Imagine being able to detect cognitive changes earlier and more accurately, potentially helping to slow disease progression and preserve quality of life. This is now possible with CAVIRE-2 (Cognitive Assessment by VIrtual REality), a groundbreaking tool that is revolutionising the way cognitive assessment is conducted.

A Game-Changing Approach to Cognitive Assessment

Traditional pen-and-paper questionnaires for cognitive testing are being transformed by cutting-edge technology. Developed through a collaboration between SingHealth Polyclinics (SHP) and local VR software firm, FXMedia, CAVIRE-2 evaluates six key cognitive functions – memory, attention, language, perceptual-motor function, social cognition, and executive function – through 13 interactive daily scenarios.

Such tests will involve users donning a VR headset and performing familiar everyday tasks, such as waiting for the green light to cross the road and counting money at a local supermarket. These scenarios will include common daily distractions like a baby crying in the background, creating an authentic environment that mirrors real-life situations, where cognitive abilities like attention, memory and problem-solving are naturally tested.

CAVIRE-2 is an effective tool in providing more practical insights than traditional paper-based tests
(From left: FXMedia Chief Executive Mark Wong, SingHealth Polyclinics’ Research Officer Lim Jie En, Clinical Associate Professor Tan Ngiap Chuan and Madam Goh Ai Lian, a participant in the study, using the headset as part of the virtual reality-based cognitive assessment tool)

The tool screens patients in a comfortable and immersive environment,
promoting a more natural assessment process

An example of the VR user interface that demonstrates how patients
are guided and prompted to complete the tasks

A More Natural Way to Assess Cognitive Health

Mr Lim Jie En, Research Officer and one of the key research investigators for this study shared, “Individuals are immersed in a 3D virtual environment where they engage in everyday tasks using natural movements like hand gestures and speech. What sets CAVIRE-2 apart is that its virtual scenarios are tailored to reflect familiar, real-life activities within the Singapore context. This allows us to assess cognitive function in a way that’s both culturally relevant and closely aligned with a person’s ability to manage daily life.”

Mr Lim Jie En presenting on the study methodology

Traditional assessment methods such as the Montreal Cognitive Assessment (MoCA) assesses an individual’s ability to perform tasks like drawing a clock, naming animals, and repeating digits. However, these tasks do not mimic the activities encountered in daily life. On the other hand, CAVIRE-2 provides objective evaluation through real-time observation of how individuals navigate daily scenarios. This addresses what researchers call "ecological validity" – ensuring that test results accurately reflect real-world functioning.

"We do not know how you perform your day-to-day activities. This is the critical gap that we try to address using virtual reality technology," explained Clinical Associate Professor (Dr) Tan Ngiap Chuan, Director of Research and Primary Care Research Institute (PCRI), SHP and Vice-chair, Research, SingHealth-Duke NUS Family Medicine Academic Clinical Programme (FM ACP). A/Prof Tan is also the main author of this research paper.

A/Prof Tan Ngiap Chuan highlighting the study background and importance in our ageing population

Proven Effectiveness

Development of CAVIRE-2 first began in 2020, with researchers conducting a comprehensive study involving 280 multi-ethnic Asian adults aged 55 to 84 at Eunos Polyclinic between August 2023 and January 2024. The study has yielded a high 88.9% accuracy in distinguishing between mild impairment and healthy cognitive levels.

Looking Ahead

"While there is currently no cure for dementia, leveraging technologies and AI to detect early cognitive changes enables timely interventions that may help to slow down disease progression and preserve quality of life," noted A/Prof Tan. For the next phase, the research team will introduce interventions to assess effectiveness in mitigating cognitive decline after an individual is diagnosed with mild cognitive impairment.

With Singapore's ageing population and the growing prevalence of dementia, CAVIRE-2 represents a promising advancement in healthcare technology. By harnessing AI technology and enabling earlier detection through a less-invasive method, this innovative tool has the potential to significantly improve health outcomes, enhance quality of life and transform the future of cognitive care in Singapore and beyond.

Not yet subscribed to our e-Newsletter? Sign up here today!