Managing a dual-task during a virtual shopping in patients with early dementia

Neuropsychological assessment of executive functions with paper and pencil tests is particularly sensitive to the lack of ecological validity especially if the purpose of the clinician is not to get a merely theoretical measure, but to assess the deficit impact on patient’s life. The classical ecological measure provided by the direct observation of the patient in his daily life can be more informative even if this practice can be unsafe for patients and difficult to implement. In order to maintain an enactive cognition perspective on the study of cognitive functions, in which the role of interaction between the embodied behaviors and the affordances provided in the coupling with the environment have a fundamental role, we introduced an ecologically like situation by means of virtual reality. This paper presents a virtual reality test, set in the scene of a supermarket that can be a valid tool to assess executive functions in dementia. The results show that the test has convergent validity, compared to the Mini Mental State Evaluation and Tower of London tests and discriminant validity in identifying the degenerative disease, compared to healthy subjects matched for age, sex and education.