# Virtual reality-based cognitive screening in psychiatry: Investigating optimal cut-offs for cognitive impairment in bipolar disorder

## TL;DR

A virtual reality test called CAVIR can help identify cognitive issues in people with bipolar disorder and other mental health conditions.

## Contribution

The study identifies optimal cut-off scores for the CAVIR test to detect cognitive impairment in bipolar disorder.

## Key findings

- A CAVIR score of ≤64 showed 74% sensitivity and 71% specificity for cognitive impairment in bipolar disorder.
- The CAVIR test was also effective in detecting cognitive issues in mood and schizophrenia spectrum disorders.
- CAVIR performance was moderately linked to cognitive impairment and functioning measures.

## Abstract

Cognitive impairment is a key treatment target across neuropsychiatric disorders, including bipolar disorder (BD), but standard neuropsychological tools often fail to capture real-world cognitive challenges. Virtual reality (VR) offers a more ecologically valid alternative. This study investigated the optimal cut-off score of the novel Cognition Assessment in Virtual Reality (CAVIR) test for detecting impaired functional cognitive capacity in BD. Cut-off scores on the CAVIR were investigated in a sample of outpatients with BD (primary clinical screening BD sample; n = 68), using the Screen for Cognitive Impairment in Psychiatry (SCIP) as the reference for objective cognitive impairment. Receiver operating characteristic (ROC) analyses were used to identify optimal cut-off scores for detecting cognitive impairment, defined as performance ≥1 SD below the healthy controls (HC) mean (n = 68). Analyses were replicated in an independent mixed sample of patients with mood or schizophrenia spectrum disorders (n = 70) and HCs (n = 70), using a full neuropsychological test battery as reference. Associations between CAVIR, SCIP and interviewer-rated functioning were also explored. In the primary clinical screening BD sample, a CAVIR total score cut-off of ≤64 showed fair sensitivity (74 %) and specificity (71 %) for detecting cognitive impairment with an area under the curve (AUC) of 0.74. This cut-off score proved robust, with the optimal cut-off in the mixed replication sample of ≤66 differing by only two points. CAVIR performance was weakly to moderately associated with SCIP and functioning. The CAVIR demonstrated fair sensitivity and specificity for detecting cognitive impairment, supporting its potential as an ecologically valid screening tool for impaired functional cognitive capacity.

•VR-based CAVIR test proved effective in identifying impaired functional cognitive capacity among bipolar outpatients.•CAVIR was also sensitive to impaired functional cognitive capacity in patients with mood or schizophrenia spectrum disorders.•The study supports CAVIR as a practical, ecologically valid tool for screening impaired functional cognitive capacity in daily life.

VR-based CAVIR test proved effective in identifying impaired functional cognitive capacity among bipolar outpatients.

CAVIR was also sensitive to impaired functional cognitive capacity in patients with mood or schizophrenia spectrum disorders.

The study supports CAVIR as a practical, ecologically valid tool for screening impaired functional cognitive capacity in daily life.