Novel supports to the assessment of cognitive functions through the combined use of technologies and subjective and objective measurements

Resumen

Cognitive functions include all the processes through which an individual perceives, records, maintains, manipulates, uses and expresses information that are involved in any everyday activity. The main standardized tools can be divided in three main groups: short scales of cognitive tracking tests - questionnaires, general neuropsychological batteries, and specific tests. These tools are well-validated and reliable but, in the last decade, several research have shown that some patients can perform these neuropsychological tests well, even when they have significant difficulties in adapting their behaviours to daily life activities. According to this, more recently, a new approach has substantially increased, potentially providing a higher ecological validity in functional cognitive abilities assessment than standardized approach: the use of advanced technological systems for neuropsychological assessment (ATSNA). ATSNA refer to a set of devices and software applications such as computerized tests, fun and interactive fantasy serious games (SG), and/or simulated virtual (VR) and/or augmented (AR) reality systems that go beyond traditional assessment tests and that supply the possibility to deliver controlled and dynamic stimuli, in ecologically valid, and secure environments. Starting from these premises, the main objective of the thesis was to design, develop, and validate a non-immersive 2D SG versus an immersive 3D SG and a daily life activity in an immersive 3D VR environment versus an AR for the assessment of cognitive functions, comparing the efficacy and effectiveness of them. The first 2D study involved 354 healthy subjects and correlations were found between the game and traditional methods, suggesting that the game could be a valid tool for assessing cognitive functions in adults. The second study, compared 2D versus a 3D ATSNA version, it involved 94 healthy subjects and showed that 3D version was able to generate lower times and higher correct answers that the 2D, suggesting initial evidence of efficacy of a more immersive system compared to a non-immersive system. Although this result highlights a potential limitation on using different technological systems due to the differences on the two interaction methods (the 2D system applied mouse and keyboard; the 3D two virtual hands' controllers) and hardware and software latency data recording. Regarding individual variability on age, gender, and education, the findings showed consistency with the reference literature. Specifically, younger showed higher performance that older; higher educational levels reflected on a better score and about gender, results showed a more composite panorama. Furthermore, to enhance the ecological validity of assessment, the last study of this thesis compared the behavioural performance and physiological responses, during an ecological cooking task, between a virtual and an augmented system on 50 healthy subjects. The cooking task consisted of 4 levels that increased in difficulty. As the level increased, additional activities appeared. The behavioural results showed that times are always lower in VR than in AR, increasing constantly in accordance with the difficulty of the tasks. Regarding physiological responses, the findings showed that AR condition produced more individual excitement and activation than VR. To conclude, ATSNA are proving to be reliable and effective tools for the assessment of cognitive functions in adults, providing more ecological validity and objectivity than traditional methods of assessment.