The effectiveness of i-virtual reality and telemedicine based cognitive approach for rehabilitation of prospective memory in individuals with Parkinson's disease and mild cognitive impairment: A randomized controlled trial

Objective: The ability to perform intended actions after a delay or specific event reflects prospective memory (PM), a multiprocess involving episodic memory and attentional/executive functions. PM difficulties are common in Parkinson’s disease patients, especially those with Mild Cognitive Impairment (PD-MCI). This study explores the efficacy of attention/executive function training on PM in PD-MCI patients using a combined immersive Virtual Reality (iVR) and Telemedicine approach. Research Methods/Design: Thirty PD-MCI patients were assessed on PM and attention-executive measures and randomly assigned to two groups: training (TR-C) or active placebo (AP-C). Training involved real-life scenarios with planning, shifting, and updating exercises, of increasing difficulty, in an immersive virtual environment. The AP-C group performed similar daily tasks with lower cognitive demands. All tasks were conducted remotely via telemedicine using iVR headsets. Outcome measures were collected at baseline (T0), post-training (T1, 4 weeks), and follow-up (T2, 2 months). A randomized controlled trial (RCT) was executed with Experimental Condition (TR-C vs. AP-C) as between factor and Time of Assessment (T0 vs. T1 and T2) and Task (prospective score and ongoing task) as within factor. Results: A mixed ANOVA revealed that the training group improved on PM tasks versus placebo, with effects lasting at follow-up. However, no significant gains were observed in executive tasks, highlighting the greater multitasking demands of PM compared to selective executive tasks. Conclusion/Implications: The study demonstrates the efficacy of iVR and telemedicine in improving PM in PD-MCI patients, highlighting the potential of innovative cognitive interventions.