Plain English Summary
Background and study aims
Dementia is a syndrome (a group of related symptoms) associated with an ongoing decline of brain functioning. The aim of the study was to evaluate the effectiveness of VR-based cognitive training for older adults and to compare this effectiveness among older adults without cognitive impairment and with mild dementia.
Who can participate?
Adults aged 60 years or older with no cognitive impairment or with mild dementia.
What does the study involve?
Cognitive training with the use of GRADYS software – a computer game with elements of VR was used. It consists of eight sessions and lasts four weeks. The training program is preceded and followed by a cognitive assessment of processes corresponding to the modules of the game which aim to improve:
4. Visuospatial processing.
What are the possible benefits and risks of participating?
Participation in the study is associated with possible benefits in cognitive functioning resulting from the training. All subjects were also diagnosed with their current cognitive status, including dementia screening tests. No financial benefits were provided for the participants.
The only inconvenience arising from participation in the study could have been the cybersickness - unwanted experiences associated with the use of VR headset (information leaflet in the attachment to the informed consent for participants, please find it attached). Participants experiencing serious cybersickness were excluded from further training.
Where is the study run from?
Kazimierz Wielki University Institute of Psychology, Poland
When is the study starting and how long is it expected to run for?
December 2015 to August 2016
Who is funding the study?
The National Centre for Research and Development, Poland
Who is the main contact?
Dr Ludmila Zając-Lamparska
GRADYS – computer simulation software with virtual reality elements for enhancement of cognitive functions in the elderly with healthy aging and with dementia diseases
1. Training using GRADYS game will result in an improvement in performance and reaching higher levels of the game difficulty in training modules.
2. The effect of the training will result in an improvement in the performance of standard cognitive measures.
3. Belonging to the group of non-demented and mildly demented older adults will differentiate the participants in terms of cognitive performance in pretest and in terms of training effects. The cognitive performance in pretest will be better in non-demented older adults. Training effects in both groups will be significant and positive, but in the group of non-demented older adults they will be greater.
Approved 26/04/2016, Bioethics Committee of the Nicolaus Copernicus University in Toruń functioning at Collegium Medicum in Bydgoszcz (Komisja Bioetyczna Uniwersytetu Mikołaja Kopernika w Toruniu przy Collegium Medicum im. Ludwika Rydygiera w Bydgoszczy, ul. M. Curie Skłodowskiej 9, 85-094 Bydgoszcz; +48 52 585-35-63; email@example.com), ref: 320/2016
Non randomised interventional pretest-posttest study design
Primary study design
Secondary study design
Non randomised study
Patient information sheet
Not available in web format, please use contact details to request a participant information sheet. The participant information sheet is in Polish because all the participants were Polish.
There were two groups: non-demented and mildly demented older adults. Participants with mild dementia were recruited from patients of a geriatric clinic, from patients of a healthcare facility of the "Nowa Wspolna Droga" Association in Gniezno and through advertisement. Participants without cognitive impairment were recruited through advertisement.
VR-based cognitive training with the use of GRADYS game. The game contains 4 modules:
4. Visuospatial processing
The training lasted 4 weeks, it comprised 8 individual training sessions, two per week. A single session lasted 45 minutes to one hour.
There are separate game scripts for four different cognitive domains: attention, memory, language, visuospatial processing. Each cognitive domain has its own gameplay, composed of several tasks involving the same cognitive function and forming a coherent storyline inspired by everyday life.
Attention: The tasks of the attention module were designed to activate selective and focused attention, sustained attention (vigilance), divided and alternating attention, and executive attention.
Example: On their way to the shop the player needs to cross the street, tramway tracks and a bike lane. To get to the other side of the street the player needs to mind the current traffic lights and the traffic on the road. When the difficulty level rises, the situation in the street gets more complicated and the number of elements that need to be taken into consideration when making the decision about crossing the street increases.
Memory: The tasks designed to stimulate memory functions concern short-term memory, long-term memory, and prospective memory.
Example: The player goes to the kitchen to prepare the salad. The recipe is displayed in the centre of the visual field for as long as the player needs to memorize all the ingredients. The number of the ingredients to memorize rises with the difficulty level of the game. To prepare the salad the player has to select the ingredients visible on the table. Once the salad is ready, the next task is to call a friend and give them the recipe.
Language: The tasks stimulating language functions are based on spoken and written text processing. To achieve this, one needs to activate phonological, spelling, semantic, and syntactic knowledge.
Example: The first task is to use an ATM machine. The player has to withdraw money and top up his phone account. To achieve this, they need to follow the instructions displayed on the ATM screen. The more difficult the game, the more complex the instructions provided to the player, and the more options to choose from on the screen.
The visuospatial modules in the game rely on visuospatial analysis, mental rotation, and visual search.
Example: The player needs to glue broken dish pieces together. On the desk, the player can see all parts that need to be glued together. Additionally, in the centre, the player can see in a different colour the piece that should be picked from the available ones and glued as the next one. To select the right piece the player has to mentally rotate it as the pieces on the desk are placed in a different position than the part being displayed in the centre. The complexity of the dish and hence the number of parts to glue together rise with the difficulty level.
Primary outcome measure
Cognitive abilities measured at baseline and at 8-weeks
1. Attention measured using: Digit Symbol from WAIS – R (PL); Colour trial test (CTT) – Adult version, d2 Test of Attention (indices: WZ – speed of processing, %B – percentage of errors, WZ-B – error-corrected speed of processing, ZK – ability to concentrate);
2. Memory measured using: Digit Span from WAIS – R (PL), Benton Visual Retention Test (BVRT), Rey Auditory Verbal Learning Test (AVLT), Famous Faces Test, Rey-Osterrieth complex figure test (ROCF) – delayed reproduction;
3. Language measured using: Verbal Fluency from ACE – III; Boston Naming Test (BNT);
4. Visuospatial processing measured using: Block Design from WAIS – R (PL), Rey-Osterrieth complex figure test (ROCF) – direct copying.
Secondary outcome measures
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Polish citizens for whom Polish was a native language
2. 60 years or older
3. Cognitively healthy older adults: Mini-Mental State Examination score of 27-30
4. Older adults with mild dementia: Mini-Mental State Examination score of 19-23
Target number of participants
Total final enrolment
Participant exclusion criteria
1. Mental disorders
2. Serious somatic illnesses
3. Auditory and motor impairments preventing the use of the game peripherals
4. Taking medication disrupting cognitive functioning
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Kazimierz Wielki University
ul. Chodkiewicza 30
Trial participating centre
Nicolaus Copernicus University in Toruń Ludwik Rydygier Collegium Medicum in Bydgoszcz
Trial participating centre
„Nowa Wspolna Droga” Association
Trial participating centre
Wyższa Szkoła Technologii Informatycznych w Warszawie (ang. The University of Information Technology in Warsaw)
Narodowe Centrum Badań i Rozwoju
National Centre for Research and Development, The National Centre for Research and Development, NCBR
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Publications in peer-reviewed journals, conference presentations.
IPD sharing statement:
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request: Ludmiła Zając-Lamparska (firstname.lastname@example.org); Paweł Izdebski (email@example.com) and Monika Wiłkość-Dębczyńska (firstname.lastname@example.org) in two weeks after request via e-mail. They will be available for scientist and for use in meta-analyses and / or systematic reviews. The raw data and/ or descriptive statistics will be provided without personal data of study participants (only anonymous data or aggregated data). This is consistent with the informed consent was obtained from all individual participants included in the study (all subjects gave written informed consent in accordance with the Declaration of Helsinki; if the participants with mild dementia had a legal guardian, the legal guardian gave written informed consent in accordance with the Declaration of Helsinki).
Intention to publish date
Participant level data
Available on request
Basic results (scientific)
2017 results in: https://www.semanticscholar.org/paper/Virtual-reality-in-cognitive-interventions-for-and-Zaj%C4%85c-Lamparska-Wi%C5%82ko%C5%9B%C4%87-D%C4%99bczy%C5%84ska/1105179af2a909383e7c160027069ded52bb2bd0 (added 30/08/2019)
2017 results in: https://www.termedia.pl/Effectiveness-of-GRADYS-a-cognitive-training-with-elements-of-virtual-reality-in-adults-older-than-60-and-without-cognitive-impairment,46,32144,0,1.html (added 30/08/2019)
2019 results in https://www.ncbi.nlm.nih.gov/pubmed/31775849 (added 02/12/2019)