A Neuropsychological Test Battery for the Assessment of Time Deficits

Completed

• Conditions: Brain Damage; Health Behavior
• Interventions: Behavioral: Virtual Reality

• Registration Number: NCT04419818
• Lead Sponsor: Istituti Clinici Scientifici Maugeri SpA

Brief Summary

Time processing involves different abilities - i.e. estimating the duration of an event and moving in past and future time - and it is a fundamental ability in everyday life. For these reasons the assessment and the rehabilitation of time deficits in brain damaged patients is extremely important.

The ability to estimate and reproduce time processing is usually evaluated using computerized tasks and it is influenced by aging: young participants overestimate and elderly participants underestimate time durations.

Virtual Reality is an ecological approach that has recently been used for the assessment of cognitive deficits. Here we use Virtual Reality to study the ability to estimate time duration of an action execution and perception in a simulated everyday activity.

Detailed Description

Time processing involves different abilities - i.e. estimating the duration of an event and moving in past and future time - and it is a fundamental ability in everyday life. However, in neuropsychology, time processing is routinely neglected in the assessment of cognitive deficits in brain-damaged patients. The discrepancy between the importance of time processing and the lack of instruments for the diagnosis of time deficits in brain damaged patients can be mainly due to the fact that time difficulties fail to emerge in a hospital context where daily activities are routinely scheduled by careers. Thus, time deficits become critical only when patients return home and, for younger patients, when they go back to working activities. For these reasons the assessment and the rehabilitation of time deficits in brain damaged patients is extremely important.

Interestingly, recent evidence has begun to demonstrate that our perceptions and sensations are influenced by motor movements and actions. Further, there is also evidence suggesting that movement not only biases perceived time, but can enhance it, suggesting the motor system directly influences temporal perception.

The ability to estimate and reproduce time in actions is usually evaluated using computerized tasks and it is influenced by aging: young participants overestimate and elderly participants underestimate time durations.

Virtual Reality is an ecological approach that has recently been used for the assessment of cognitive deficits. Here we use Virtual Reality to study the ability to estimate time duration of an action execution and perception in a simulated everyday activity.

The primary aim of the project is to measure the impact of time deficits and its effects on everyday life: a neuropsychological battery assessing time processing (Time Estimation, Time Reproduction, Mental Time Travel) is tested using both computerized and virtual reality tasks.

Moreover, the project aims also to investigate i) the correlation between Time Reproduction in a computerized task and the ability to reproduce the duration of an executed action in Virtual Reality; ii) the correlation between Time Estimation in a computerized task and the ability to estimate the duration of an executed action in Virtual Reality.

Study Timeline

• Study Start: 2019-02-01
• Study First Submitted: 2020-06-03
• Study First Submitted QC: 2020-06-03
• Study First Posted: 2020-06-05
• Primary Completion: 2022-12-01
• Study Completion: 2023-01-13
• Status Verified: 2023-09
• Last Update Submitted: 2023-09-21
• Last Update Posted: 2023-09-25

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 96

Inclusion Criteria

• patients with focal right and left brain-damage

Exclusion Criteria

• generalized cognitive impairment (score lower than 24 at the Mini Mental State Examination)
• psychiatric disorders
• additional neurological disorders
• abusive use of alcohol or illicit drugs

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Healthy controls	Virtual Reality	A group of 40 (20 young and 20 elderly) healthy controls (HC) will perform: * a computerized test battery to measure time abilities (Mental Time Travel, Time Estimation and Time Reproduction); * a neuropsychological screening (Mini Mental State Examination) to assess inclusion/exclusion criteria; * questionnaires to evaluate the time needed to execute actions and the ability to locate daily activities in time.
Right brain damaged patients	Virtual Reality	A group of 20 right brain damaged (RBD) patients will perform: * a computerized test battery to measure time abilities (Mental Time Travel, Time Estimation and Time Reproduction); * a neuropsychological screening (Mini Mental State Examination and Token Test) to assess inclusion/exclusion criteria; * questionnaires to evaluate the time needed to execute actions and the ability to locate daily activities in time.
Left brain damaged patients	Virtual Reality	A group of 20 left brain damaged (LBD) patients will perform: * a computerized test battery to measure time abilities (Mental Time Travel, Time Estimation and Time Reproduction); * a neuropsychological screening (Mini Mental State Examination and Token Test) to assess inclusion/exclusion criteria; * questionnaires to evaluate the time needed to execute actions and the ability to locate daily activities in time.

Primary Outcome Measures

Name	Time	Method
Assessment of Time Estimation Ability on the Time Estimation Task - long intervals	baseline	The Time Estimation task consists of a red square that is displayed for different durations (3500, 5500, 7500, 9500, 11500 ms) on the computer screen. Participants are instructed to verbally judge whether the duration of each stimulus is "short" or "long" with respect to previously acquired pair of reference durations (3500 and 11500 ms).; A psychophysical response function will be created for each participant by calculating the proportion of "long" responses: the Point of Subjective Equality (PSE) is the duration at which a participant is equally likely to classify the stimuli as short or long. Lower PSE reflects a relative shift towards overestimation of temporal midpoint. Conversely, higher PSE reflects a relative shift towards underestimation of temporal midpoint.
Assessment of Time Estimation Ability on the Time Estimation Task - short intervals	baseline	The Time Estimation task consists of a red square that is displayed for different durations (1400, 1700, 2000, 2300, 2600 ms) on the computer screen. Participants are instructed to verbally judge whether the duration of each stimulus is "short" or "long" with respect to previously acquired pair of reference durations (1400 and 2600 ms).; A psychophysical response function will be created for each participant by calculating the proportion of "long" responses: the Point of Subjective Equality (PSE) is the duration at which a participant is equally likely to classify the stimuli as short or long. Lower PSE reflects a relative shift towards overestimation of temporal midpoint. Conversely, higher PSE reflects a relative shift towards underestimation of temporal midpoint.
Assessment of Time Reproduction Ability on the Time Reproduction Task - short intervals	baseline	In the Time Reproduction task a blue square is presented for a variable time interval (1400, 1700, 2000, 2300, 2600 ms) on the computer screen. Next, a red square appears on the screen and participants are instructed to reproduce the entire duration of the preceding blue square by pressing the space bar on the keyboard.; The reproduced time intervals will be compared to the real ones: the difference will be positive when reproduced time will be longer (underestimation of time duration) and negative when reproduced time will be shorter (overestimation of time duration) than the real one.
Assessment of Mental Time Travel Ability on the Mental Time Travel (MTT) Task	baseline	In the MTT task participants are listened to auditory stimuli consisting of brief descriptions of personal and non-personal events. They are required to project themselves in the past (10 years ago), present or future (10 years from now) and to verbally determine whether each event has already happened (relative past event) or is yet to happen (relative future event) with respect to the specific self-location in time (past, present and future).; Error rates and reaction times will be recorded and analyzed.
Assessment of Time Reproduction Ability on the Time Reproduction Task - long intervals	baseline	In the Time Reproduction task a blue square is presented for a variable time interval (3500, 5500, 7500, 9500, 11500 ms) on the computer screen. Next, a red square appears on the screen and participants are instructed to reproduce the entire duration of the preceding blue square by pressing the space bar on the keyboard.; The reproduced time intervals will be compared to the real ones: the difference will be positive when reproduced time will be longer (underestimation of time duration) and negative when reproduced time will be shorter (overestimation of time duration) than the real one.

Secondary Outcome Measures

Name	Time	Method
Assessment of Verbal Estimation Ability on the Cognitive Estimation Task (CET)	baseline	The test comprised 21 questions requiring participants to give oral, numerical responses. Two different scoring procedures will be considered: absolute error score and bizarreness. The total score for all 21 items ranges from a best of zero to a worst of 42. The greater the error score, the poorer the performance on the CET (cut-off = 18). The total bizarreness score ranges from 0 and 21 (cu-off = 4). The higher the bizarreness score, the greater the impairment in cognitive estimation.
Assessment of Verbal Comprehension on the Token Test	baseline	The Token test is a test of auditory language processing in which participants are asked to manipulate tokens of different shapes, sizes, and colors in response to increasingly complex instructions. One point is credited for a correct performance on the first presentation and 0.5 point if the performance is correct only on the second presentation. The score ranges from 0 to 36 (cut-off = 26,50).
Assessment of Verbal Estimation Ability on the Time and Weight Estimation Test (STEP)	baseline	The STEP assesses aspects of executive functioning related to cognitive estimation ability. The questionnaire is composed of two distinct ten-item sections, focusing on time (e.g., How long does it take to have a shower?) and weight (e.g., How heavy is a pair of jeans?) estimations. Each item scores from 0 (bizarre estimation) to 3 (best estimation), for a total maximum score for each section of 30, with a cut-off value for normality above 20 for each section.
Assessment of Functional Abilities on the Questionnaire of Temporal Ability	baseline	The Questionnaire of temporal ability is a new instrument to measure the ability to locate 10 daily activities in time.
Assessment of General Cognitive Functioning on the Mini Mental State Examination (MMSE)	baseline	The MMSE is a 30-point questionnaire that examines functions including registration (repeating named prompts), attention and calculation, recall, language, ability to follow simple commands and orientation. The score ranges from 0 to 30 (cut-off = 24).
Correlation between Time Estimation, Time Reproduction and Virtual Reality	baseline	Time Estimation, Time Reproduction and VR tasks will be correlated to investigate the relationship between computerized tasks and virtual reality tasks.

Trial Locations

Locations (1)

ICS Maugeri IRCCS, U.O. di Rieducazione e Recupero funzionale di Castel Goffredo; 🇮🇹 Castel Goffredo, Mantova, Italy