Design and implementation of virtual reality-based cognitive training programmes for patients with mild cognitive impairment: Development study.

Background: Maintaining activities of daily living (ADLs) in patients with cognitive impairment slows the progression from mild cognitive impairment (MCI) to major neurocognitive disorders. Among the various cognitive functions, executive function is closely related to ADLs. Therefore, utilising ADLs to train executive function may help stall cognitive impairment progression. With the advancements in digital technology, we can employ virtual reality (VR) to repetitively train patients using ADLs. Objective: We present the design and concept of a VR-based ADL training programme tailored for patients with MCI. Methods: Our programme targeted patients with MCI aged 60-79 years. We developed simulations of ADLs that are typically difficult to practise repetitively, such as shopping, using public transportation, and driving, in a virtual environment. The activities were designed to include both target tasks and unexpected events, with difficulty levels adjusted according to user performance. Results: We designed and implemented VR-based supermarket, bus, and driving programmes. Each programme first presents the training objectives to the users. The users start the activity by pressing a button when they fully understand their goals and are ready to proceed. During these activities, unexpected events occur, such as characters asking questions in the supermarket or on the bus and abrupt stops during driving. The endpoint is delineated by the training objectives. The programme ends when the user reaches the designated endpoint in the VR environment. Conclusion: We developed a VR-based cognitive training programme to maintain ADLs and slow cognitive decline in patients with MCI.