Detecting dementia earlier through Cogniclear VR

You might have experienced it yourself: one of your loved ones struggles to remember things and even the names of close people. These may be the early signs of dementia, one of the world’s most widespread neurodegenerative diseases. 

In 2020, around 280,000 Dutch citizens were affected by dementia. According to the estimates reported in the National Dementia Strategy, this figure is set to increase to 420,000 by 2030 and surpass the half-million mark by 2040. Care costs would soar accordingly, from the €6.6 billion spent in 2015 to a €15.6 billion expenditure forecasted for 2040. The recently launched Virtuleap’s Cogniclear offers a more accurate way to spot these early signs using virtual reality (VR). 

Since 2019, the Lisbon-headquartered startup has been active at the intersection of VR and neuroscience, developing software to improve cognitive diagnostics and therapy. To this extent, Cogniclear offers an immersive and more reliable alternative to conventional cognitive impairment tests, which can miss some relevant cues to spot cognitive decline. “It works as a periodic checkup physicians can prescribe to assess a patient’s cognitive skills,” explains the CEO Amir Bozorgzadeh. 

Neurogenerative diseases can lead to difficulty remembering things, finding the right words, and performing daily tasks. The earlier such cognitive decline is spotted, the more can be done to help patients.

Spotting dementia with dedicated exercises

Like performing an intelligent quotient (IQ) test, the user is guided through a series of exercises. The Montreal Cognitive Assessment test (MoCA) is the reference test for mild cognitive impairment and the basis for Virtuleap’s cognitive analysis. The 14 exercises cover all cognitive categories assessed by the MoCA, such as problem-solving, attention, and cognitive flexibility. 

“One, for instance, is about acknowledging the difference in shapes and sizes, something a healthy individual would easily pass. That is the point of the whole test: if one has an aberration in one of the exercises, it is immediately recognized,” clarifies Bozorgzadeh.

As one performs the exercise, the software tracks how each exercise is done and collects motion data. Posture and hand motion are closely monitored, parallel to general physiological data such as pupil dilation and heart rate variability. “Every 3 minutes, Cogniclear collects over 200,000 data points,” adds Bozorgzadeh. 

A screenshot from one of the cognitive exercises - © Virtuleap

Assessing cognitive function

At the end of the test, the software elaborates on all the collected information. Its algorithms can recognize deficiencies. The doctor receives a detailed report on the individual’s condition. A general score and dedicated assessments are given for each ability. 

“One of the advantages Cogniclear brings is that it allows the patient to conduct the test alone, without the presence of an examiner,” claims Virtuleap’s co-founder. Examiners’ influence is a longly debated topic in the field. A long strand of research has been investigated for decades on how testers can impact the examinee, intentionally and non-intentionally. 

VR limitations for detecting dementia

Cogniclear was incubated in pharmaceutical company Roche's dementia program 'Building Together Tomorrow' in 2022 and tested in Lisbon’s Lusíadas hospital for over 2 years. Around 60 people could experience it. While the feedback was mostly positive, limitations exist in using VR for such sensitive applications. 

With the current version, users still need controllers to perform the cognitive check. “We are looking for ways to allow the test without the controllers. It would be even more valid and closer to the real experience,” says Bozorgzadeh. While headsets are becoming lighter and usable by most people for 20 minutes, many experience headaches even after a few minutes. Virtuleap’s CEO believes using headsets as compact as a pair of glasses would be ideal. 

Given how easily cybersickness can be caused, software development also has limitations. Bozorgzadeh: “Moving around a room, for example, would allow doing more exercises, but that can easily cause discomfort, and we can’t implement it.”

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The new standard for detecting cognitive decline 

Having a past in the videogame development industry, Bozorgzadeh started exploring VR and its capabilities around a decade ago. In his view,  healthcare and education are the two use cases where VR can add the most value. Virtuleap’s first product, Enhance, offers brain training exercises. 

In the coming months, five clinical studies will add to the two that have already proven Cogniclear’s validity. The VR cognitive scan will also soon be available in the Netherlands. In addition to helping spot dementia more promptly, the VR software can also help trace digital biomarkers, other valuable indicators of cognitive decline.