1 INTRODUCTION 1 引言

According to the World Health Organisation, there are currently more than 55 million people with dementia worldwide. Every year, there are nearly 10 million new cases. (World Health Organization, 2023). As dementia progresses, people's cognitive and physical abilities gradually decline (Brodaty et al., 2015), and they exhibit behavioural and psychological symptoms such as agitation, dyskinesia, apathy and anxiety (Kales et al., 2015). Amid a global shortage of health workers, dementia care is complicated and burdensome. Formal and informal caregivers play an important role in improving the quality of care for people with dementia, as they are the people who know about their condition and spend the most time with them (Alushi et al., 2015; Li et al., 2022). Informal caregivers refer to a non-professional caregiver who provides life care, emotional support and financial help to people with dementia in a residential environment, usually without professional knowledge learning and training, and does not need to be paid (e.g. family or friends) (Teri et al., 1997). Formal caregivers are trained professionals who have received training or education in nursing and usually need to be paid (e.g. nursers or health care assistants) (Johns Hopkins Medicine, 2023). However, the available evidence suggests that both formal and informal caregivers have never experienced their lives from the perspective of people with dementia, are unable to perceive their needs (Cariñanos-Ayala et al., 2022), lack understanding and empathy for changes in dementia-related behaviour and psychological symptoms and may be prejudiced or have negative attitudes towards people with dementia (Borsje et al., 2016; Papastavrou et al., 2007). These factors negatively affect the health outcomes and quality of life of people with dementia and their caregivers (Travers et al., 2013). Therefore, there is a need to provide formal and informal caregivers with higher-quality and more specialised education and training to improve their knowledge and skills in dementia care.
据世界卫生组织统计，目前全球有超过 5,500 万痴呆症患者。每年新增病例近 1000 万例。(世界卫生组织，2023 年）。随着痴呆症的发展，患者的认知能力和身体机能会逐渐下降（Brodaty et al.在全球医护人员短缺的情况下，痴呆症护理工作既复杂又繁重。正规和非正规照护者在提高痴呆症患者的照护质量方面发挥着重要作用，因为他们是了解患者病情并与患者相处时间最长的人（Alushi 等人，2015 年；Li 等人，2022 年）。非正规照护者是指在居住环境中为痴呆症患者提供生活照料、情感支持和经济帮助的非专业照护者，他们通常没有经过专业知识学习和培训，也不需要报酬（如家人或朋友）（Teri 等人，1997 年）。正式照护者是受过护理培训或教育的专业人员，通常需要支付报酬（如护士或保健助理）（Johns Hopkins Medicine, 2023）。然而，现有证据表明，正规和非正规照护者从未从痴呆症患者的角度体验过他们的生活，无法感知他们的需求（Cariñanos-Ayala 等人，2022 年），对痴呆症相关行为和心理症状的变化缺乏理解和同情，并可能对痴呆症患者持有偏见或负面态度（Borsje 等人，2016 年；Papastavrou 等人，2007 年）。 这些因素对痴呆症患者及其照护者的健康状况和生活质量产生了负面影响（Travers 等人，2013 年）。因此，有必要为正规和非正规照护者提供更高质量、更专业的教育和培训，以提高他们在痴呆症照护方面的知识和技能。

2 THE REVIEW 2 审查

Simulation is a pedagogical strategy that engages learners in life experiences. This experiential teaching puts learners in direct contact with the real-world environment in which they are learning rather than just reading, listening or writing (Cook et al., 2011). Virtual reality includes interactive simulations created with computer hardware and software to present users with opportunities to engage in environments that appear and feel similar to real-world objects and events (Weiss et al., 2014). Current virtual reality technology is widely used in healthcare professionals' education and training, such as the use of virtual environments to enhance the realism of simulated patients in nursing education and the simulation of complex environments, such as operating rooms or emergency rooms, and provide medical personnel with an opportunity to practice before treating patients (Tene et al., 2024; Weaver, 2011). The use of virtual reality requires fewer resources than traditional lecture-style education and is not limited by location or time (Plotzky et al., 2020). A meta-analysis of randomised controlled and cluster-randomised controlled trials found that virtual reality-based health professional educational programmes improved participants' knowledge and skills to a greater extent (Kyaw et al., 2019), and there is growing support for the use of virtual reality-based simulations in education (Han et al., 2020).
模拟是一种让学习者参与生活体验的教学策略。这种体验式教学使学习者直接接触到他们正在学习的真实世界环境，而不仅仅是阅读、聆听或写作（Cook 等人，2011 年）。虚拟现实包括使用计算机硬件和软件创建的交互式模拟，为用户提供参与环境的机会，这些环境看起来和感觉上与现实世界的物体和事件相似（Weiss et al.）当前的虚拟现实技术广泛应用于医疗保健专业人员的教育和培训，例如在护理教育中使用虚拟环境来增强模拟病人的真实感，以及模拟手术室或急诊室等复杂环境，为医务人员提供治疗病人前的练习机会（Tene 等人，2024 年；Weaver，2011 年）。与传统的讲座式教育相比，使用虚拟现实技术所需的资源更少，而且不受地点或时间的限制（Plotzky 等人，2020 年）。对随机对照试验和分组随机对照试验进行的一项荟萃分析发现，基于虚拟现实的卫生专业教育计划在更大程度上提高了参与者的知识和技能（Kyaw等人，2019年），越来越多的人支持在教育中使用基于虚拟现实的模拟（Han等人，2020年）。

Virtual reality technology has advantages in the field of dementia education due to its ability to immerse participants in a virtual environment, allow them to experience the lives of people with dementia from a first-person perspective, and think from the perspective of a person with dementia (Herrera et al., 2018). In the theoretical framework proposed by Slater et al. virtual reality technology enables participants to develop a ‘sense of presence’ or a feeling that the virtual environment is real, which may promote greater motivation and engagement in learning and generate thoughts and emotions similar to a real-life environment (Mantovani, 2003; Slater & Wilbur, 1997). More importantly, educational programmes based on virtual reality technology allow participants to experience how people with dementia perceive the world to deepen their understanding and empathy and improve their attitudes towards people with dementia (Green et al., 2014; Whitelock et al., 2000). Dementia educational programmes using virtual reality technology are designed to target a wide range of participants, including students, community residents, formal caregivers and informal caregivers (Gilmartin-Thomas et al., 2018; Sari et al., 2020;Stargatt et al., 2022; Wijma et al., 2018). In one non-randomised controlled study, 278 students (n = 64 medical, n = 214 pharmacy) were divided into intervention group (n = 80) and control group (n = 198) to receive virtual simulation educational programmes and standard curriculum, respectively. After 1 month, the medical students in the intervention group showed positive improvements in their awareness and attitudes towards people with dementia. (Gilmartin-Thomas et al., 2018). In the quasi-experimental study of Stargatt et al. and Wijma et al., empathy and self-confidence of formal (n = 40) and informal (n = 35) dementia caregivers were assessed immediately following virtual reality-based dementia education intervention. The results showed significant increases in empathy and self-confidence following the intervention (Stargatt et al., 2022; Wijma et al., 2018). Another one-group pre-test and post-test design study indicated that education using virtual reality could improve the attitudes of community residents (n = 42) and promote their willingness to help people with dementia (Sari et al., 2020).
虚拟现实技术能够让参与者沉浸在虚拟环境中，让他们从第一人称的角度体验痴呆症患者的生活，并从痴呆症患者的角度进行思考，因此在痴呆症教育领域具有优势（Herrera et al.）根据斯莱特等人提出的理论框架，虚拟现实技术能让参与者产生 "临场感"，或感觉虚拟环境是真实的，这可能会促进学习动机和参与度的提高，并产生与现实生活环境类似的想法和情感（Mantovani，2003；Slater & Wilbur，1997）。更重要的是，基于虚拟现实技术的教育计划可以让参与者体验痴呆症患者是如何感知世界的，从而加深他们对痴呆症患者的理解和同情，改善他们对痴呆症患者的态度（Green 等人，2014 年；Whitelock 等人，2000 年）。使用虚拟现实技术的痴呆症教育计划旨在针对广泛的参与者，包括学生、社区居民、正式照护者和非正式照护者（Gilmartin-Thomas 等人，2018 年；Sari 等人，2020 年；Stargatt 等人，2022 年；Wijma 等人，2018 年）。在一项非随机对照研究中，278 名学生（n = 64 名医学生，n = 214 名药学学生）被分为干预组（n = 80）和对照组（n = 198），分别接受虚拟仿真教育课程和标准课程。1 个月后，干预组的医学生对痴呆症患者的认识和态度有了积极的改善。(Gilmartin-Thomas 等人，2018 年）。在Stargatt等人和Wijma等人的准实验研究中，干预组的医学生对痴呆症患者的认识和态度有了积极的改善（Gilmartin-Thomas等人，2018年）。在基于虚拟现实的痴呆症教育干预之后，立即对正式（40 人）和非正式（35 人）痴呆症照护者的同理心和自信心进行了评估。结果显示，干预后移情能力和自信心都有了明显提高（Stargatt 等人，2022 年；Wijma 等人，2018 年）。另一项单组前测试和后测试设计研究表明，使用虚拟现实技术进行教育可以改善社区居民（n = 42）的态度，促进他们帮助痴呆症患者的意愿（Sari 等人，2020 年）。

Four reviews of dementia educational programmes, including virtual reality, have been published. These reviews summarised evidence that educational programmes improve participant outcomes, including knowledge, attitudes, empathy, sensitivity and self-confidence (Adewuyi et al., 2022; Cariñanos-Ayala et al., 2022; Jones et al., 2021; Williams & Daley, 2021). However, these studies focused on nursing students and provided no evidence for dementia caregivers. Formal and informal caregivers provide direct care to people with dementia, and the effectiveness of virtual reality-based educational programmes for this population has not been determined. A previous scoping review investigating the influence of virtual reality simulation for caregivers in dementia care education included only six ongoing studies and single-arm before-and-after studies; it did not include studies with a control design. Besides, this study did not describe the different effects of education programs on formal and informal caregivers separately (Hirt & Beer, 2020). To the best of our knowledge, there is much evidence for dementia educational programmes involving virtual reality technology that has not been aggregated, and there is a lack of research that categorises these educational programmes. Therefore, the present study aimed to map the evidence for a virtual reality-based dementia educational programmes and explore its effects on dementia formal and informal caregivers.
目前已发表了四篇关于痴呆症教育计划（包括虚拟现实）的综述。这些综述总结了教育项目可改善参与者成果的证据，包括知识、态度、同理心、敏感性和自信心（Adewuyi 等人，2022 年；Cariñanos-Ayala 等人，2022 年；Jones 等人，2021 年；Williams & Daley，2021 年）。然而，这些研究主要针对护理专业学生，并没有为痴呆症护理人员提供证据。正式和非正式护理人员为痴呆症患者提供直接护理，而基于虚拟现实的教育计划对这一人群的有效性尚未确定。之前的一项范围审查调查了虚拟现实模拟对痴呆症护理教育中护理人员的影响，其中只包括六项正在进行的研究和单臂前后对比研究，并不包括采用对照设计的研究。此外，这项研究也没有分别描述教育项目对正式和非正式照护者的不同影响（Hirt & Beer，2020 年）。据我们所知，有许多涉及虚拟现实技术的痴呆症教育项目的证据尚未汇总，也缺乏对这些教育项目进行分类的研究。因此，本研究旨在绘制基于虚拟现实技术的痴呆症教育项目的证据图，并探讨其对痴呆症正式和非正式照护者的影响。

3 AIM(S) 3 AIM（S）

This study explored existing literature on the implementation of virtual reality-based dementia educational programmes for dementia formal and informal caregivers. This scoping review investigated three research questions: (1) Types and programmes content of the existing dementia educational programmes based on virtual reality technology for dementia formal and informal caregivers, (2) the effects of these educational programmes on the knowledge level, perception, attitude and nursing competence of dementia formal and informal caregivers.
本研究探究了有关为痴呆症正式和非正式照护者实施基于虚拟现实技术的痴呆症教育项目的现有文献。本次范围界定综述调查了三个研究问题：（1）现有基于虚拟现实技术的痴呆症正规和非正规照护者痴呆症教育项目的类型和项目内容；（2）这些教育项目对痴呆症正规和非正规照护者的知识水平、认知、态度和护理能力的影响。

4 METHOD 4ETHOD

4.4 Search outcome 4.4 搜索结果

In total, 853 articles were identified through database searches and 150 duplicate articles were removed. A total of 703 articles were screened for titles and abstracts, and 679 articles were excluded. The full texts of 24 articles were read and screened, and 16 articles met the inclusion criteria. Figure 1 shows the reasons for excluding full text articles. Three articles were included after screening the reference lists of the included articles or the reference lists of the reviews. The final scoping review contained 19 articles.
通过数据库搜索共找到 853 篇文章，删除了 150 篇重复文章。共筛选了 703 篇文章的标题和摘要，排除了 679 篇文章。阅读并筛选了 24 篇文章的全文，其中 16 篇符合纳入标准。图 1 显示了排除全文文章的原因。在筛选了纳入文章的参考文献目录或综述的参考文献目录后，有 3 篇文章被纳入其中。最终的范围界定综述包含 19 篇文章。

5 RESULTS 5 结果

6 DISCUSSION 6 讨论

To the best of our knowledge, this review is the first scoping review to explore virtual reality-based dementia educational programmes for formal and informal caregivers of people with dementia. This study provided a detailed mapping of existing virtual reality-based dementia educational programmes and evaluated the effects of these educational programmes on improving the knowledge, perceptions, attitudes and nursing competence of dementia formal and informal caregivers. Although caregivers were receptive to virtual reality-based educational programmes, these programmes must be further optimised.
据我们所知，本综述是首次针对痴呆症患者的正式和非正式照护者探讨基于虚拟现实的痴呆症教育项目的范围界定综述。本研究详细介绍了现有的基于虚拟现实的痴呆症教育项目，并评估了这些教育项目在提高痴呆症正式和非正式照护者的知识、认知、态度和护理能力方面的效果。尽管照护者对基于虚拟现实的教育计划持欢迎态度，但这些计划还必须进一步优化。

Eight virtual reality-based dementia educational programmes (Beville, 2002; Han et al., 2020, 2021; Jütten et al., 2018; Slater et al., 2019, 2021; Stargatt et al., 2021, 2022; Sung et al., 2022; Wijma et al., 2018) and nine virtual reality-based dementia educational programmes (Aicken et al., 2021; Jütten et al., 2018; Kim, 2021; Maskeliūnas et al., 2019; Prins et al., 2020; Slater et al., 2019; Solecki et al., 2021; Stargatt et al., 2021; Sung et al., 2022; Tropea et al., 2022) had positive effects on the perceptions and attitudes of dementia formal and informal caregivers, respectively. The model of Lane et al. hypothesised that knowledge directly influences behaviour and is indirectly adjusted by attitudes (Lane & Yu, 2020). However, the results of this review might reveal a new way to enhance care capabilities and promote helping behaviours by acting directly on emotions and increasing empathy without the need to acquire knowledge via lectures or other forms of education. Virtual reality technology creates a simulated body in space that allows participants to experience the life of a person with dementia from a first-person perspective (Yamaguchi et al., 2022). Participants felt a strong ‘sense of presence’ in virtual reality conditions, and this experiential learning occurred at cognitive and emotional levels. Formal and informal caregivers deeply understood the psychological and behavioural symptoms of people with dementia and developed empathy and positive attitudes towards them. This ‘understanding and empathy’ is likely to influence behaviour and practice (Digby et al., 2016). However, it is worth noting that the studies that revealed this result were mostly those with a quasi-experimental design (n = 8) (Beville, 2002; Jütten et al., 2018; Maskeliūnas et al., 2019; Prins et al., 2020; Slater et al., 2021; Solecki et al., 2021; Stargatt et al., 2022; Wijma et al., 2018), randomised controlled studies also had problems such as failure to report blind method and analysis in allocated group (Han et al., 2021; Stargatt et al., 2022; Sung et al., 2022). Therefore, whether perception and attitude can directly affect the path of behaviour still needs to be verified by high-quality randomised controlled trial. In addition, the study found that virtual reality-mediated learning was more impactful than traditional face-to-face teaching. This form of virtual reality education is not overly dependent on cultural or linguistic backgrounds, and it provides different levels of assistance to learners of different ages, educational backgrounds and linguistic backgrounds (Olson et al., 2011). Given this diversity, it is important to know which educational programmes are suitable for different groups in the future. Notably, two studies in this review reported the effects of unfamiliarity with virtual reality procedures and devices in older formal caregivers (Aicken et al., 2021; Kim, 2021). Therefore, adequate familiarity with the use of educational devices in dementia formal caregivers before the implementation of educational programmes based on virtual reality education technologies is necessary.
8个基于虚拟现实的痴呆症教育项目（Beville，2002；Han等人，2020，2021；Jütten等人，2018；Slater等人，2019，2021；Stargatt等人，2021，2022；Sung等人，2022；Wijma等人，2018）和9个基于虚拟现实的痴呆症教育项目（Aicken等人，2021；Jütten等人，2018；Kim，2021；Maskeliūnas等人，2019；Prins等人，2020；Slater等人，2019；Solema等人，2018）、2021年；Jütten等人，2018年；Kim，2021年；Maskeliūnas等人，2019年；Prins等人，2020年；Slater等人，2019年；Solecki等人，2021年；Stargatt等人，2021年；Sung等人，2022年；Tropea等人，2022年）分别对痴呆症正式和非正式照护者的认知和态度产生了积极影响。Lane 等人的模型假设，知识直接影响行为，并由态度间接调整（Lane & Yu, 2020）。然而，本综述的结果可能揭示了一种新的方法，即通过直接作用于情感和增加同理心来提高护理能力和促进帮助行为，而无需通过讲座或其他形式的教育来获取知识。虚拟现实技术在空间中创造了一个模拟体，让参与者以第一人称的视角体验痴呆症患者的生活（Yamaguchi 等人，2022 年）。参与者在虚拟现实条件下感受到了强烈的 "存在感"，这种体验式学习发生在认知和情感层面。正式和非正式照顾者深刻理解了痴呆症患者的心理和行为症状，并对他们产生了共鸣和积极的态度。这种 "理解和共情 "很可能会影响行为和实践（Digby 等人，2016 年）。然而，值得注意的是，揭示这一结果的研究大多采用准实验设计（n = 8）（Beville, 2002; Jütten et al.然而，随机对照研究也存在未报告盲法和分配组分析等问题（Han等，2021；Stargatt等，2022；Sung等，2022）。因此，感知和态度是否能直接影响行为路径仍需通过高质量的随机对照试验来验证。此外，研究还发现，以虚拟现实为媒介的学习比传统的面对面教学更有影响力。这种虚拟现实教育形式不过分依赖于文化或语言背景，它能为不同年龄、教育背景和语言背景的学习者提供不同程度的帮助（Olson 等人，2011 年）。鉴于这种多样性，未来了解哪些教育计划适合不同群体非常重要。值得注意的是，本综述中有两项研究报告了老年正式护理人员不熟悉虚拟现实程序和设备的影响（Aicken 等人，2021 年；Kim，2021 年）。因此，在实施基于虚拟现实教育技术的教育计划之前，有必要让老年痴呆症正规照护者充分熟悉教育设备的使用。

Currently, little is known about the effectiveness of virtual reality-based dementia educational programmes in improving the nursing competence of formal and informal caregivers. Although studies have reported that understanding and empathy translated into outcomes in participants' behaviour, including nursing competence, enabling them to respond to challenges in practice (Slater et al., 2019), only one studies in this review addressed improvements in informal caregivers' nursing competence. Therefore, how to apply the theoretical knowledge learned in virtual reality-based dementia educational programmes to practice remains to be studied. There are many competing needs (e.g. lack of staff, time and resources) in dementia care that interfere with formal caregivers' ability to translate positive attitudes into practice. If virtual reality-based dementia educational programmes are embedded in the structured plan of dementia care, it will provide a more complete learning experience for dementia formal caregivers and reduce some of the waste of human and material resources.
目前，人们对基于虚拟现实的痴呆症教育项目在提高正式和非正式护理人员护理能力方面的有效性知之甚少。虽然有研究报告称，理解和移情转化为参与者的行为结果，包括护理能力，使他们能够应对实践中的挑战（Slater 等人，2019 年），但本综述中只有一项研究涉及非正规护理人员护理能力的提高。因此，如何将在基于虚拟现实的痴呆症教育项目中学到的理论知识应用于实践仍有待研究。痴呆症护理中有许多相互竞争的需求（如缺乏人手、时间和资源），这些需求干扰了正式护理人员将积极态度转化为实践的能力。如果将基于虚拟现实的痴呆症教育计划嵌入痴呆症护理的结构化计划中，将为痴呆症正式护理人员提供更完整的学习体验，并减少部分人力和物力资源的浪费。

Preliminary findings from three studies suggested dementia educational programmes with virtual reality experiences alone might not be sufficient to significantly improve knowledge (Stargatt et al., 2021; Tropea et al., 2022; Yamaguchi et al., 2022). This finding highlighted the need to consider teaching or learning strategies outside of virtual reality experiences, potentially using different methods to capture the knowledge gained from experiences, such as dementia education lectures and e-book modules to consolidate and expand knowledge (Sung et al., 2022), maintain sustainability and prevent burnout (Solecki et al., 2021). In the future, this idea could be used when designing dementia educational programmes and further validate the validity of the findings. Besides, it is beneficial for caregivers to combine discussion groups or presentations during or at the end of teaching. Debriefing is an essential element of experiential learning to acquire knowledge because it provides a safe environment for sharing, reflection and critical thinking (Siew et al., 2021), where formal and informal caregivers have the opportunity to discuss dementia care experiences and care strategies with peers or specialists. However, the combination of virtual reality experiences with other educational methods requires more resources and time (Aicken et al., 2021), and existing research cannot determine whether the costs involved in these educational programmes are balanced with the benefits of the programmes. Further evaluation of the cost-effectiveness of educational programmes based on virtual reality technology needs to be conducted in the future.
三项研究的初步结果表明，仅有虚拟现实体验的痴呆症教育计划可能不足以显著提高知识水平（Stargatt等人，2021年；Tropea等人，2022年；Yamaguchi等人，2022年）。这一发现凸显了考虑虚拟现实体验之外的教学或学习策略的必要性，有可能使用不同的方法来获取从体验中获得的知识，如痴呆症教育讲座和电子书模块，以巩固和扩展知识（Sung 等人，2022 年），保持可持续性并防止倦怠（Solecki 等人，2021 年）。今后，在设计痴呆症教育计划时可采用这一想法，并进一步验证研究结果的有效性。此外，在教学过程中或教学结束时结合讨论小组或演讲，对护理人员也有好处。汇报是体验式学习获取知识的基本要素，因为它为分享、反思和批判性思维提供了一个安全的环境（Siew et al.然而，将虚拟现实体验与其他教育方法相结合需要更多的资源和时间（Aicken 等人，2021 年），现有研究无法确定这些教育计划所涉及的成本是否与计划的收益相平衡。今后需要进一步评估基于虚拟现实技术的教育计划的成本效益。

The challenges and responsibilities posed by dementia should not stop at the level of dementia formal and informal caregivers but should be structured at the social level to strengthen the understanding of dementia in the whole community, which is consistent with the social model of disability (Anastasiou & Kauffman, 2013). There is a need to conduct virtual reality-based educational programmes in dementia safety centres in various localities so that caregivers and the public can experience and receive education. However, most of the scenes constructed using virtual reality technology depict the negative psychology or behaviour of people with dementia. Although disability simulation effectively raises awareness of dementia, they may inadvertently perpetuate the ‘tragedy discourse’ that prevails throughout society (McParland et al., 2017). This view is consistent with the disability simulation of undergraduate students conducted by Nario-Redmond et al. in 2017 (Nario-Redmond et al., 2017). For this study, 60 undergraduates were randomly assigned to a disability awareness simulation group with dyslexia, hearing impairment or mobility impairment. Before and after the simulation, all participants were asked about their emotions, their thoughts and attitudes towards disability. The results showed that the disability simulation made participants feel more negative, and the reading and mobility disorders simulations made them feel more anxious, embarrassed and helpless, and even perceived themselves as more vulnerable to becoming disabled. This phenomenon also appeared in Silverman et al.'s study (Silverman, 2015; Silverman et al., 2017). However, it is worth noting no studies reported controversy about this disability simulation (e.g. negative perceptions of disability or reduced respect/perceptions of ability) among formal or informal caregivers when applying virtual reality-based dementia educational programmes. Therefore, future studies are necessary to report on this situation to identify and prioritise the challenges associated with the disease and to describe whether disability simulation leads to greater stigmatisation of the disease and a tendency to view people with dementia with despair, which will help researchers judge the feasibility and effectiveness of virtual reality-based dementia educational programmes.
痴呆症带来的挑战和责任不应停留在痴呆症正式和非正式照护者的层面，而应在社会层面进行构建，以加强整个社区对痴呆症的理解，这与残疾的社会模式是一致的（Anastasiou & Kauffman，2013 年）。有必要在各地的痴呆症安全中心开展基于虚拟现实的教育项目，以便护理人员和公众能够体验和接受教育。然而，大多数利用虚拟现实技术构建的场景都描述了痴呆症患者的消极心理或行为。尽管残疾模拟能有效提高人们对痴呆症的认识，但它们可能会无意中延续整个社会普遍存在的 "悲剧话语"（McParland 等人，2017 年）。这一观点与 Nario-Redmond 等人在 2017 年对本科生进行的残疾模拟研究（Nario-Redmond et al.）在这项研究中，60 名本科生被随机分配到有阅读障碍、听力障碍或行动障碍的残疾意识模拟组。在模拟之前和之后，所有参与者都被询问了他们的情绪、想法以及对残疾的态度。结果显示，残疾模拟让参与者感到更加消极，而阅读障碍和行动障碍模拟则让他们感到更加焦虑、尴尬和无助，甚至认为自己更容易成为残疾人。这一现象也出现在西尔弗曼等人的研究中（Silverman，2015；Silverman et al.，2017）。然而，值得注意的是，没有任何研究报告了关于这种残疾模拟的争议（例如，Silverman et al. 在应用基于虚拟现实的痴呆症教育计划时，正式或非正式照顾者会对残疾产生负面看法，或对能力的尊重/看法降低。因此，未来的研究有必要报告这种情况，以确定与该疾病相关的挑战并将其列为优先事项，同时描述残疾模拟是否会导致对该疾病的更大鄙视以及对痴呆症患者的绝望倾向，这将有助于研究人员判断基于虚拟现实的痴呆症教育计划的可行性和有效性。

Furthermore, improvements are needed for virtual reality-based dementia educational programmes. (1) Virtual reality neuroscience investigations: The development of virtual reality experience symptom measurement tools for participants who feel scared, dizzy, etc., for the first time can assess participants' symptoms before and during implementation (Kim, 2021). (2) Deepening the immersive experience: Compared with virtual reality technology using PCs, tablets or large displays, wearable devices (helmets, gloves, etc.) provide more realistic visual, auditory and tactile simulations (Zagury-Orly et al., 2023). (3) Personalisation: At present, there are no effective drugs for the treatment of dementia (Yiannopoulou & Papageorgiou, 2020). Therefore, as dementia progresses, formal and informal caregivers need to deal with the different cognitive and behavioural symptoms of people with dementia. However, existing educational programmes are only applicable for a certain stage of dementia and may no longer be applicable when people with dementia progress and develop more severe dementia symptoms (e.g. aggressive behaviour and self-care difficulties) (World Health Organization, 2023). Consequently, dementia educational programmes based on virtual reality technology must tailor scenarios and content for inform and informal caregivers according to different types (e.g. Alzheimer's disease and vascular dementia), symptoms (e.g. memory loss, anxiety and apathetic) and degrees (e.g. mild, moderate and severe) of dementia. (4) Involvement of stakeholders in the development process: Co-design of technologies with advice from people with dementia and their caregivers is an emerging trend (Span et al., 2013). Kenigsberg et al. emphasised that the decision to consult people with dementia and their caregivers while creating virtual scenarios, implementing educational programmes and evaluating programmes' effectiveness is justified, thus ensuring that they accurately depict some of the life experiences of people with dementia and developing educational programmes that fit the purposes of the study (Kenigsberg et al., 2019). In the future, the field of dementia care and/or virtual reality education can continue to follow the principle of stakeholder participation in development, implementation and evaluation.
此外，还需要改进基于虚拟现实的痴呆症教育计划。(1) 虚拟现实神经科学调查：开发虚拟现实体验症状测量工具，对首次感到恐惧、头晕等症状的参与者进行测量，可以在实施前和实施过程中对参与者的症状进行评估（Kim，2021 年）。(2）加深沉浸式体验：与使用个人电脑、平板电脑或大型显示器的虚拟现实技术相比，可穿戴设备（头盔、手套等）可提供更逼真的视觉、听觉和触觉模拟（Zagury-Orly et al.）(3) 个性化：目前，还没有治疗痴呆症的有效药物（Yiannopoulou & Papageorgiou, 2020）。因此，随着痴呆症的发展，正规和非正规护理人员需要应对痴呆症患者不同的认知和行为症状。然而，现有的教育计划只适用于痴呆症的某一阶段，当痴呆症患者病情发展并出现更严重的痴呆症症状（如攻击性行为和自理困难）时，这些计划可能就不再适用了（世界卫生组织，2023 年）。因此，基于虚拟现实技术的痴呆症教育计划必须根据痴呆症的不同类型（如阿尔茨海默氏症和血管性痴呆）、症状（如记忆力减退、焦虑和冷漠）和程度（如轻度、中度和重度），为信息提供者和非正规护理者量身定制情景和内容。(4) 让利益相关者参与开发过程：根据痴呆症患者及其照顾者的建议共同设计技术是一种新兴趋势（Span 等人，2013 年）。Kenigsberg et al. 他们强调，在创建虚拟场景、实施教育计划和评估计划效果时咨询痴呆症患者及其护理人员的决定是合理的，这样可以确保他们准确描述痴呆症患者的一些生活经历，并制定符合研究目的的教育计划（Kenigsberg et al.）未来，痴呆症护理和/或虚拟现实教育领域可以继续遵循利益相关者参与开发、实施和评估的原则。

7 CONCLUSIONS 7 结论

Virtual reality-based dementia educational programmes offer new ideas for improving teaching models and may be a safe and effective way to improve dementia formal and informal caregivers' perceptions, attitudes and nursing competence. Notably, when virtual reality experiences were combined with other teaching or learning strategies, the knowledge gained from the experience significantly improved the knowledge level of formal and informal caregivers. Virtual reality-based dementia educational programmes are currently not widely available, but our findings demonstrate the potential of educational programmes to support formal and informal caregivers of people with dementia. In the future, high-quality randomised controlled trials or cohort studies with larger sample sizes and longer intervention durations should be designed to explore which type of educational programmes are more beneficial for formal and informal caregivers of people with dementia. Besides, the development process of virtual reality-based dementia educational programmes and theoretical underpinning should be described in detail. More importantly, in the process of developing virtual reality-based dementia educational programmes, it is necessary to involve not only experts in the field of dementia and virtual reality, but also consumers and community involvement with life experience who may provide valuable advice.
基于虚拟现实的痴呆症教育计划为改进教学模式提供了新思路，可能是提高痴呆症正式和非正式护理人员认知、态度和护理能力的一种安全有效的方法。值得注意的是，当虚拟现实体验与其他教学或学习策略相结合时，从体验中获得的知识能显著提高正式和非正式护理人员的知识水平。基于虚拟现实的痴呆症教育计划目前还没有广泛应用，但我们的研究结果表明，教育计划具有为痴呆症患者的正式和非正式照护者提供支持的潜力。今后，应设计样本量更大、干预时间更长的高质量随机对照试验或队列研究，以探讨哪种类型的教育项目对痴呆症患者的正式和非正式照护者更有益。此外，还应详细介绍基于虚拟现实的痴呆症教育项目的开发过程和理论基础。更重要的是，在开发基于虚拟现实的痴呆症教育项目的过程中，不仅需要痴呆症和虚拟现实领域的专家参与，还需要有生活经验的消费者和社区参与，他们可以提供宝贵的建议。

AUTHOR CONTRIBUTIONS 作者贡献

Shengze Zhi: conceptualization, methodology, writing—original draft, formal analysis, data curation, validation. Shizheng Gao: data curation, writing—original draft. Juanjuan Sun: data curation, validation. Dongfei Ma: writing—review and editing. Yanjie Zho: conceptualization, writing—original draft. Meng He: conceptualization, writing—original draft. Xiangning Zhu: formal analysis. Yueyang Dong: formal analysis. Buheliqianmu Aini: validation. Jiao Sun: supervision, writing—review and editing.
支盛泽：构思、方法、撰写-原稿、形式分析、数据整理、验证。Shizheng Gao：数据整理、撰写-原稿。孙娟娟：数据整理、验证。马东飞：撰写-审阅和编辑。赵艳杰：构思、撰写-原稿。何萌：构思、撰写-原稿。Xiangning Zhu：形式分析。岳阳东：形式分析。布合力前木-艾尼：验证。孙娇：指导、撰写-审阅和编辑。

FUNDING INFORMATION 资金信息

Supported by Graduate Innovation Fund of Jilin University [2023CX130]; Supported by the Department of Science and Technology of Jilin Province [20230203076SF].
吉林大学研究生创新基金[2023CX130]资助；吉林省科技厅[20230203076SF]资助。

CONFLICT OF INTEREST STATEMENT
利益冲突声明

None. 无。