[Virtual reality as a tool for the prevention, diagnosis and treatment of cognitive impairment in the elderly: a systematic review]. / Realidad virtual como herramienta de prevención, diagnóstico y tratamiento del deterioro cognitivo en personas mayores: revisión sistemática.

INTRODUCTION: In recent decades, research into the effects of virtual reality on different neurological disorders has increased exponentially. Yet, the literature focused on the beneficial effects of virtual reality on cognitive impairment in elderly people is limited. AIM: To explore the application of virtual reality as a preventive, diagnostic or therapeutic tool for cognitive impairment in elderly people. PATIENTS AND METHODS: A literature search was conducted in the Medline and Web of Science databases, including all the literature published from their inception up until December 2019. RESULTS: Of the 270 publications found, 15 met the inclusion criteria: two examined the effect of virtual reality as a tool for the prevention of cognitive impairment, six looked at its possible applications in diagnosis, and seven explored its effectiveness as a form of treatment. CONCLUSIONS: There is evidence of the potential effect of virtual reality as a preventive strategy against the development of cognitive impairment in elderly people. There is also evidence of its applicability as a diagnostic tool for detecting the development of mild cognitive impairment or dementia, and of its effectiveness as a treatment, since it improves the cognitive functioning of elderly people with cognitive impairment. Further studies are needed that are more methodologically robust and have long follow-up times in order to examine the real impact of virtual reality and to be able to generalise its application in different areas of the management of cognitive impairment.

TITLE: Realidad virtual como herramienta de prevención, diagnóstico y tratamiento del deterioro cognitivo en personas mayores: revisión sistemática.Introducción. En las últimas décadas, se ha incrementado exponencialmente la investigación sobre los efectos de la realidad virtual en diferentes trastornos neurológicos. Sin embargo, la bibliografía centrada en los beneficios de la realidad virtual sobre el deterioro cognitivo en personas mayores es limitada. Objetivo. Explorar la aplicación de la realidad virtual como herramienta preventiva, diagnóstica o de tratamiento del deterioro cognitivo en personas mayores. Pacientes y métodos. Se llevó a cabo una búsqueda bibliográfica en las bases de datos Medline y Web of Science, incluyendo toda la bibliografía publicada desde sus inicios hasta diciembre de 2019. Resultados. De las 270 publicaciones encontradas, 15 cumplieron los criterios de inclusión: dos examinaron el efecto de la realidad virtual como herramienta de prevención del deterioro cognitivo; seis, su aplicabilidad diagnóstica; y siete, su efectividad como tratamiento. Conclusiones. Existe evidencia del potencial efecto de la realidad virtual como estrategia preventiva frente al desarrollo de deterioro cognitivo en personas mayores. Existe también evidencia de su aplicabilidad como herramienta diagnóstica de detección de desarrollo de deterioro cognitivo leve o demencia, y de su efectividad como tratamiento, ya que mejora el funcionamiento cognitivo de personas mayores con deterioro cognitivo. Son necesarios futuros estudios metodológicamente más robustos y con amplios tiempos de seguimiento para examinar el impacto real de la realidad virtual y poder generalizar su aplicación en los diferentes ámbitos de manejo del deterioro cognitivo.

Influence of cognitive impairment on the freezing of gait in non demented people with Parkinson's disease. / Influencia del deterioro cognitivo en la congelacion de la marcha en pacientes con enfermedad de Parkinson sin demencia.

INTRODUCTION: Freezing of gait (FOG) is a motor disturbance usually appearing in advanced Parkinson's disease (PD). Cognitive and executive function seems to play an important role in this phenomenon. AIM: To investigate if cognitive and kinematic parameters correlate with FOG in PD patients without dementia. PATIENTS AND METHODS: We conducted an observational cross-sectional study. Participants were classified in two groups: freezers and non-freezers. Clinical information was obtained by Hoehn and Yahr scale, Unified Parkinson's Disease Rating Scale and balance test of Short Physical Performance Battery. Cognitive function was evaluated using Minimental Examination and the Fuld Object Memory Evaluation; executive function was assessed with the Frontal Assessment Battery test. Battery kinematic parameters were assessed by means of gait speed, cadence, stride length and stride time. RESULTS: Twenty-five participants with PD without dementia completed the evaluation. Statistical significant differences between freezers and non-freezers were found in global cognition (p = 0,02), memory (p = 0,04), executive function (p = 0,04), cadence (p = 0,02), stride length (p = 0,04) and stride time (p = 0,01). CONCLUSION: Cognitive parameters may have an important contribution to the manifestation of freezing of gait in PD. These results may have important clinical implications for developing future non-pharmacological and cognitive interventions strategies targeted to PD patients with FOG.

TITLE: Influencia del deterioro cognitivo en la congelacion de la marcha en pacientes con enfermedad de Parkinson sin demencia.Introduccion. La congelacion de la marcha (CDM) es una alteracion motora que suele aparecer en estadios avanzados de la enfermedad de Parkinson (EP). Las funciones cognitivas y ejecutivas parecen tener un papel importante en la aparicion de este fenomeno. Objetivo. Investigar si los parametros cognitivos y cinematicos se correlacionan con la CDM en pacientes con EP sin demencia. Pacientes y metodos. Estudio observacional y transversal. Los participantes se clasificaron en dos grupos: con y sin CDM. La informacion clinica se obtuvo mediante la escala de Hoehn y Yahr, la Unified Parkinson's Disease Rating Scale y la prueba de equilibrio de la Short Physical Performance Battery. La funcion cognitiva se valoro con el miniexamen cognitivo y la Fuld Object Memory Evaluation, y la funcion ejecutiva, con la Frontal Assessment Battery. Los parametros cinematicos se valoraron mediante la velocidad de la marcha, la cadencia, la longitud del paso y el tiempo del paso. Resultados. Veinticinco participantes con EP sin demencia completaron el programa. Se encontraron diferencias estadisticamente significativas entre individuos con y sin CDM en cognicion global (p = 0,02), memoria (p = 0,04), funcion ejecutiva (p = 0,04), cadencia (p = 0,02), longitud del paso (p = 0,04) y tiempo del paso (p = 0,01). Conclusion. Diversos parametros cognitivos pueden contribuir de forma importante en la aparicion de la CDM en la EP. Estos resultados pueden tener implicaciones clinicas relevantes para el desarrollo de estrategias e intervenciones no farmacologicas y cognitivas dirigidas a pacientes con EP y con CDM.

Age-related occipito-temporal hypoactivation during visual search: relationships between mN2pc sources and performance.

Recently, an event-related potential (ERP) study (Lorenzo-López et al., 2008) provided evidence that normal aging significantly delays and attenuates the electrophysiological correlate of the allocation of visuospatial attention (N2pc component) during a feature-detection visual search task. To further explore the effects of normal aging on the N2pc neural sources, neuromagnetic activity during the execution of a visual search task was recorded in healthy young (N=14) and older (N=20) participants by using magnetoencephalography (MEG). The possible relationships between these neural sources and overt performance were explored by assessing the co-variation between the neural N2pc activity and both the task performance and the execution in the Trail Making Test Form A (TMT-A). Results revealed that young participants showed greater activity in occipito-temporal regions than older participants during the mN2pc (magnetic counterpart of the N2pc component) latency range (190-270ms). Moreover, older participants showed reduced relative activation in the right occipito-temporal source of mN2pc. These findings suggest that the previously observed age-related changes in N2pc parameters are associated with a significant hypoactivation of occipito-temporal N2pc sources that is more marked in the right hemisphere.

Visual target processing in high- and low-performing older subjects indexed by P3 component.

AIM: To explore the possible changes in the parameters of the P3 event-related potential (ERP) component among groups of young and older healthy subjects characterized as either high- or low-performers in a visual attention task. METHODS: Both conventional and single-trial analyses of the visual P3 component were performed on each group of subjects. RESULTS: P3 component significantly increased in latency as a function of age. The high-performing older subjects showed the posterior predominance of P3, as in young subjects. However, the low-performing older subjects showed a significant P3 amplitude reduction at posterior locations and topographically more widespread activity. Furthermore, single-trial analysis showed that low-performing older subjects presented higher intertrial variability in P3 latency, few trials with P3 generation, and a reduced P3 amplitude in these trials in whom P3 was generated. CONCLUSION: These data suggest a specific decline in visual target processing in the low-performing older subjects, which would imply a reduction in these attentional brain resources that are allocated to correctly select the relevant stimuli. The implications of this finding for the actual compensation versus dedifferentiation debate in normal aging are discussed.

Modulations of the visual N1 component of event-related potentials by central and peripheral cueing.

OBJECTIVE: The aim of this study is to investigate the effects of the central and peripheral cueing on N1 component of the event-related potentials (ERPs) and the time course of these effects. METHODS: ERPs were recorded while participants performed a discrimination task on the height of target bars, which were presented after informative-central, informative-peripheral or uninformative-peripheral cues with stimulus onset asynchronies (SOAs) of 100, 300, 500 or 700 ms. RESULTS: Peripheral cues (informative and uninformative) elicited stronger effects of cue validity on N1 300 ms after cue onset, whereas central cues led to a more sustained validity effect on N1, with later stronger effects, at 500 ms SOA. CONCLUSIONS: The present data showed that central and peripheral cues affected to the level of processing reflected by the N1 component, but there were differences in the time course of these effects. Attentional orienting in response to central cueing resulted in a sustained validity effect on N1, relative to the more transitory activation of the process reflected by the N1 validity effect in this peripheral cueing task. SIGNIFICANCE: This study provides a detailed within-subject analysis of the time course of the effects of central and peripheral cueing on N1.

The time course of the effects of central and peripheral cues on visual processing: an event-related potentials study.

OBJECTIVE: The varying results of visual event-related potential (ERP) studies of central and peripheral cueing suggest that these types of cue may modulate stimuli processing with different time courses. The aim of this study was to investigate differences in the time course of facilitatory effects on the visual processing induced by peripheral and central cues. METHODS: ERPs were recorded for visual target stimuli that were preceded by informative-central, informative-peripheral or uninformative-peripheral cues with stimulus onset asynchronies (SOAs) of 100, 300, 500 or 700 ms. RESULTS: Validly cued stimuli elicited an enhanced P1 component with peripheral cueing at 100 ms SOA. P1 amplitude in valid trials was reduced at 300, 500 and 700 ms SOAs with uninformative-peripheral cueing, but only at 500 ms SOA with informative-peripheral cueing. With informative-central cueing, there was no validity effect on P1. CONCLUSIONS: These results suggest that the automatic attraction of attention by a peripheral cue results in improved sensory processing at the cued location. This facilitation is replaced by an inhibitory effect when SOA increases, although cue informativeness may modulate this effect. Central cueing does not affect sensory processing at the P1 level.