Can Virtual Reality Cognitive Remediation in Bipolar Disorder Enhance Specific Skills in Young Adults through Mirror Neuron Activity?-A Secondary Analysis of a Randomized Controlled Trial

Introduction: Impairments in social cognition and cognitive deficits in bipolar disorder (BD) offer insights into the disorder's progression. Understanding how interventions impact both cognitive and emotional aspects of social cognition is essential. This study examines the effects of virtual reality (VR) cognitive remediation on cognitive skills, stratified by age, in the early stages of the disorder. Methods: A secondary analysis of a randomized controlled trial (RCT) compared the efficacy of VR cognitive remediation on cognitive skills between young adults (<= 58 years) and older adults (>= 59 years) in the experimental group with BD. Results: The experimental group included 39 participants: 24 <= 58 years and 15 >= 59 years. Young adults showed greater improvement in the Digit Span Backward (0.37 +/- 0.35 vs. 0.07 +/- 0.26, F = 9.882, p = 0.020) and Digit Symbol tests (3.84 +/- 3.05 vs. 1.16 +/- 3.8, F = 5.895, p = 0.020). Older adults improved more in the Frontal Assessment Battery (1.00 +/- 0.95 vs. 0.54 +/- 0.21, F = 5.295, p = 0.027), Matrix test (0.58 +/- 0.35 vs. 0.37 +/- 0.26, F = 4.606, p = 0.038), and Test of Tale (0.81 +/- 0.36 vs. 0.42 +/- 0.38, F = 10.115, p = 0.003). Conclusions: Young adults improved more in complex cognitive tasks, while older adults showed better results in simpler tasks. The effectiveness of VR may be due to hyperstimulation of mirror neurons. Further studies are needed to confirm these findings.