Virtual Reality in Palliative Care: A Systematic Review

Background: Virtual reality (VR) using head-mounted displays (HMDs) has demonstrated to be an effective tool for treating various somatic and psychological symptoms. Technological advances and increased affordability of VR technology provide an interesting option for delivering psychological interventions to patients in palliative care. The primary aim of this systematic review was to synthesise the available research on the use of VR for enhancing psychological and somatic outcomes for palliative care patients. Secondary aims included assessing general satisfaction and overall usability. Method: A pre-registered systematic literature search was conducted according to PRISMA guidelines using OVID Emcare, Cochrane Library, Embase, Medline, PsycINFO, and PubMed Care Search: Palliative Care Knowledge Network. Peer-reviewed experimental, quasiexperimental, observational, case, and feasibility studies consisting of single or multiple VR sessions using HMDs that reported psychological and/or somatic outcomes were included. Results: Eight studies published between 2019 and 2021 were included, representing 138 patients. While the reported quantitative psychological and somatic outcomes were ambiguous, the qualitative outcomes were largely positive. Participants were generally satisfied with VR, and most studies reported the VR interventions as usable, feasible, and acceptable. Conclusions: VR shows promise in palliative care and generally addresses a range of symptoms with few adverse effects. Future research should consist of adequately powered RCTs evaluating dosage and focusing on providing meaningful activities to enhance outcomes further.Jessica L. Martin, Dimitrios Saredakis, Amanda D. Hutchinson, Gregory B. Crawford, and Tobias Loetsche

Conversion to MCI and dementia in Parkinson's disease: a systematic review and meta-analysis

Objective: To systematically review and meta-analyse conversion rates from normal cognition to Mild Cognitive Impairment (MCI) and dementia in Parkinson's disease (PD) patients. Reversion rates in patients with MCI (i.e. PD-MCI) were also investigated. Methods: Electronic searches of PsycINFO, Medline and EBSCOhost were conducted in January 2018, with 1833 articles identified after duplicate removal. Articles were included if they assessed conversion/reversion in PD patients between normal cognition, PD-MCI and PD dementia (PD-D). Results: In total, 39 articles met the inclusion criteria, representing 4011 patients (mean age range 58-75; 61% male). Within three years, in those with PD and normal cognition, 25% (95%CI 20-30%) converted to PD-MCI and 2% (95%CI 1-7%) converted to dementia. Of those with PD-MCI, 20% (95%CI 13-30%) converted to dementia while 28% (95%CI 20-37%) reverted back to a state of normal cognitive function. The conversion rates to MCI and dementia were higher, and reversion rates lower, when follow-up was ≥3 years. When International Parkinson and Movement Disorder Society (MDS) criteria were used to diagnose MCI, Level I criteria were associated with a greater reversion estimate from PD-MCI to normal cognitive function. Conclusions: These findings summarise the trajectory of cognitive impairment in PD and highlight that MCI is common in this patient group. Understanding cognitive trajectories in PD patients is important for patient care in terms of prognosis, as well as for identifying windows for intervention for cognitive symptoms. As the number of PD patients increases with an ageing population, this information can inform future policy and planning.Dimitrios Saredakis, Lyndsey E. Collins-Praino, Daria S. Gutteridge, Blossom C.M. Stephan, Hannah A.D. Keag

Virtual reality intervention to improve apathy in residential aged care: protocol for a multisite non-randomised controlled trial

Introduction Apathy is a prevalent neuropsychiatric symptom for older adults residing in aged care. Left untreated, apathy has been associated with accelerated cognitive decline and increased risk of mortality. Reminiscence therapy is commonly used in aged care and has demonstrated to reduce apathy. Traditional methods of reminiscence use physical objects and more recently technology including tablets and laptop computers have demonstrated potential. Virtual reality (VR) has successfully been used to treat psychological disorders; however, there is little evidence on using VR for behavioural symptoms such as apathy in older adults. Using VR to deliver reminiscence therapy provides an immersive experience, and readily available applications provide access to a large range of content allowing easier delivery of therapy over traditional forms of therapy. This study aims to identify changes in apathy after a reminiscence therapy intervention using head-mounted displays (HMDs).Methods and analysis Participants will be allocated to one of three groups; reminiscence therapy using VR; an active control using a laptop computer or physical items and a passive control. A total of 45 participants will be recruited from residential aged care (15 in each group). The three groups will be compared at baseline and follow-up. The primary outcome is apathy, and secondary outcomes include cognition and depression. Side effects from using HMDs will also be examined in the VR group. Primary and secondary outcomes at baseline and follow-up will be analysed using linear mixed modelling.Ethics and dissemination Ethics approval was obtained from the University of South Australia Human Research Ethics Committee. The results from this study will be disseminated through manuscript publications and national/international conferences.Trial registration number ACTRN12619001510134

Cerebrovascular function during cognition in Parkinson's disease: a functional transcranial Doppler sonography study

Objective: Recent evidence has linked cerebrovascular abnormalities with Parkinson's Disease (PD), which may provide a new neurophysiological understanding of cognitive impairment in PD. The current study aimed to compare cerebrovascular functioning, during a cognitive task and at rest, in those with and without PD. Methods: Idiopathic PD patients (n = 30) and age- and gender-matched healthy controls (n = 30) undertook cognitive testing and completed a word generation task while blood flow velocity was monitored bilaterally with functional transcranial Doppler sonography (fTCD) of the middle cerebral arteries. The lateralisation index and its standard deviation and timing, along with the maximum peak velocity for the left and right hemispheres and their latencies and standard deviations, were calculated for each participant. Results: The PD patients showed significantly more variability of the lateralisation index compared to the control group; but there were no differences in the lateralisation index itself nor in the peak velocities. In the PD group, the variability in the peak velocities showed significant positive correlations with performance on executive function tests. Conclusion: Normal ageing has been associated with a reduction in the lateralisation index, but no alterations in the standard deviation, suggesting that cerebrovascular functional changes associated with PD differ from those of typical ageing. The within-subject variability observed in the PD group indicate abnormalities within the neurovascular coupling response. Further, the association between the within-subject variability and executive functioning in the PD group, suggests that cerebrovascular dysfunction plays an important role in cognitive impairment in PD.Daria S.Gutteridge, Dimitrios Saredakis, Nicholas A.Badcock, Lyndsey E.Collins-Praino, Hannah A.D.Keag