ABSTRACT
BACKGROUND: Detection of attentional disorders in complex situation related to daily life activities in multiple sclerosis patients needs better adapted tools than traditional cognitive assessment. OBJECTIVE: To investigate the usefulness of virtual reality assessment of attention in multiple sclerosis, especially to evaluate alertness and divided attention using driving simulation. METHODS: In this preliminary study, 11 relapsing-remitting patients (median EDSS: 2; mean disease duration of 10.3 years) and 11 healthy matched controls performed a driving simulation under three conditions (monotonous driving, divided attention driving and urban driving) where Standard Deviation of Lateral position (SDLP) was the main evaluated criteria. In comparison, traditional cognitive assessment of attentional functions was administered (SDMT, alertness and divided attention of TAP battery). Statistical non-parametric Mann-Whitney U tests were used to compare performances between groups in the two types of assessments. Exploratory correlational analyses were further conducted. RESULTS: No significant difference was observed between groups for traditional attentional assessment except for information processing speed (SDMT; pâ¯<â¯0.01). Considering virtual reality, patients were less efficient than controls on the primary parameter of safe driving (SDLP; pâ¯<â¯0.05). They also committed more errors and omissions (pâ¯<â¯0.01) and speed fluctuations (pâ¯<â¯0.01) during the divided-attention driving condition. Urban driving did not reveal difference between groups. Lack of significant correlations between traditional and virtual reality attentional assessment suggested that they do not evaluate the same cognitive processes. CONCLUSION: Patients experienced difficulties in maintaining the trajectory and the speed of the simulated vehicle which may be indicative of attentional difficulties, especially alertness and divided attention. These impairments were not revealed by the traditional cognitive assessment. Results of this preliminary study shed new light about the usefulness of virtual reality techniques and their future interest as a part of cognitive rehabilitation programs. They also highlights the need to develop driving preventive measures in MS.
Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/etiology , Automobile Driving , Multiple Sclerosis/complications , Adult , Case-Control Studies , Disability Evaluation , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Random Allocation , Reaction Time/physiology , Statistics, Nonparametric , Virtual RealityABSTRACT
INTRODUCTION: A large body of evidence indicates that sleep favors memory consolidation. STATE OF THE ART: This process would occur, mainly during slow-wave sleep, by means of a dialogue between the hippocampus and neocortical areas. Low levels of acetylcholine and cortisol are also needed to favor the transfer of memory traces toward the neocortex, where they will be stored for the long-term. PERSPECTIVES: The aim of this article is, first, to give an overview of studies conducted in young healthy subjects and underpinning the hypothesis that sleep is involved in memory consolidation. Then, we will investigate the potential links between changes in sleep architecture and episodic memory impairment in both aging and Alzheimer's disease. Finally, we will see how these results can affect clinical practice. CONCLUSION: Sleep-dependent memory consolidation is impaired both in aging and Alzheimer's disease. These findings suggest the importance of taking into account sleep when assessing memory function in patients.
