Skip to main content Accessibility help

Development and Feasibility of a Virtual Reality Task for the Cognitive Assessment of Older Adults: The ECO-VR

  • Camila R. Oliveira (a1), Brandel José P. Lopes Filho (a2), Michael A. Sugarman (a3), Cristiane S. Esteves (a2), Margarida Maria B. M. P. Lima (a4), Carmen Moret-Tatay (a5), Tatiana Q. Irigaray (a2) and Irani Iracema L. Argimon (a2)...


Cognitive assessment with virtual reality (VR) may have superior ecological validity for older adults compared to traditional pencil-and-paper cognitive assessment. However, few studies have reported the development of VR tasks. The aim of this study was to present the development, feasibility, content validity, and preliminary evidence of construct validity of an ecological task of cognitive assessment for older adults in VR (ECO-VR). The tasks were prepared based on theoretical and clinical backgrounds. We had 29 non-expert judges identify virtual visual stimuli and three-dimensional scenarios, and five expert judges assisted with content analysis and developing instructions. Finally, six older persons participated in three pilot studies and thirty older persons participated in the preliminary study to identify construct validity evidence. Data were analyzed by descriptive statistics and partial correlation. Target stimuli and three-dimensional scenarios were judged adequate and the content analysis demonstrated that ECO-VR evaluates temporo-spatial orientation, memory, language and executive functioning. We made significant changes to the instructions after the pilot studies to increase comprehensibility and reduce the completion time. The total score of ECO-VR was positively correlated mainly with performance in executive function (r = .172, p < .05) and memory tests (r = .488, p ≤ .01). The ECO-VR demonstrated feasibility for cognitive assessment in older adults, as well as content and construct validity evidences.


Corresponding author

*Correspondence concerning this article should be addressed to Camila R. Oliveira. Faculdade Meridional IMED/Pontifícia Universidade Católica do Rio Grande do Sul. Passo Fundo (Brazil). E-mail:


Hide All
Almeida, O. P., & Almeida, S. A. (1999). Confiabilidade da versão brasileira da Escala de Depressão em Geriatria (GDS) versão reduzida [Reliability of the Brazilian version of the Geriatric Depression Scale (GDS) short form]. Arquivos de Neuropsiquiatria, 57, 421426.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5 th Ed.). Washington, DC: American Psychiatric Association.
Brunner, I., Skouen, J. S., Hofstad, H., Strand, L. I., Becker, F., Sanders, A. M., … Verheyden, G. (2014). Virtual reality training for upper extremity in subacute stroke (VIRTUES): Study protocol for a randomized controlled multicenter trial. BMC Neurology, 14, 186.
Burgess, P. W., Veitch, E., de Lacy Costello, A., & Shallice, T. (2000). The cognitive and neuroanatomical correlates of multitasking. Neuropsychologia, 38, 848863.
Canty, A. L., Fleming, J., Patterson, F., Green, H. J., Man, D., & Shum, D. H. K. (2014). Evaluation of a virtual reality prospective memory task for use with individuals with severe traumatic brain injury. Neuropsychological Rehabilitation, 24, 238265.
Chaves, M. L. F., & Izquierdo, I. (1992). Differential diagnosis between dementia and depression: A study of efficiency increment. Acta Neurologica Scandinavica, 85, 378382.
Climent-Martínez, G., Luna-Lario, P., Bombín-González, I., Cifuentes-Rodríguez, A., Tirapu-Ustárroz, J., & Díaz-Orueta, U. (2014). Neuropsychological evaluation of the executive functions by means of virtual reality. Revista de Neurología, 58, 465475.
Cooper, H., Camic, P. M., Long, D. L., Panter, A. T., Rindskopf, D., & Sher, K. J. (2012). APA handbook of research methods in psychology, Vol. 1: Foundations, planning, measures, and psychometrics. Washington, DC: American Psychological Association.
Fagundes, A. J. F. M. (1995). Descrição, definição e registro do comportamento [Description, definition and behavior registry]. São Paulo, Brazil: Edicon.
Fajnerová, I., Rodriguez, M., Levčík, D., Konrádová, L., Mikoláš, P., Brom, C., … Horáček, J. (2014). A virtual reality task based on animal research - spatial learning and memory in patients after the first episode of schizophrenia. Frontiers in Behavioral Neuroscience, 8, 115.
Flynn, D., van Schaik, P., Blackman, T., Femcott, C., Hobbs, B., & Calderon, C. (2003). Developing a virtual reality-based methodology for people with dementia: A feasibility study. Cyberpsychology & Behavior, 6, 591611.
Freeman, D., Antley, A., Ehlers, A., Dunn, G., Thompson, C., Vorontsova, N., … Slater, M. (2014). The use of immersive virtual reality (VR) to predict the occurrence 6 months later of paranoid thinking and posttraumatic stress symptoms assessed by self-report and interviewer methods: A study of individuals who have been physically assaulted. Psychological Assessment, 26, 841847.
Grewe, P., Lahr, D., Kohsik, A., Dyck, E., Markowitsch, H. J., Bien, C. G., … Piefke, M. (2014). Real-life memory and spatial navigation in patients with focal epilepsy: Ecological validity of a virtual reality supermarket task. Epilepsy & Behavior, 31, 5766.
Jebara, N., Orriols, E., Zaoui, M., Berthoz, A., & Piolino, P. (2014). Effects of enactment in episodic memory: A pilot virtual reality study with young and elderly adults. Frontiers in Aging Neuroscience, 6, 338.
Jovanovski, D., Zakzanis, K., Ruttan, L., Campbell, Z., Erb, S., & Nussbaum, D. (2012). Ecologically valid assessment of executive dysfunction using a novel virtual reality task in patients with acquired brain injury. Applied Neuropsychology: Adult, 19, 207220.
Kochhann, R., Varela, J. S., Lisboa, C. S. M., & Chaves, M. L. F. (2010). The mini mental state examination review of cutoff points adjusted for schooling in a large Southern Brazilian sample. Dementia & Neuropsychologia, 4, 3541.
Kongs, S. K., Thompson, L. L., Iverson, G. L., & Heaton, R. K. (2000). Wisconsin Card Sorting Test - 64 card version: Professional manual. Odessa, TX: Psychological Assessment Resources.
Masur, J., & Monteiro, M. (1983). Validation of the “CAGE” alcoholism screening test in Brazilian psychiatry inpatient hospital setting. Brazilian Journal of Medical and Biological Research, 16, 215218.
Mendez, M. F., Joshi, A., & Jimenez, E. (2015). Virtual reality for the assessment of frontotemporal dementia, a feasibility study. Disability and Rehabilitation: Assistive Technology, 10, 160164.
Morganti, F. (2004). Virtual interaction in cognitive neuropsychology. In Riva, G., Botella, C., Légeron, P., & Optale, G. (Eds.), Cybertherapy: Internet and virtual reality as assessment and rehabilitation tools for clinical psychology and neuroscience (pp. 5570). Amsterdam, the Netherlands: Ios Press.
Plancher, G., Tirard, A., Gyselinck, V., Nicolas, S., & Piolino, P. (2012). Using virtual reality to characterize episodic memory profiles in amnestic mild cognitive impairment and Alzheimer’s disease: Influence of active and passive encoding. Neuropsychologia, 50, 592602.
Raspelli, S., Pallavicini, F., Carelli, L., Morganti, F., Poletti, B., Corra, B., … Riva, G. (2011). Validation of a neuro virtual reality-based version of the multiple errands test for the assessment of executive functions. Studies in Health Technology and Informatics, 167, 9297.
Rey, A. (1941). L’examen psychologique dans les cas d’encéphalopathie traumatique [The psychological examination in cases of traumatic encephalopathy]. Archives of Psychology, 28, 286340.
Riva, G., Gaggioli, A., Villani, D., Preziosa, A., Morganti, F., Corsi, R., … Vezzadini, L. (2007). NeuroVR: An open source virtual reality platform for clinical psychology and behavioral neurosciences. Studies in Health Technology and Informatics, 25, 394399.
Schultheis, M. T., Himelstein, J., & Rizzo, A. A. (2002). Virtual reality and neuropsychology: Upgrading the current tools. Journal of Head Trauma Rehabilitation, 17, 378394.
Tarnanas, I., Schlee, W., Tsolaki, M., Müri, R., Mosimann, U. P., & Nef, T. (2013). Ecological validity of virtual reality daily living activities screening for early dementia: Longitudinal study. JMIR Serious Games, 1, 114.
Tarnanas, I., Tsolaki, M., Nef, T., Müri, R., & Mosimann, U. P. (2014). Can a novel computerized cognitive screening test provide additional information for early detection of Alzheimer’s disease? Alzheimer’s & Dementia, 10, 790798.
Wechsler, D. (1997). WMS-III: Wechsler Memory Scale (3 rd Ed.). San Antonio, TX: The Psychological Corporation.
Weniger, G., Ruhleder, M., Lange, C., Wolf, S., & Irle, E. (2011). Egocentric and allocentric memory as assessed by virtual reality in individuals with amnestic mild cognitive impairment. Neuropsychologia, 49, 518527.
Wilson, B. A., Alderman, N., Burgess, P. W., Emslie, H., & Evans, J. J. (1996). Behavioral assessment of the dysexecutive syndrome. Bury St. Edmunds, UK: Thames Valley Test Company.
Zucchella, C., Sinforiani, E., Tassorelli, C., Cavallini, E., Tost-Pardell, D., Grau, S., … Nappi, G. (2014). Serious games for screening pre-dementia conditions: From virtuality to reality? A pilot project. Functional Neurology, 29, 153158.


Development and Feasibility of a Virtual Reality Task for the Cognitive Assessment of Older Adults: The ECO-VR

  • Camila R. Oliveira (a1), Brandel José P. Lopes Filho (a2), Michael A. Sugarman (a3), Cristiane S. Esteves (a2), Margarida Maria B. M. P. Lima (a4), Carmen Moret-Tatay (a5), Tatiana Q. Irigaray (a2) and Irani Iracema L. Argimon (a2)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed