Learning how to treat Alzheimer’s disease with Virtual Reality

A new first-person program in the Virtual Reality Studio is helping medical students understand Alzheimer’s disease and dementia from their future patients’ perspectives.

The VR program, from Embodied Labs, displays how dementia affects communication in the brain – and how that affects a person’s relationships with their family and friends – from the onset of symptoms to late-stage Alzheimer’s, where people lose control of motor skills and verbal communication. 

Christina Cauble, a geriatric education specialist and adjunct instructor, partnered with the Health Sciences Library to integrate this program into the Medical Schools’ Becoming a Doctor series.

“It’s really a powerful tool for building empathy and having students see things from a different perspective,” Cauble said. “The overall goal for this experience was just to build empathy for what it is like to have dementia.” 

The class session divided students into groups, with some heading into the VR Studio and others staying behind in the classroom for another activity, then switching locations at the halfway mark. 

In the VR Studio, students took turns experiencing dementia through the eyes of Beatriz, an older adult Latina woman with progressive Alzheimer’s, as she starts to experience symptoms  and eventually transitioning into residential care. 

“Students need that first-person perspective,” said Nicole Theis-Mahon, the collections coordinator, which is why Embodied Labs is so valuable. The Libraries’ doesn’t have anything in its collection that provides that same insight. 

“You can watch an interview in a movie, but still, you are an observer. It’s not from a perspective that you’re encountering or seeing,” Theis-Mahon said. “It’s very, very unique in that sense. I can’t think of anything else that’s like it.” 

Understanding the reality of dementia

Health sciences students need to have a holistic understanding of people, rather than simply treating a disease or illness, Theis-Mahon said. Through its first-person point of view, Embodied Labs helps break down that barrier, so students can pause and connect with their patients. 

The immersion of the program makes students more aware of the challenges people with dementia face, and what might be frustrating or confusing for them. The Beatriz Lab, for example, used audio distortions to exhibit some of the auditory processing impairments caused by Alzheimer’s.  

One common misconception health-care providers have about people with dementia, Cauble explained, is that they cannot advocate for themselves. It can be easier to communicate and focus on a family member who is verbal, but that family member isn’t the patient. 

“No matter how progressed someone is, I firmly believe that they can all feel the energy in a room very profoundly, even if that person is completely nonverbal,” Cauble said. 

Another misconception is that people with Alzheimer’s should live in a care facility, but that isn’t always the right choice for everyone. People tend to believe that dementia progresses linearly and consistently. But in reality, people experience plateaus, then significant changes, more plateaus, sometimes improvements, and so on. 

“I’ve seen people who have been nonverbal for years come back and sing a song that they knew in their childhood. …  A lot of people feel like there is no quality of life, or very minimal quality of life, for patients who have dementia,” Cauble said. “There can be really beautiful moments, and there can be a good quality of life. But it takes a lot of people to support that. …  A lot of times people just assume that it’s going to be too hard, and so they don’t always put forth the effort necessary.” 

Health-care providers need to put in the effort too, especially when someone is initially diagnosed and can still comprehend what’s happening to them. Sometimes providers hesitate to fully explain dementia, because it can be uncomfortable or emotional, but sharing that information makes future care much easier.  

In the later stages of Alzheimer’s, people’s perception of reality changes. They’ll speak about friends and loved ones who have passed away, for example, because they have gone back to a time where those people are still alive. 

Health-care providers are tempted to pull them into our reality by reminding their patients that those loved ones are gone. But from their perspective, that’s a brand new experience of loss, fresh and raw. A better approach, Cauble said, is to enter their reality and connect with them where they’re at. 

Learning to slow down

Cauble previously worked in assisted living facilities and nursing homes, and she was drawn to geriatric care because of how personalized the care is in that field. To provide long-term care, she had to build relationships with her patients. 

In her current position, promoting geriatric learning opportunities for students in various health science programs, she’s found that most students had never considered geriatric care as a viable career option, or even an option period. 

“It’s really important to expose students to the fact that working in the long-term care industry is an option, and it’s a good option. … I think the most misunderstood thing about geriatric care is that it is simple and boring,” Cauble said. “Geriatric care is one of the highest complexity levels of care that they will provide because these individuals are living with multiple morbidities.”

Students can sometimes fall into task-orientation mode and prioritize checking boxes, she said. And while that’s important, health-care providers need to connect with their patients, and when talking to a person with dementia, that’s twice as hard. 

This type of geriatric care requires providers to slow down, empathize with their patients, and think about the entirety of their lives, not just the fraction of time they spend in health-care settings. Providers also have to think creatively, because things that work for one patient won’t necessarily work for another.  

“If somebody is interested in really pushing their boundaries as a physician, as a pharmacist, as whatever it might be, going into geriatrics will do that. I mean it will push you. You will have to think critically,” she said. “People often see it as, I dunno, a snooze fest, and they don’t understand how complex it truly is, and the skill that it takes to do it very well.” 

Cauble believes that Embodied Labs gives students a glimpse of what people with dementia experience and opens their minds to the possibility of geriatric care. After the class session, several students approached her expressing interest in the field, “which is great cause we need geriatricians.”

“Great session, the VR was cool and impactful,” wrote one student in a reflection piece. “I think it will affect the way I see and treat patients with dementia.” 

“Good experience, wish it was longer in the VR itself,” wrote another. 

Partnering with the Libraries

Cauble has been talking with the Libraries about implementing Embodied Labs into the curriculum for over a year, waiting for the right opportunity. Working with the team at the Health Sciences Library was “fantastic.” 

“I cannot speak more highly about working with them. And just so responsive and so supportive of this,” she said. “They were phenomenal. I would not have been able to pull that off without the support of that whole team, and I’ll tell you, they showed up in droves.”

In addition to Cauble and Theis-Mahon, several Libraries staff members helped facilitate the class session, including Academic Technologist and VR Program Lead Charlie Heinz, and Medical School Liaison Librarians Ryn Gagen, Brooke Olson, and Merete Christianson. 

For Theis-Mahon, this was a great partnership opportunity, showcasing how these new technologies can aid specific courses and learning outcomes, as well as the strengths of working with liaison librarians to develop impactful educational programs and content. 

“Christina’s fabulous, and I just love working with her so much. … She looks at geriatric education from an interprofessional lens. And it’s really beneficial to get someone who can see what might be valuable to all programs in the Health Sciences,” Theis-Mahon said. “I’m excited to work with her going forward to find opportunities to do something like this in other areas of the Health Sciences.”

If any instructor in the Medical School, College of Pharmacy, School of Nursing, or other health science department, is interested in incorporating programs like Embodied Labs into their curriculum, please contact Cauble at caubl010@umn.edu or Theis-Mahon at theis025@umn.edu.