Vestibular cognition assessment system: Tablet-based computerized visuospatial abilities test battery

Abstract

IntroductionThe vestibular system is anatomically connected to extensive regions of the cerebral cortex, hippocampus, and amygdala. However, studies focusing on the impact of vestibular impairment on visuospatial cognition ability are limited. This study aimed to develop a mobile tablet-based vestibular cognitive assessment system (VCAS), enhance the dynamic and three-dimensional (3D) nature of the test conditions, and comprehensively evaluate the visuospatial cognitive ability of patients with vestibular dysfunction.Materials and methodsFirst, the VCAS assessment dimensions (spatial memory, spatial navigation, and mental rotation) and test content (weeding, maze, card rotation, and 3D driving tests) were determined based on expert interviews. Second, VCAS was developed based on Unity3D, using the C# language and ILruntime hot update framework development technology, combined with the A* algorithm, prime tree algorithm, and dynamic route rendering. Further, the online test was built using relevant game business logic. Finally, healthy controls (HC) and 78 patients with vertigo (VP) were recruited for the VCAS test. The validity of VCAS was verified using the test results of random controls.ResultsIn the weeding test, the HC group had a significantly longer span and faster velocity backward than did the VP group. In the 12 × 12 maze, statistically significant differences in step and time were observed between the two groups, with VP taking longer time and more steps. In the mental rotation task, no significant difference was observed between the two groups. Similarly, no significant difference was found in the performance of the two groups on maps 2, 3, and 4 in the 3D driving task.DiscussionThus, impaired visuospatial cognition in patients with vestibular dysfunction is primarily related to spatial memory and navigation. VCAS is a clinically applicable visuospatial cognitive ability test for VP.

Vestibular contribution to spatial orientation and navigation

“…Following the seminal publication of Brandt et al . [ 28 ] in 2005, which showed selective deficits of spatial cognition in a virtual Morris Water Task in patients with a complete bilateral vestibular loss, several studies have been published over the last years reporting differential spatial orientation and navigation deficits in patients with various vestibular pathologies in real-space as well as desktop and immersive virtual reality setups [ 29 , 30 , 31 ▪ , 32 ▪ ]. As a general note, these results may be interpreted in consideration of different vestibular inputs and reference frames inherent to the respective setups, that is desktop virtual reality or paper-pencil applications may rather probe two-dimensional static vestibular spatial memory [ 29 , 33 ], while real-space or immersive virtual reality navigation allows for multisensory and specifically 3D vestibular inputs induced by translational and rotational head and body movements [ 3 , 34 ].…”

Rethinking Driving Assessment: A Hypothesis-Driven Proposal for Cognitive Evaluation

“…However, these tasks often fall short in ecological validity as they fail to capture the dynamic and complex nature of driving [81,82]. To address this, computerized tasks have been developed, offering a more realistic and comprehensive assessment of these skills [83][84][85].…”