Authors: (including presenting author): :
Wong, CSM(1), Ng, SHW(1), Fung EML(1), Leung AKY(1), Lo, KM(2)
Affiliation: :
1. Occupational Therapy Department, Alice Ho Miu Ling Nethersole Hospital (AHNH) 2. Department of Medicine, AHNH
Keyword 1: :
Occupational Therapy
Keyword 2: :
Virtual Reality
Keyword 5: :
Behavioural and Psychological Symptoms of Dementia
Introduction: :
Individuals with moderate-to-severe dementia experience significant disruptions in occupational performance — the ability to carry out meaningful daily activities and roles. Immersive virtual reality (VR) offers a person-centred, multi-sensory, controllable environment that enables failure-free engagement in simulated occupations, such as nature-based leisure or graded functional tasks mimicking Instrumental Activities of Daily Living (IADL). This aligns with Occupational Therapy (OT) principles of tailored interventions to enhance self-efficacy and promote carryover to real life. Emerging evidence supports VR in advanced dementia, but robust data on engagement, behavioural and psychological symptoms of dementia (BPSD), and quality of life in moderate-to-severe stages remain limited.
Objectives: :
To evaluate the preliminary efficacy of an 8-week caregiver-supported immersive VR intervention on engagement, BPSD, well-being, and quality of life for persons with dementia and caregivers.
Methodology: :
This feasibility study used a single-group pre-post design. From June to August 2025, six outpatients (mean age 79 years; mean HK-MoCA 12.5) were recruited from the OT Department. Inclusion criteria included clinical dementia diagnosis, no uncorrected visual impairment, no seizures or acute cardiac history. Participants received weekly 30-minute VR sessions via head-mounted displays, featuring Hong Kong scenic leisure videos and graded tasks (simulated grocery shopping, adapted archery). Caregivers provided verbal prompts as needed. Outcomes were assessed pre-and post-intervention using the Engagement of a Person with Dementia Scale (EPWDS), Neuropsychiatric Inventory-Questionnaire (NPI-Q) for BPSD severity and caregiver distress, and proxy-rated Dementia Quality of Life measure (DEMQOL-Proxy).
Result & Outcome: :
EPWDS total score improved from 25.0 to 42.0, with gains in affective expression, visual attention, and active participation. Participants showed meaningful autobiographical memories and emotions of joy, calmness, and curiosity. NPI-Q severity decreased from 19.8 to 12.7 and caregiver distress from 26.7 to 16.7, mainly due to reduced agitation, apathy, anxiety, and depression. DEMQOL-Proxy rose from 76.3 to 90.5, reflecting increased positive emotions. Caregivers noted emotional responses rarely seen in daily life. This affordable and user-friendly VR approach holds strong potential for outpatient, community, and residential aged care settings. Effective management through VR may help prevent crises leading to acute hospital admissions (e.g., severe behavioural disturbances, low engagement or caregiver burnout). Longer-term, it may reduce reliance on restraints, sedatives, or antipsychotics linked to prolonged stays and complications.
