The Picture Interpretation Test 360 - A Virtual Reality Screening Tool for Executive Dysfunction and Rehabilitation Stratification in Mild Cognitive Impairment

Sep 30, 2026

Mild Cognitive Impairment (MCI) marks a critical transition between normal aging and dementia, where executive dysfunction strongly influences prognosis. Traditional neuropsychological tests can miss early executive deficits due to limited ecological validity. A 360-degree Virtual Reality assessment, the Picture Interpretation Test 360 (PIT 360), evaluates whether VR-based interpretation discriminates MCI from healthy controls, identifies executive dysfunction within MCI, and aligns with standard neuropsychological measures.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages23

Reading Time58 min

AccessFree to download

Abstract

Background/Objectives

Methods

Results

Conclusions

1. Introduction

Article The Picture Interpretation Test 360 ◦ : A Virtual Reality Screening Tool for Executive Dysfunction and Rehabilitation Stratification in Mild Cognitive Impairment Chiara Stramba-Badiale 1, *, Eleonora Noselli 1,2, Alessandra Magrelli 1, Silvia Serino 3,4, Chiara Pupillo 2,5, Stefano De Gaspari 2,5, Sarah Todisco 1, Karine Goulene 6, Marco Stramba-Badiale 6, Cosimo Tuena 1,7 and Giuseppe Riva 1,2 Academic Editor: Daniele Giansanti Received: 27 November 2025 Revised: 28 December 2025 Accepted: 30 December 2025 Published: 31 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Applied Technology for Neuro-Psychology Laboratory, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy; [eleonora.noselli@unicatt.it](eleonora.noselli@unicatt.it) (E.N.); [magrelli13@gmail.com](magrelli13@gmail.com) (A.M.); [tod.sarah88@gmail.com](tod.sarah88@gmail.com) (S.T.); [c.tuena@auxologico.it](c.tuena@auxologico.it) (C.T.); [giuseppe.riva@unicatt.it](giuseppe.riva@unicatt.it) (G.R.) 2 Humane Technology Lab, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; [chiara.pupillo@unicatt.it](chiara.pupillo@unicatt.it) (C.P.); [stefano.degaspari@phd.unipi.it](stefano.degaspari@phd.unipi.it) (S.D.G.) 3 Department of Psychology, Università degli Studi di Milano-Bicocca, 20126 Milan, Italy; [silvia.serino@unimib.it](silvia.serino@unimib.it) 4 Bicocca Center for Applied Psychology, University of Milano-Bicocca, 20126 Milan, Italy 5 Department of Computer Science, University of Pisa, 56126 Pisa, Italy 6 Department of Medicine, Neurology and Rehabilitation, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy; [goulene@auxologico.it](goulene@auxologico.it) (K.G.); [stramba_badiale@auxologico.it](stramba_badiale@auxologico.it) (M.S.-B.) 7 Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy * Correspondence: [c.strambabadiale@auxologico.it](c.strambabadiale@auxologico.it) Abstract Background/Objectives: Mild Cognitive Impairment (MCI) represents a critical transition stage between normal aging and dementia, with executive dysfunction playing a key prognostic role. Traditional neuropsychological tests show limited ecological validity and may fail to detect early executive deficits. Virtual Reality (VR) offers an innovative alternative by reproducing everyday situations in realistic environments. This study investigated whether the Picture Interpretation Test 360◦ (PIT 360◦ ), a VR-based assessment, can (1) discriminate between MCI patients and healthy controls (HCs); (2) identify executive dysfunction within the MCI group; and (3) correlate with standard neuropsychological measures. Methods: One hundred and one participants aged ≥65 years (53 MCI, 48 HCs) underwent a comprehensive neuropsychological assessment and PIT 360◦ evaluation. The PIT 360◦ requires interpreting a complex scene in a 360-degree virtual environment. Hierarchical linear regression, Receiver operating characteristic (ROC) curve analysis, and binary logistic regression were performed to examine group differences and diagnostic accuracy. MCI patients were stratified based on their performance on the Modified Five Point Test to identify visuospatial dysexecutive deficits. Results: MCI patients showed significantly longer PIT 360◦ completion times than HCs (92.6 vs. 65.3 s, p = 0.006), independent of age. MCI patients with visuospatial dysexecutive deficits exhibited the most severe deficits (median = 105 s, p = 0.017 vs. HCs) . ROC analysis revealed adequate discriminative ability (AUC = 0.64, 95% CI [0.53, 0.75]) with a preliminary, sample-derived cut-off at ≥22 s, yielding high sensitivity (86.5%) but low specificity (42.6%) . This threshold requires validation in independent samples. PIT 360◦ completion time correlated significantly wi

FAQs

What is the goal of the PIT 360 in this study?

To determine whether PIT 360 can discriminate MCI from healthy controls, identify executive dysfunction within the MCI group, and correlate with standard neuropsychological measures.

How were participants and MCI status assessed?

One hundred and one participants aged 65+ underwent comprehensive neuropsychological assessment and PIT 360 evaluation, with MCI stratified using performance on the Modified Five Point Test to detect visuospatial dysexecutive deficits.

What diagnostic performance did PIT 360 show for discriminating MCI?

ROC analysis showed adequate discrimination (AUC = 0.64) using a preliminary cut-off at ≥22 s, with high sensitivity (86.5%) but low specificity (42.6%), requiring validation in independent samples.

Sep 30, 2026

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