Objective:

The objective of this study was to utilize a novel virtual reality paradigm, Cleveland Clinic Virtual Reality Shopping (CC-VRS), to identify changes in instrumental activities of daily living (IADL) associated with Parkinson’s disease (PD).

Background:

Understanding the effects of medication or surgical interventions on PD IADL performance is necessary to ensure optimized function and maximize independence. The CC-VRS combines virtual reality content with an omnidirectional treadmill to create an immersive full-scale grocery shopping environment that presents cognitive and physical challenges, objectively and quantitatively evaluating cognitive and motor function.

Design/Methods:

Fourteen individuals with PD (UPDRS-III 25.9 ± 13.9, ON antiparkinsonian medication), and 14 age- and gender-matched healthy adults completed Basic and Complex shopping scenarios; the latter includes additional cognitive and physical demands while shopping. During the scenario, participants physically navigated through the virtual grocery store on the omnidirectional treadmill that allowed them to walk in a straight line and perform 90° and 180° turns. The store route, shopping items, and distractors were standardized across participants.

Results:

Motor and cognitive performance differed across PD and control groups. From a motor perspective, PD patients exhibited significantly shorter step length (p<0.05) and experienced multiple freezing episodes while turning. Cognitive function was evaluated through list observation behaviors; PD patients spent significantly more time looking at their virtual shopping list (p<0.01) and time for each list activation was nearly twice that of controls (p<0.01). Both groups tolerated the virtual environment well, as Simulator Sickness Questionnaire scores for both groups were minimal following completion of CC-VRS.   

Conclusions:

The CC-VRS platform successfully quantifies PD motor symptoms and subtle cognitive declines in mild PD versus healthy controls. The CC-VRS platform was well-tolerated across groups and offers an innovative approach to objectively quantifying IADL performance, with potential for use in titrating medication and tuning deep brain stimulation parameters.