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Meta-Analysis
. 2025 Jan 10:27:e59195.
doi: 10.2196/59195.

Virtual Reality Interventions for Older Adults With Mild Cognitive Impairment: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Qin Yang  1 , Liuxin Zhang  1 , Fangyuan Chang  1 , Hongyi Yang  1 , Bin Chen  1 , Zhao Liu  1
Affiliations
Meta-Analysis

Virtual Reality Interventions for Older Adults With Mild Cognitive Impairment: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Qin Yang et al. J Med Internet Res. .

Abstract

Background: Alzheimer disease is incurable, but it is possible to intervene and slow down the progression of dementia during periods of mild cognitive impairment (MCI) through virtual reality (VR) technology.

Objective: This study aimed to analyze the effects of VR interventions on older adults with MCI. The examined outcomes include cognitive abilities, mood, quality of life, and physical fitness, including general cognitive function, memory performance, attention and information processing speed, executive function, language proficiency, visuospatial abilities, depression, daily mobility of individuals, muscle performance, and gait and balance.

Methods: A total of 4 web-based databases (Web of Science, PubMed, Embase, and Ovid) were searched up to December 30, 2023, for randomized controlled trials assessing the self-reported outcomes of VR-based technology on cognition, mood, quality of life, and physical fitness in older adults (aged ≥55 years) with MCI. Two reviewers independently screened the search results and reference lists of the identified papers and related reviews. Data on the intervention components and delivery and behavioral change techniques used were extracted. A meta-analysis, risk-of-bias sensitivity analysis, and subgroup analysis were performed where appropriate to explore potential moderators. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the quality of evidence.

Results: This review analyzed 18 studies involving 722 older adults with MCI. VR was delivered through different immersion levels with VR cognitive training, VR physical training, or VR cognitive-motor dual-task training. VR interventions showed significant improvements in memory (standardized mean difference [SMD] 0.2, 95% CI 0.02-0.38), attention and information processing speed (SMD 0.25, 95% CI 0.06-0.45), and executive function (SMD 0.22, 95% CI 0.02-0.42). VR without therapist involvement improved memory as well as attention and information processing speed. VR cognitive training also resulted in significant improvements in attention and information processing speed in older adults with MCI (SMD 0.31, 95% CI 0.05-0.58). In addition, immersive VR had a significant impact on improving attention and information processing speed (SMD 0.25; 95% CI 0.01-0.50) and executive function (SMD 0.25; 95% CI 0.00-0.50). However, the effects of the intervention were very small in terms of general cognitive function, language proficiency, visuospatial abilities, depression, daily living ability, muscle performance, and gait and balance. Quality of evidence varied, with moderate ratings for certain cognitive functions and low ratings for others, based on the GRADE approach.

Conclusions: VR interventions can improve memory, attention and information processing speed, and executive function in older adults with MCI. The quality of evidence is moderate to low, and further research is needed to confirm these findings and explore additional health-related outcomes.

Keywords: Alzheimer disease; VR; attention; cognitive function; executive function; health care; memory; meta-analysis; mild cognitive impairment; older adults; virtual reality.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. MCI: mild cognitive impairment; RCT: randomized controlled trial; VR: virtual reality.
Figure 2
Figure 2
Summary of the risk-of-bias assessment.
Figure 3
Figure 3
Forest plot of general cognitive ability: comparison of general cognitive ability improvement at postintervention time points based on virtual reality intervention versus conventional treatment or no intervention control group.
Figure 4
Figure 4
Forest plot of performance and memory: comparison of performance and memory improvement at postintervention time points based on virtual reality intervention versus conventional treatment or no intervention control group.
Figure 5
Figure 5
Forest plot of attention and information processing speed: comparison of attention and information processing speed improvement at postintervention time points based on virtual reality intervention versus conventional treatment or no intervention control group.
Figure 6
Figure 6
Forest plot of executive function: comparison of executive function improvement at postintervention time points based on virtual reality intervention versus conventional treatment or no intervention control group.
Figure 7
Figure 7
Forest plot of subgroups with and without therapist participation (performance and memory): comparison of performance and memory at postintervention time points based on therapist involvement or no therapist involvement.
Figure 8
Figure 8
Forest plot of subgroups with and without therapist participation (attention and information processing speed): comparison of attention and information processing speed at postintervention time points based on therapist involvement or no therapist involvement.
Figure 9
Figure 9
Forest plot of subgroups by intervention content (attention and information processing speed): comparison of virtual reality cognitive training, virtual reality physical training, virtual reality cognitive-motor dual-task training, and virtual reality program in improving attention and information processing speed at postintervention time points.
Figure 10
Figure 10
Forest plot of subgroups by immersion level (attention and information processing speed): Immersive, semi-immersive, nonimmersive, and combined immersive and semi-immersive immersion levels improved attention and information processing speed at postintervention.
Figure 11
Figure 11
Forest plot of subgroups by immersion level (executive ability): comparison of immersion, semi-immersive, nonimmersive, and combined immersive and semi-immersive immersion levels in improving executive ability at postintervention time points.
See this image and copyright information in PMC

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