In a groundbreaking endeavor led by researchers Francisco Reis, Pedro Reisinho, and Rui Raposo from the University of Aveiro, an innovative approach is being employed to address the challenges posed by dementia. Their ongoing research explores the intersection of interactive narratives, virtual reality, and neuroscience, aiming to enhance the lives of individuals grappling with dementia. Leveraging cutting-edge technology, including the Muse 2 headband and Naxon Labs' Emotions platform, the team seeks to employ immersive experiences to stimulate oral communication competencies and assess the potential for improving psychological well-being among participants. This multidisciplinary initiative not only sheds light on the impact of reminiscence therapy but also pioneers the use of neurofeedback to guide interventions in real-time. The collaborative efforts of this research team underscore the transformative potential of merging technology and compassionate care in the realm of dementia studies.

 

By Franscisco Reis, Pedro Reisinho and Rui Raposo

 

The global population is witnessing a significant increase in the prevalence of individuals aged 65 and above, primarily attributable to the rising average life expectancy in recent decades. This demographic transition has brought to the forefront a growing incidence of age-related illnesses, with dementia being of particular concern (Fishman, 2017). Currently, approximately 57 million people are estimated to have their daily lives impacted by dementia, and projections indicate that this number will triple by 2050 (Nichols et al., 2022), considering that nearly ten million new cases are diagnosed each year, with Alzheimer’s disease representing 60-70% of these diagnoses (World Health Organization, 2017). As the number of dementia cases continues to increase, there are worrisome repercussions stemming from the recent pandemic.

The constraints imposed by the COVID-19 containment measures were imperative for reducing the number of viral cases and controlling the pandemic, in addition to the undeniable importance of lowering the mortality rate among risk groups. Nevertheless, in these risk groups, particularly in elderly people with dementia, short-term side effects from social isolation, such as increased levels of agitation and apathy, have been observed (Emmerton & Abdelhafiz, 2021; Manca et al., 2020).

In addition, internet reliance has become a transversal aspect of various processes in our daily lives. Varying according to the extent of affectation, the inability to use web-based digital platforms to perform something as crucial as communicating with others has pushed people living with dementia into a more fragile situation than the one they face daily (Manca et al., 2020), exacerbating their sense of loneliness (Emmerton & Abdelhafiz, 2021) due abrupt and harsh changes in their social activities with family and friends. Thus, in this scenario, not only does it become impossible to estimate, in the medium and long term, the neurological impact that COVID-19 will have on people currently living with the condition (Ghaffari et al., 2021), but also how it will influence the number of new cases diagnosed.

Faced with the inexistence of a pharmacological solution for reversing the gradual evolution of the symptoms associated with the condition, research has also looked upon non-pharmacological methods (Algar et al., 2016), as possible method for mitigating and delaying the progressive loss of quality of life of those affected.

 

This is the context in which doctoral student and researcher Pedro Reisinho, under the supervision of Professor Rui Raposo and Professor Nelson Zagalo from the Department of Communication and Art, and Professor Oscar Ribeiro from the Department of Education and Psychology, all from the University of Aveiro, has been developing his thesis. Pedro’s PhD research in Information and Communication in Digital Platforms, funded by the National Foundation for Science and Technology, focuses precisely on the potential of merging interactive narratives and virtual reality as reminiscence instrumentsfor people with dementia.

By engaging users with memory-related content during reminiscence therapy sessions, the project aims not only to stimulate oral communication competencies but also to assess the potential for improving their psychological well-being, as well as attenuating and delaying behavioural and psychological symptoms associated with dementia.

The virtual reminiscence model proposed consists of a structured program comprising a minimum of ten sessions that resort to reminiscence tools and techniques which integrate and explore immersive personal experiences. Eight sessions are dedicated to enabling each participant to explore virtual story worlds tailored to their life story and collect "memories" by taking photographs with a virtual camera. Participants are encouraged to share stories about what is happening or whatever they feel like sharing.

During the last two sessions, the participants are asked to share with the research team the stories associated with the memories collected in photographs throughout the previous sessions.

After completing the program, participants will have the possibility to keep the collected memories, meanwhile printed out, and share them with family and friends.

To aid the data collection, the research conducted will also collect data from a portable electroencephalography device, the Muse 2, with the aid of Naxon Labs' Emotions platform. The emotional monitoring of the participants’ emotional states will enable the research team to access real-time information regarding the participants’ experience and their responses to various stimuli presented throughout the sessions. This will allow the team to intervene and try to mitigate potential adverse effects resulting from the re-experience of memories associated with negative emotions.

 

Some exploratory studies have already been conducted in this context through the work done by Francisco Reis, a student from the Master Program in Multimedia Communication at the University of Aveiro. Francisco’s work focused on studying the effect that immersive experiences with 360º audiovisual content had on users and their oral communication activities during the experience.

Participants in the study were provided with two short 360º clips without previously knowing what they were going to see. The first video had little or no relation with the participants’ personal memories, while the second video included footage of a place well known by the participants and chosen with the help of the participants’ family or friends. When presented with the first video, the participants only talked when they were asked questions about what they were seeing. On the other hand, when presented with footage of a well-known place from their past, the second video, the participants would spontaneously start to talk and share stories about memories connected with it.

 

Exploratory sessions at University of Aveiro. The participant is using the Muse 2 headband and a Virtual Reality set. The Muse 2 headband is connected to Naxon Emotions platform which displays the data in the laptop.

 

Naxon Emotions applications as displayed during the sessions.

 

The virtual reality environment showed to the participants during the sessions.

 

While all of this was happening, the Muse 2 headband and the Emotions software were providing a glimpse as to what the participant was feeling at the time. It was very interesting to see that while reminiscing about the place and the stories that took place there, the participants would experience peaks of joy that, sometimes, would shift into a state of momentary sadness. The results attained were considered a great proof of concept as to the possibilities presented by this sort of experience as a therapeutic tool worth further exploring in the context of people with dementia. It is relevant to outline that the participants in Francisco Reis’ study did not have dementia.

The study did, however, provide evidence that this sort of immersive experience could and should be considered as a possible complementary activity for people with dementia as a means of stimulating their oral communication competencies and, consequently, possibly contributing to the delay of the deterioration of those same competencies.

 

In the next phase of our research, our plan involves conducting the initial validation of the virtual reminiscence model, specifically focusing on the data collection protocol and the prototype. A comprehensive set of questionnaires and scales has been thoughtfully selected to measure the proposed indicators, including oral communication, psychological well-being, and neuropsychiatric symptoms. These assessments are being conducted by Juliana Silva, a master's student in neuropsychiatry, under the supervision of Professor Oscar Ribeiro. To enhance the depth of this data collection, we will cross-reference the indicators with audiovisual information and data stemming from Muse 2, in conjunction with the Emotions Platform.

The participants for our study are being selected with the assistance of the Laboratório de Envelhecimento de Ílhavo. This collaborative effort has been instrumental in facilitating participant engagement and providing the necessary facilities for conducting tests. Thanks to our close collaboration with the Laboratório de Envelhecimento, we were able to conduct tests to assess the technology adoption and potential side effects of virtual reality, having obtained promising results that will be made publicly available shortly.

 

This ongoing research is being conducted at the University of Aveiro in Portugal, a European Higher Education Institution recognized for its prestige in research and teaching, both at a national and international level in multiple scientific fields. Most of the research team are currently members of DigiMedia, the Digital Media and Interaction Research Centre located at the Department of Communication and Art (DeCA). DigiMedia is an interdisciplinary unit oriented towards innovation in the research of new interaction solutions for human-centred digital media applications, with a highly transdisciplinary approach to Digital Media that combines research done in the fields of e-Health and Wellbeing, Social iTV, Social Media and Learning, Games and Storytelling, and Cyberculture, the ongoing research is constantly challenging current practices and promotes future thinking approaches in its projects.

For more information on the activities of DigiMedia please visit the website at https://digimedia.web.ua.pt/.

 

References

Algar, K., Woods, R. T., & Windle, G. (2016). Measuring the quality of life and well-being of people with dementia: A review of observational measures. Dementia, 15(4), 832–857. https://doi.org/10.1177/1471301214540163

Emmerton, D., & Abdelhafiz, A. H. (2021). Care for Older People with Dementia During COVID19 Pandemic. SN Comprehensive Clinical Medicine, 3(2), 437–443. https://doi.org/10.1007/s42399-020-00715-0

Fishman, E. (2017). Risk of Developing Dementia at Older Ages in the United States. Demography, 54(5), 1897–1919. https://doi.org/10.1007/S13524-017-0598-7

Ghaffari, M., Ansari, H., Beladimoghadam, N., Aghamiri, S. H., Haghighi, M., Nabavi, M., Mansouri, B., Mehrpour, M., Assarzadegan, F., Hesami, O., Sedaghat, M., Farahbakhsh, M., & Lima, B. S. (2021).

Neurological features and outcome in COVID-19: dementia can predict severe disease. Journal of NeuroVirology, 27, 86–93. https://doi.org/0.1007/s13365-020-00918-0

Manca, R., De Marco, M., & Venneri, A. (2020). The Impact of COVID-19 Infection and Enforced Prolonged Social Isolation on Neuropsychiatric Symptoms in Older Adults With and Without Dementia: A Review. Frontiers in Psychiatry, 11, 585540. https://doi.org/10.3389/fpsyt.2020.585540

Nichols, E., Steinmetz, J. D., Vollset, S. E., Fukutaki, K., Chalek, J., Abd-Allah, F., Abdoli, A., Abualhasan, A., Abu-Gharbieh, E., Akram, T. T., Hamad, H. Al, Alahdab, F., Alanezi, F. M., Alipour, V., Almustanyir, S., Amu, H., Ansari, I., Arabloo, J., Ashraf, T., … Vos, T. (2022). Estimation of the Global Prevalence of Dementia in 2019 and Forecasted Prevalence in 2050: An Analysis for the Global Burden of Disease Study 2019. The Lancet Public Health, 7, e105–e125. https://doi.org/10.1016/S2468-2667(21)00249-8

World Health Organization. (2017). Global Action Plan on the Public Health Response to Dementia 2017–2025. Geneva: World Health Organization.