I would imagine that most people reading this article have some experience of dementia either through knowing or having contact with a sufferer but, nevertheless, I think it is helpful to start off with a definition and some broad facts:
'Dementia is a multifaceted disorder that impairs cognitive functions such as memory, language, and executive functions necessary to plan, organize, and prioritize tasks required for goal-directed behaviours'.
[Linda Garcia, Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, EntourAGE Lab, Ottawa, Canada, Bruyère Research Institute, Ottawa, Canada]
Ninety percent of persons with dementia present with dementia of the Alzheimer’s type, vascular dementia, diffuse Lewy body dementia, or frontotemporal dementia.
[Sounder E, Chastain JR, & Williams RD (2002) Dementia in the New Millennium. MEDSURG Nursing. 11(2): 61-70]
The most common cause of dementia is Alzheimer’s disease, which leads to a physiological impairment in the functioning of neurons in the cerebral cortex, primarily in the hippocampus.
[Torpy JM, Lynm C, & Glass RM (2010) Dementia. Journal of the American Medical Association. 304(17): 1972]
The first stage of this type of dementia is marked by the individuals’ inability to retain new information reliably and their difficulty in using cueing to enhance the retention of information. Typically, in the second stage, communication, behavioural and personality changes become more pronounced affecting daily life. In the last stage of Alzheimer’s disease, most affected individuals lose their functional abilities to perform goal-oriented tasks which may include eating, grooming, and other self-care activities.
[Clark C (2000) Clinical manifestations and diagnostic evaluation of patients with Alzheimer's disease. In C. Clark and J.Q. Trojanowski (Eds.). Neurodegenerative dementias (pp. 95-111). New York: McGraw-Hill]
Regardless of the form, many persons with dementia spend less time than their age-matched peers engaging in daily social activities. They are more likely to experience confusion and difficulties recognizing familiar environments or people at some point in the progression of the disease.
Now let's start to consider how VR might assist given that we already know how immersive virtual environments allow researchers to create very realistic scenarios whilst maintaining a high level of experimental control. Flynn et al. incorporated a user-centred-approach and found that it is feasible to immerse persons with dementia in a virtual environment. The authors reported that persons with dementia felt a sense of control and enjoyed the interaction in virtual environments. There was also no significant deterioration in terms of simulator sickness and well-being.
[Flynn D, Schaik PV, Blackman T, FemCott C, Hobbs B, & Calderon C (2003. Developing a Virtual Reality-Based Methodology for People with Dementia: A Feasibility Study. Cyberpsychology & Behavior. 6(6): 591-611]
Immersive virtual environment technology gives researchers the opportunity to study how persons with dementia interact with their environment and which elements are most facilitating or create the least distress whilst capitalizing on residual cognitive resources. Virtual reality technologies offer the potential to capture the impact [fMRI scanning] of physical environments, as well as social interactions by deconstructing these environments. Further research into this area will help develop a better understanding of how persons with dementia can act to influence their environments and how changes in the environment can affect them. The objective may not be to learn a new skill but rather to understand how to better design physical spaces or modify social environments to enhance the quality of life of the sufferer.
We are not, therefore, looking at the acquisition of new skills as sufferers tend to experience rapid deteriorations in their brain mappings throughout the journey of dementia. Such progression, however, might be slowed down by medications and brain-stimulating activities based on the theory of neuroplasticity – the ability of brains and nervous systems to reconstruct new cellular synapses as a result of the interaction with enriched environments.
[Kempermann G, Gast D, & Gage FH (2002) Neuroplasticity in old age: Sustained fivefold induction of hippocampal neurogenesis by long-term environmental enrichment. Annals of Neurology. 52(2): 135-143]
[Clare L (2012) Cognitive rehabilitation and people with dementia. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/en/article/129/]
In addition, virtual reality would allow researchers to systematically study the various desired brain-stimulating activities as a function of the rate of neuroplasticity experienced in persons with different types of dementia. It is known that dementia of different types may experience deterioration in different regions of the brains; thus, it is very important to explore the possibility of conducting such ‘targeted’ brain-stimulating activities in light of deteriorating regions of the damaged brain.
Persons with dementia typically function in the here and now and immersive virtual environment technologies might prove to be useful in creating pleasant virtual worlds where they may find it easier to interact while maximizing residual cognitive processes. These worlds may offer much needed respite to both formal and informal caregivers while allowing pleasant, meaningful activities in the here and now for persons with dementia.
Anecdotally this seems to be the experience being promoted by The Wayback which is a VR project designed to trigger memories and emotions in people with dementia and help them re-engage with relatives and carers.
Users can view the film by downloading a free app onto their smartphone, which they then insert into an inexpensive virtual reality headset.
“It was born of frustration, really. I wished there’d been something around at that time that would have helped me and my family through a difficult period”
[Andy Garnett, co-creator who lost a family member who suffered from dementia]
The idea began to form after a drive around Camden, north London, by another one of the creators, Dan Cole, with his father who was then in the early stages of Alzheimer’s.
“It was his old stomping ground and he kept recognising places and telling me little tales; the pub his dad drank in, where he hung about with his mates, even an alley where he once got into a scrap”
“In that fleeting moment it was so clear in his mind. I could ask questions. He could tell me things.”
“It was the idea you could move forward by going back, maybe use those memories as a starting point for a shared experience.”
The film itself recreates a street party held to celebrate Queen Elizabeth’s coronation on June 2, 1953 and was made over two days in a north-London street with a volunteer cast, crew of 187 and painstakingly sourced period props, costumes and menu (even down to fish-paste sandwiches)
Married couple Ronald and Anne Graham-Clarke are watching the film together. “Oh, this is fun. I feel as if I’m at the party,” says Ronald, 89. Both he and Anne, 84, are chuckling. She taps her foot to the music. Afterwards, Anne tells Sarah Hoare, one of Langham Court’s directors, about watching the coronation at home in Scotland with her parents and sister. “My family bought a TV for the first time to watch it. It was my parents’ wedding anniversary too. It was a great party.”
Anne’s response, says Hoare, is a wonderful example of virtual reality’s potential. “She completely came out of herself because she was relaxed and enjoying herself. I have never actually seen her laugh before.”
Dan Cole agrees. “If the film can open some memories, start a conversation or bring a smile, that’s a success”.
“People living with dementia become more feeling beings than thinking beings… Feelings endure and are more to be trusted when facts diminish.” Facilitating a trip back in time “to their undamaged longer-term memories” can, he says, unlock the happy emotions that accompany them.
Having got to the end of this article I can well understand the reader questioning how this relates to the stated aim of the DWF's BIRG: is dementia really an issue which affects the UK insurer market? Possibly not… but I still thought it worthy of inclusion in this series of articles for a couple of reasons:
- the underlying theme is the innovative use of virtual reality technology in healthcare, the new and creative ways that researchers and clinicians are trying to use that technology and the way in which, in future, it may affect the treatment delivery mechanisms for everyone's benefit;
- given the research focus on neuroplasticity consider also whether there could be any additional benefits in terms of brain injury research and how 'more targeted' rehabilitation might assist in functional recovery.