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Randomized Controlled Trial
. 2025 Jun 15:473:123507.
doi: 10.1016/j.jns.2025.123507. Epub 2025 Apr 14.

Effects of virtual reality cognitive training on executive function and prospective memory in Parkinson's disease and healthy aging

Eleonora Fiorenzato  1 , Silvia Zabberoni  2 , Maria Stefania De Simone  3 , Alberto Costa  4 , Gaetano Tieri  5 , Sara Taglieri  6 , Antonella Peppe  7 , Giovanni Augusto Carlesimo  8 , Carlo Caltagirone  9 , Angelo Antonini  10 , Giorgia Cona  11
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Free article
Randomized Controlled Trial

Effects of virtual reality cognitive training on executive function and prospective memory in Parkinson's disease and healthy aging

Eleonora Fiorenzato et al. J Neurol Sci. .
Free article

Abstract

Background: Neurocognitive disturbances in Parkinson's disease (PD) are common and can impact several aspects of daily functioning and quality of life. This multicenter study evaluated the efficacy of a novel immersive virtual reality (iVR) cognitive training (CT) targeting executive functions (EF)-planning, shifting, and updating abilities-to improve prospective memory (PM) in PD patients with mild cognitive impairment (PD-MCI). Potential transfer effects were also examined in healthy older adults (HC).

Methods: In this double-blind randomized controlled trial, 30 PD-MCI were randomized into a 4-week EF-training (PD-CT) or active placebo (PD-AP), delivered at home through a combined approach of telemedicine and iVR. Similarly, 30 age- and education-matched HC were assigned to the EF-training (HC-CT) or active placebo (HC-AP).

Results: The PD-CT group exhibited significant improvements in PM (in time-based and verbal-response tasks) and in EF, particularly in inhibition abilities (in the Stroop test), with effects sustained at 2-month follow-up. These gains were absent in the PD-AP group. Regression analyses revealed that PM enhancements were primarily driven by improved inhibition and shifting abilities. The EF-training was effective also in the older adults, the HC-CT group showed improvements in planning abilities (in the Zoo Map test) at post-intervention and 2-month follow-up, while no cognitive gains were observed in the HC-AP group.

Conclusions: This innovative iVR-based EF-training effectively enhances PM and inhibition in PD-MCI, and planning abilities in healthy older adults, demonstrating its potential for improving cognition in both populations. These findings support the use of iVR and telemedicine for accessible, personalized non-pharmacological cognitive interventions.

Keywords: Cognitive rehabilitation; Executive dysfunction; Healthy aging; Prospection; Telehealth; Virtual healthcare.

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Conflict of interest statement

Declaration of competing interest AA has received compensation for consultancy and speaker related activities from UCB, Boehringer Ingelheim, Britannia, AbbVie, Kyowa Kirin, Zambon, Bial, Neuroderm, Theravance Biopharma, Roche; he receives research support from Chiesi Pharmaceuticals, Lundbeck, Cariparo Foundation. He serves as consultant for Boehringer–Ingelheim for legal cases on pathological gambling. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. All the other authors declare that there are no additional disclosures to report.

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