Evaluating a novel visuospatial-tracking virtual reality test in older adults with and without

Emma Churchill, University of California San Diego, San Diego, United States
Kevin Kuehn, University of California San Diego, San Diego, United States
Anne Heaton, University of California San Diego, San Diego, United States
Abigail Priel, Emory University, Atlanta, United States
Gabrielle Black, Emory University, Atlanta, United States
Peter Torre, San Diego State University, San Diego, United States
David Moore, University of California San Diego, San Diego, United States
David Salmon, University of California San Diego, San Diego, United States
Drenna Waldrop, Emory University, Atlanta, United States
Michelle LaPlaca, Georgia Institute of Technology, Emory, United States
Raeanne Moore, University of California San Diego, San Diego, United States


In recent years, visuospatial-tracking technology has emerged as an effective diagnostic tool in clinical practice and research. Visuospatial tracking encompasses the dynamic interaction of cognitive functions directing attention, visuospatial processing, and anticipatory responses to visual stimuli. The primary goal of this study was to examine relationships between performance on a novel visuospatial-tracking test, called Target Tracking (TT), administered in a virtual reality (VR) environment without cameras, and other cognitive domain scores among older adults with and without Mild Cognitive Impairment (MCI).

Participants and Methods:

This study included 119 participants (aged 60-91, Mage=68.67, 66% male, 54% non-Hispanic white, Meducation years=14.86, 66% had a diagnosis of HIV, 66% MCI+) of the multisite DETECT study using a novel multimodal VR screening tool for neurocognitive impairment. Participants were recruited from UCSD's HIV Neurobehavioral Research Program and Emory University Center for AIDS Research from 2020-2023. Participants completed a comprehensive neuropsychological battery and DETECT VR assessment, including a neurocognitive test module and the TT test. The TT test requires visuospatial tracking a ball along a semi-circle and pressing a button upon perceiving the ball’s entry into the designated target area. In this study, "delta" signifies the difference between a participant's tracked response and the target position, with smaller values indicating greater accuracy and proximity. We used a log transformation to normalize the TT distribution and linear regression to examine differences in MCI status via TT delta scores. Additionally, correlations were examined between TT scores and cognitive domain scores from a traditional pen-and-paper neuropsychological battery, as well as DETECT neurocognitive screening module scores.


Participants with and without MCI performed similarly on the TT test (MCI+: M=19.8, SD=6.79; MCI-: M=19.8, SD=6.30; F(1, 87)=0.542, p=0.464). We observed differences in TT scores based on sex, where men exhibited smaller deltas (b=-0.13, t(df=117) = -2.11, p = .04), and ethnicity, in which non-Hispanics performed better (b = 0.36, t(df = 115) = 2.66, p < .01). There were no differences based on age, education or HIV status. TT scores correlated with all cognitive domain scaled scores from the comprehensive battery, notably executive functioning (r=-0.37, p<.001), learning (r=-0.33, p<.001), and recall (r=-0.38, p<.001). Additionally, compared to DETECT-administered neurocognitive scores, TT correlated with immediate word recall (r=-0.27, p=.003).


Performance on the newly developed VR TT test showed no difference between individuals with and without MCI in this sample, suggesting limited sensitivity to MCI-related changes in engaged cognitive dimensions. This finding aligns with literature demonstrating that target tracking primarily assesses aspects of visual-spatial processing preserved in individuals with MCI. Small, yet significant, correlations between the DETECT TT test, executive functions, and memory suggests that the TT test may be capturing cognitive functions independent of those captured by more traditional neurocognitive tests. This observation highlights the TT test's unique contribution to the DETECT VR assessment, designed to be a multimodal neurologic screening tool. Additional investigation into the information captured by the TT assessment and its utility in HIV and Alzheimer's disease risk studies necessitates longitudinal research and mechanistic inquiries.

Category: MCI (Mild Cognitive Impairment)

Keyword 1: cognitive screening
Keyword 2: mild cognitive impairment
Keyword 3: teleneuropsychology