Enhancing the measurement of authentic executive functioning using virtual reality: a validation study

Impairments of executive function are common in neuropsychiatric disorders, and have been associated with poor outcomes and high costs for those experiencing mental illness. Effective interventions targeting such deficits are sorely needed. However, cognition is notoriously difficult to measure accurately, as traditional paradigms lack the complexity and dynamicity of the everyday situations in which impairments are most apparent. The field of virtual reality (VR) has recently undergone advancements in technology, which means that VR can now offer a truly immersive and interactive experience.

We have recently developed a set of executive function measures within highly immersive virtual reality environments; these tests can be administered far more naturalistically than has previously been possible. These focus on spatial working memory, planning, co-ordination of actions and multi-tasking. We expect that in addition to seeing more natural cognitive functioning, these environments might be more sensitive and acceptable to patient groups than traditional pen-and-paper methods.

There is evidence that cognitive abilities fluctuate across the menstrual cycle - many tasks show poorer performance in the mid-luteal phase of the cycle (usually day 10-16). Because levels of cortisol (a stress hormone) may also be involved in this phenomenon and cortisol has a known influence on cognition, we will also measure menstrual cycle-related cortisol changes at both the follicular (between day 1-13) and luteal phases of the menstrual cycle in healthy premenopausal women. This group-type is highly suitable for validation of neurocognitive tasks, as cognition shows reliable changes with menstrual phase, a lack of age-related cognitive decline, and serve as their own control group by having two study sessions where differences in cognitive performance are anticipated.

The purpose of the study is to test new interactive and immersive assess neurocognitive functioning and HPA axis function through the measurement of cortisol in follicular and luteal phases of the menstrual cycle in healthy premenopausal women. We predict that HPA axis activity will be increased in the luteal phase, correlating with impaired neurocognitive functioning.