Emrich-Mills, Luke; (2024) Developing a novel spatial memory task for early Alzheimer’s diagnosis with immersive virtual reality and eye-tracking. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Alzheimer's disease (AD) involves pathophysiological damage in the medial temporal lobe (MTL), an area of the brain implicated in spatial processing. Consequently, testing spatial cognition has become a promising approach for identifying early behavioural changes in AD compared to healthy aging. Immersive virtual reality (iVR) is a suitable medium for administering spatial tasks due to its naturalistic spatial interaction and controlled stimulus presentation, with an iVR path integration test already demonstrating impressive diagnostic potential for early AD. Additionally, modern head-mounted virtual reality displays come equipped with integrated eye tracking, permitting combined exploration of AD-related eye movement changes alongside spatial testing. In this thesis, I describe the development of a novel iVR spatial memory task with concomitant eye-tracking for detecting ageing- and AD-related behavioural and gaze fixation changes. The task was based on a classic viewpoint-shifting paradigm that was previously untested in older or memory-impaired participants. The design, development, and feasibility of the task are reported prior to results on the diagnostic potential of eye movement and memory metrics for discriminating participants at high risk of AD from lower-risk individuals, with a secondary focus on healthy age-related differences. Participants with Mild Cognitive Impairment and presence of AD biomarkers (MCI+) were compared to those without biomarkers (MCI-) and to healthy, age-matched adults. Healthy younger participants were also recruited to examine aging effects. Group differences were observed in how, where and when participants viewed spatial stimuli during memory encoding and retrieval. These effects extended beyond differences in task performance, were dependent on spatial condition, and outperformed traditional neuropsychological tests in identifying MCI+ participants from controls. Findings provide early support for a spatial eye-tracking task as a promising addition to future diagnosis of AD.

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