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Older adults with subjective cognitive decline (SCD) are at high risk of developing dementia and frequently experience subclinical symptoms (e.g., anxiety, depression) which are themselves associated with dementia and cognitive decline risk. To date, the lack of effective disease-modifying treatments, along with the reliable identification of modifiable lifestyle risk factors (e.g., cognitive activity, dietary habits, physical exercise), have led to growing interest to invest in non-pharmacological interventions that may reduce the prevalence and incidence of dementia and cognitive decline in older adults. In this framework, the aim of this project is to evaluate the efficacy of an Immersive Virtual Reality (IVR) and telemedicine-based multi-component intervention, combining cognitive training and a health and lifestyle education program, for preventing cognitive decline and dementia in at-risk individuals (i.e., SCD). For this purpose, a randomized, double-blinded controlled trial (RCT) will be conducted on seventy-five eligible individuals with SCD, who will be randomly assigned to one of three conditions: (a) multi-component intervention (MC-I), including SCD-tailored cognitive IVR training plus a health and lifestyle education program, (b) cognitive-only intervention (CO-I), including the SCD-tailored cognitive IVR training plus an active control for the education program, and (c) active control intervention (AC-I) for both cognitive training and education program. Intervention will be provided in 20 at-home sessions (4 sessions/week, each lasting about 30 minutes) over a period of 5 weeks. Outcome measures include clinical, neuropsychological, behavioural and neuroimaging data that will be collected before and immediately after intervention in order to detect potentially intervention-induced changes in objective cognitive functioning (primary outcome), subjective cognitive functioning, mood, quality of life and brain connectivity (secondary outcome). Users' compliance with IVR and telemedicine approach will be also evaluated, as well as individuals' factors affecting training efficacy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Multi-component Intervention (MC-I) | Experimental | VR cognitive training + Psychoeducation program |
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| Cognitive-only intervention (CO-I) | Active Comparator | VR Cognitive training + Psychoeducation active control |
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| Active control intervention (AC-I) | Active Comparator | VR Cognitive active control + Psychoeducation active control |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Multi-component Intervention (MC-I): VR Cognitive training and Psychoeducation on health and lifestyle | Device | In a period of 5 consecutive weeks, participants will receive:
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| Measure | Description | Time Frame |
|---|---|---|
| Cognitive functioning (1): change scores on the Face-Name Associative Memory Exam | The Face-Name Associative Memory Exam (short form - FNAME12) is an associative long-term memory task that requires the participant to learn and retrieve 12 novel face-name and face-occupation pairs. It consists of two learning phases, followed by an immediate cued recall and a 30-min delayed recall and recognition trial. For each trial, scores range from 0 to 12, where higher scores indicate better memory performance. | Baseline, post-intervention (around 6 weeks after baseline) |
| Cognitive functioning (2): change scores on the Visual Short-Term Memory Binding Test | The Visual Short-Term Memory Binding Test is a recognition task based on a change detection paradigm for arrays of stimuli presented on a computer screen. Two conditions are investigated, that is, a shape-only condition as the first and a shape-color condition as the second. In both conditions, participants are asked to remember visual arrays of two or three black polygons (in the shape-only condition) or colored polygons (in the shape-color condition) presented for 2 s (study phase). For each condition, scores range from 0 to 32, where higher scores indicate better memory performance. | Baseline, post-intervention (around 6 weeks after baseline) |
| Cognitive functioning (3): change scores on the Spatial pattern separation test | The Spatial pattern separation test assesses the ability to differentiate partially overlapping patterns of activation in order to retrieve one pattern as separate from others that are similar. Specifically, it consists of 36 trials, in which the participant is required to learn the location of a grey circle on a sceen; then the participant is required to recognize the position of the previously-learned grey circle with respect to a foil located either to the left or the right of the target. Scores range from 0 to 36, where higher scores indicate better memory performance. | Baseline, post-intervention (around 6 weeks after baseline) |
| Measure | Description | Time Frame |
|---|---|---|
| Transfer effect on self-perceived cognitive functioning: change scores on the Subjective Memory Complaints Questionnaire | The Subjective Memory Complaints Questionnaire assesses the subjective experience of memory decline. It consists of two sections. Part I provides a global evaluation of memory concerns responses to four general questions (4 items); Part II provides an evaluation of memory concerns in daily life (27 items). For each of the 31 items, participants are asked to respond on a 4-point Likert scale (1 = No, it does not happen to me; 2 = Sometimes, but it does not worry me; 3 = Yes and it worries me; 4 = Yes and it constitutes a problemin at least one area ofmy life, e.g., work, family, leisure, relationships). Scores range from 31 to 124. Higher scores are indicative of more serious memory complaints. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Maria Stefania De Simone, Dr | Contact | (+39) 06-51501189 | ms.desimone@hsantalucia.it |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| I.R.C.C.S Santa Lucia Foundation | Recruiting | Rome | Lazio | 00179 | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40718565 | Derived | De Simone MS, Zabberoni S, Costa A, Tenaglia E, Tieri G. The effects of an immersive virtual reality and telemedicine-based multi-component intervention in individuals with subjective cognitive decline: study protocol of a randomized controlled trial. Front Psychol. 2025 Jul 11;16:1591239. doi: 10.3389/fpsyg.2025.1591239. eCollection 2025. |
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| Cognitive-only intervention (CO-I): VR Cognitive training (+ Psychoeducation active control) | Device | In a period of 5 consecutive weeks, participants will receive:
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| Active control intervention (AC-I): VR Cognitive active control + Psychoeducation active control | Device | In a period of 5 consecutive weeks, participants will receive:
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| Baseline, post-intervention (around 6 weeks after baseline) |
| Intervention-induced changes in whole-brain functional connectivity | Connectomics changes after intervention will be investigated between pairs of regions of the whole brain (with particular interest in areas mainly involved in training-related cognitive processes) and in the global and local topological properties of large-scale networks through graph theoretical approach. | Baseline, post-intervention (around 6 weeks after baseline) |
| Transfer effect on mood (1): change scores on the 30-item Geriatric Depression Scale | It is a brief self-report questionnaire in which participants are asked to respond to the 30 questions by answering yes or no in reference to how they felt on the day of administration. Scores range from 0 to 30, where higher scores indicate higher depression. | Baseline, post-intervention (around 6 weeks after baseline) |
| Transfer effect on mood (2): change scores on the State-Trait Anxiety Inventory | It is a brief self-report questionnaire to measure the presence and severity of current symptoms of anxiety and a generalized propensity to be anxious. There are two subscales within this measure: the State Anxiety Scale (S-Anxiety), which evaluates the current state of anxiety, and the Trait Anxiety Scale (T-Anxiety), which evaluates relatively stable aspects of "anxiety proneness". Range of scores for each subtest is 20-80, with higher scores indicating greater anxiety. | Baseline, post-intervention (around 6 weeks after baseline) |
| Transfer effect on mood (3): change scores on the 18-item Apathy Evaluation Scale (AES) | The Apathy Evaluation Scale is a four-point Likert-Scale measure, composed of 18 items that assess and quantify emotional, behavioural and cognitive aspects of apathy. Every item is rated on a four-point response scale (0 = not at all true/characteristic to 3 = very much true/characteristic). Higher scores indicate more severe apathy. | Baseline, post-intervention (around 6 weeks after baseline) |
| Transfer effect on quality of life and health status: Change scores on the Short Form-36 Health Survey | The 36-Item Health Survey taps eight health concepts, including physical functioning, emotional well-being, social functioning, energy/fatigue, and general health perceptions. It also includes a single item that provides an indication of perceived change in health. Scores range from 0 to 100, where higher scores define a more favorable health state. | Baseline, post-intervention (around 6 weeks after baseline) |