association (NIA-AA, Albert et al., 2011)
• Subjects diagnosed with SCD according to diagnostic criteria proposed in research settings (Molinuevo et al., 2017)
• All enrolled subjects must be aged between 40 and 80 years and have at least 5 years of education

Exclusion criteria

• Presence of psychiatric disorders (major depression, psychosis, anxiety disorders)
• Presence of severe dementia
• History of cerebral ischemia
• Contraindications to brain MRI: pregnant women, pacemakers, non-latest-generation metal joint prostheses, electrodes, neurostimulators, or prostheses that may interfere with magnetic fields, unless there is a written statement of suitability from the specialist who performed the intervention