Background: Neuropsychological tests of executive function have limited real-world predictive and functional relevance. An emerging solution for this limitation is to adapt the tests for implementation in virtual reality (VR). We thus developed two VR-based versions of the classic Color-Trails Test (CTT), a well-validated pencil-and-paper executive function test assessing sustained (Trails A) and divided (Trails B) attention - one for a large-scale VR system (DOME-CTT) and the other for a portable head-mount display VR system (HMD-CTT). We then evaluated construct validity, test-retest reliability, and age-related discriminant validity of the VR-based versions and explored effects on motor function. Methods: Healthy adults (n=147) in three age groups (young: n=50; middle-aged: n=80; older: n=17) participated. All participants were administered the original CTT, some completing the DOME-CTT (14 young, 29 middle-aged) and the rest completing the HMD-CTT. Primary outcomes were Trails A and B completion times (tA, tB). Spatiotemporal characteristics of upper-limb reaching movements during VR test performance were reconstructed from motion capture data. Statistics included correlations and repeated measures analysis of variance. Results: Construct validity was substantiated by moderate correlations between the 'gold standard' pencil-and-paper CTT and the VR adaptations (DOME-CTT: tA 0.58, tB 0.71; HMD-CTT: tA 0.62, tB 0.69). VR versions showed relatively high test-retest reliability (intraclass correlation; VR: tA 0.60-0.75, tB 0.59-0.89; original: tA 0.75-0.85, tB 0.77-0.80) and discriminant validity (area under the curve; VR: tA 0.70-0.92, tB 0.71-0.92; original: tA 0.73-0.95, tB 0.77-0.95). VR completion times were longer than for the original pencil-and-paper test; completion times were longer with advanced age. Compared with Trails A, Trails B target-to-target VR hand trajectories were characterized by delayed, more erratic acceleration and deceleration, consistent with the greater executive function demands of divided vs. sustained attention; acceleration onset later for older participants. Conclusions: The present study demonstrates the feasibility and validity of converting a neuropsychological test from two-dimensional pencil-and-paper to three-dimensional VR-based format while preserving core neuropsychological task features. Findings on the spatiotemporal morphology of motor planning/execution during the cognitive tasks may lead to multimodal analysis methods that enrich the ecological validity of VR-based neuropsychological testing, representing a novel paradigm for studying cognitive-motor interactions.

中文翻译：

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多模式沉浸式追踪制作–研究认知-运动相互作用的虚拟现实范式

背景：执行功能的神经心理学测试在现实世界中的预测和功能相关性有限。针对此限制的一种新兴解决方案是使测试适应虚拟现实（VR）的实现。因此，我们开发了两种基于VR的经典颜色足迹测试（CTT）版本，这是一种经过充分验证的铅笔和纸张执行功能测试，用于评估持续（足迹A）和分散（足迹B）的注意力-其中一个代表大型-规模的VR系统（DOME-CTT），另一个用于便携式头戴式显示器VR系统（HMD-CTT）。然后，我们评估了基于VR的版本的结构效度，重测信度和与年龄相关的判别效度，并探讨了对运动功能的影响。方法：参加三个年龄组（年轻：n = 50；中年：n = 80；年龄大：n = 17）的健康成年人（n = 147）。所有参与者均接受了原始的CTT，其中一些完成了DOME-CTT（14位年轻，29岁的中年人），其余完成了HMD-CTT。主要结果是试验A和B的完成时间（tA，tB）。从运动捕捉数据中重建了VR测试过程中上肢到达运动的时空特征。统计数据包括相关性和方差的重复测量分析。结果：构建体有效性通过“黄金标准”铅笔和纸质CTT与VR适应之间的适度相关性得到证实（DOME-CTT：tA 0.58，tB 0.71； HMD-CTT：tA 0.62，tB 0.69）。VR版本显示出相对较高的重测可靠性（类内相关性; VR：tA 0.60-0.75，tB 0.59-0.89;原始：tA 0.75-0.85，tB 0.77-0.80）和判别效度（曲线下面积; VR：tA 0.70 -0.92，tB 0。71-0.92；原始值：tA 0.73-0.95，tB 0.77-0.95）。VR完成时间比原始的纸笔测试更长；随着年龄的增长，完成时间会更长。与轨迹A相比，轨迹B目标到目标的VR手轨迹具有延迟，更不稳定的加速和减速特性，这与注意力分散和持续注意力更大的执行功能要求相一致。较晚的参与者加速发作。结论：本研究证明了在保留核心神经心理学任务特征的同时，将神经心理学测试从二维纸笔转换为基于VR的三维格式的可行性和有效性。