Cognition Assessment in Virtual Reality (CAVIR)-Spanish Version: Validation of a Novel Virtual Reality Test for Daily-Life Cognitive Skills in Bipolar Disorder

Abstract

Objectives: There is a need for ecologically valid measures of real-life cognitive functioning. We investigated: (I) the sensitivity of the Cognition Assessment in Virtual Reality (CAVIR) test, which assesses daily-life cognitive skills in an immersive virtual reality kitchen scenario, to capture cognitive impairments in a Spanish sample of patients with bipolar disorder (BD) compared to healthy controls (HCs); (II) the convergent validity of CAVIR against standard neuropsychological tests and functional measures. Methods: Patients with BD in full/partial remission (n = 40) and HCs (n = 40) completed the CAVIR–Spanish version and standard neuropsychological tests; the Hamilton Depression Rating Scale (HRDS-17), the Young Mania Rating Scale (YMRS), the Functioning Assessment Short-Test (FAST) and the Brief University of California Performance-based Skills Assessment (UPSA-B). Between-group comparisons of CAVIR global and subtask scores were conducted, together with correlation and linear regression analyses adjusting for age and mood symptoms. Results: CAVIR was sensitive to cognitive impairments in BD, with patients showing poorer performance than HCs on CAVIR global composite (BD = −1.09, 95% CI [−1.44, 0.74] vs. HCs = −0.19, 95% CI [−0.53, 0.15]) (F(1,72) = 9.52, p = 0.003, 2 = 0.12) and subtasks of sustained attention (BD = −1.25, 95% CI [−1.83, −0.70] vs. HCs = −0.14, 95% CI [−0.66, 0.37]) (F(1,69) = 6.12, p = 0.016, 2 = 0.08), processing speed (BD = −1.64, 95% CI [−2.11, −1.18] vs. HCs = −0.20, 95% CI [−0.66, 0.25]) (F(1,68) = 13.67, p < 0.001, 2 = 0.17) and working memory (BD = −0.91, 95% CI [−1.42, −0.41] vs. HCs = 0.05, 95% CI [−0.42, 0.52]) (F(1,71) = 5.50, p = 0.022, 2 = 0.07). The global CAVIR composite and subtasks scores were associated with standard global neurocognitive composite and domains, respectively (σ = 0.50–0.74, p < 0.001). The global CAVIR and all subtasks scores were associated with both observed/interview-based (FAST; σ = −0.29 to −0.55, p < 0.001) and performance-based (UPSA-B; σ = 0.29–0.49, p < 0.05) functional outcomes. Conclusions: The CAVIR-Spanish version is a sensitive and valid instrument for measuring real-life cognitive skills in BD and may be implemented in clinical settings and treatment trials targeting cognition following further studies.