Table 3 Characteristics of the interventions in the included studies
Authors and year of publication | Study type | Intervention and VR type | Task/place simulated | Duration (Days × weeks × minutes) | Outcome measurements | Specific cognitive abilities | Main findings | Conclusions |
|---|---|---|---|---|---|---|---|---|
Foloppe et al. (2018) [53] | Single case | Non-Immersive CRE | Virtual and real cooking tasks | 4d × 4w × 60 min | Patient: MMSE, IADL-9, RDES, ADRQL-F. Caregiver: MiniZarit, RSES, ADRQL-F | Memory, attention, planning, sequencing, basic motor skills, iADL | The patient showed a modest but significant improvement in assisted autonomy when relearning cooking activities with VR (15.4% in the virtual condition, 11.3% in the real condition) The need for assistance decreased, although instrumental activities of daily living did not change Mini-Zarit (caregiver burden) was reduced from moderate to mild | VR enabled the AD patient to improve in cooking tasks, with stable results up to a 6-month follow-up. However, there was no knowledge transfer to other iADLs Hybrid programs combining VR and real environments may be beneficial in achieving generalization to other activities Therefore, VR interventions should be tailored to individual needs and histories |
Schreiber et al. (1999) [58] | Pilot pretest–posttest | Non-Immersive CTR | Virtual apartment | 5d × 2 w × 30 min | NAI Picture Test, NAI Figure Test, RBMT Picture Test, RBMT Route Learning (immediate and delayed) | Immediate and late retention and visual-figurative and topographic material | VR training improved the retention of significant visual-figurative and topographic information, with notable differences between the training and control groups on the NAI Picture Test (P = 0.006) and the RBMT Route Learning, delayed (P = 0.025) Subjects with dementia experienced real improvements in training and achieved lower difficulty levels on delayed retention | Pre- and post-training neuropsychological assessment indicated a direct transfer to real-life situations in the training group Standardized psychometric tests revealed a positive effect of computer-based training in certain memory domains, specifically in the target areas |
Zhu et al. (2022) [68] | Pilot pretest–posttest | Immersive CTR | Virtual Supermarket | 3 d × 5 w × 20/30 min | MoCA-CS, MMSE, AVLT, STT, SDMT, PSS, GDS | Executive function, attention, memory, general cognition | Both groups (MCI and MD) showed significant improvements in all measures of cognitive function The MD group improved overall cognitive function significantly more than the MCI group in MoCA, SDMT, STT, and AVLT In addition, an intervention effect was found in improving perceived stress | VR-based intervention protocol was effective in improving the general cognitive function (memory, executive function, and attention) of patients with MCI and MD Adjusting task difficulty according to the baseline cognitive level of patients with MD positively improved cognitive function |
Man et al. (2012) [59] | RCT | Non-Immersive CTR | Virtual apartment, Virtual supermarket | 2/3 d × 4 w × 30 min | FOME-TE, FOME-TR, FOME-DR, MMQ-contentment, MMQ-ability, MMQ-strategy, HK Lawton IADL | episodic memory, total recall, delayed recall, memory, satisfaction with performance, iADL | The VR group showed significant improvements in total encoding, total recall and delayed recall (FOME), and MMQ strategy The active control group improved total recall, delayed recall (FOME), and MMQ satisfaction | Virtual training significantly improved memory performance (immediate and delayed episodic memory recall) regardless of educational level VR environments with audiovisual stimuli can improve information encoding |
Panerai et al. (2021) [64] | CT | Non-Immersive CTR | 1) Follow instructions 2) Medication intake 3) Fill a suitcase 4) Virtual supermarket | 5d × 6w × 3 h (5-people group) | MMSE, CPM, CBT, DS, RAVL (immediate, delayed), FAB, IADL | General cognition, ecological memory, visual-auditory memory, selective attention,verbal memory, iADL | The experimental group (EG) showed improvements in correct responses, missing responses, number of cues and execution times compared to the active control group (ACG) There was no improvement in the iADL scale in both groups A spontaneous transfer of re-learned functional skills to iADL in EG is suggested | VR showed ecological validity, improving functional skills in patients with early-stage dementia Daily living skills need specific training to be relearned Skill generalization is related to cognitive functioning and hippocampal integrity |
Masoumzadeh et al. (2020) [57] | Pilot pretest–posttest | Immersive CTR | Driving simulator (VRDS) | 5d × 4w × 30 min | MWT, SSQ, MADRS | spatial cognition, independence, mood, depression | Significant advances in spatial cognition (Morris test) and learning in older adults with varying degrees of dementia Improvements in mood and cognitive functions More training time is suggested for patients with MCI and AD | VRDS training had positive effects on older adults’ spatial cognition, even on those with different degrees of dementia There were also improvements in mood and cognitive functions |
Fasilis et al. (2018) [55] | Pilot pretest–posttest | Non-Immersive CRE | Virtual supermarket, Virtual cooking tasks, home arrangement and cleaning | 3d × 5w × 40 min | DS, BSRT, TMT-A, Hanoi Tower, FAB, WCST | Working memory, attention, problem-solving, rigid thinking, executive function | Significant improvements in working memory, memory retention, executive functions, and rigid thinking Statistically significant increase in FAB battery (executive functions) between pre-and post-training Knowledge transfer to daily activities observed | Relative improvement in the total cognitive variables considered Possible ceiling effect in healthy participants. Therapeutic benefits and transferability to real-life situations in 3D virtual environments Need for further research to assess the "therapeutic effect" |
Hofmann et al. (2003) [69] | CT | Non-Immersive CTR | Virtual Supermarket | 3d × 4w | CDR, MMSE, TMT-A, MADRS | Navigation, decision making, memory, basic motor skills | Improvement trend in all three groups, but only the reduction in errors in patients with AD was significant Improvements in all groups up to 3 weeks later Patients with depression presented higher latency than healthy patients, and no correlation was found between MADRS and performance | The intervention showed promising results, especially in reducing errors in patients with AD However, further research is needed to address methodological limitations and assess the ecological validity of computer-based ADL applications in different patient groups |
Kang et al. (2021) [61] | RCT | Immersive CTR | Find differences, select objects to perform tasks, Virtual supermarket, find a path, place furniture in a space, catch animals in a certain order | 2d × 4w × 20/30 min | ROCF, MMSE, DS, TMT-A, K-BNT, SVLT, COWAT, SCWT, TMT-B, GDS, AES, PANAS-P, PANAS-N, QoL-AD | Visuospatial processing, naming ability, verbal memory, phonetic fluency, frontal executive function and psychiatric symptoms | The intervention showed significant improvements in the EG in the total score and basic components of the RCFT Non-significant improvements were found in naming skills, delayed verbal memory recall, and phonetic fluency Improvements in psychiatric symptoms such as apathy, affect, and quality of life in the EG | The intervention positively affected various cognitive functions and psychiatric conditions, as well as increased frontal-occipital functional connectivity in older people in the predementia state Future research with larger samples and control groups is needed to validate these results |
Yamaguchi et al. (2012) [51] | Pilot pretest–posttest | Non-Immersive Re-learning | Virtual cooking tasks | 2d × 1w × 90 min | Written ILM, Self-recorded ILM | Ability to learn and perform ADL in virtual environments | Patients with AD take longer in daily functional activities. Error-free learning methods in virtual environments could benefit patients with AD Participants reported difficulties with mouse use and needed more time to become familiar with virtual tasks | Training in virtual environments may increase functional autonomy in patients with AD However, further studies are required to confirm these results, considering the limitations, such as the low number of participants, differences in AD stages, and few training sessions |
Park (2022) [62] | RCT | Non-Immersive CTR | Virtual supermarket | 2d × 8w × 60 min | EFPT-K, K-IADL | Visual memory, attention, navigation, executive function, iADL | The study found that virtual shopping training significantly improved executive functions and iADLs in patients with MCI compared to the control group, supporting the ecological validity of this approach | Virtual shopping training is clinically effective in improving executive function and iADLs in patients with MCI Shopping in virtual environments can be an effective form of training, as it requires complex cognitive skills and helps patients cope with distractions |
Maeng et al. (2021) [66] | CT | Immersive CTR | Virtual supermarket | 2d × 4w × 50/60 min | CERAD-K, KQOL-AD, GDS, SSQ, Presence Q, Presence S | Memory, attention, executive function | Improvements in cognition in patients with MCI and healthy older adults Both groups improved in learning new information, visuospatial construction, and frontal lobe function The MCI group specifically improved in word recall and recognition and TMT-A performance, while the healthy older adult group improved on the Korean-Boston naming test | VRCT improves cognition in patients with MCI and healthy older adults Despite limitations, such as a small sample size and lack of follow-up, the study suggests that VRCT programs may be applicable and effective in populations with reduced cognitive ability |
Kim et al. (2021) [67] | CT | Immersive CTR | Virtual supermarket | 2d × 4w × 50/60 min | CERAD neuropsychological battery, CRI (total, education, working activity, leisure time) | Memory, attention, executive function, verbal memory, visuo-spatial processing, learning capacity | Greater improvement in the total CERAD score was found for cognitively normal participants with higher versus lower scores on the Education subdomain of the CRIq Healthy older adults and patients with MCI improved on CERAD tests after using a cognitive training application Education was associated with better CERAD scores, whereas leisure time showed a negative correlation | The results suggest that cognitive training benefits healthy older adults and patients with MCI Education is an important factor in cognitive rehabilitation, while leisure time and age also influence outcomes Sex showed no relationship with the results |
Park et al. (2019) [63] | Pilot pretest–posttest | Immersive CTR | Virtual apartment | 3d × 6w × 30 min | CERAD-K, TMT-A, TMT-B, CDR, MMSE, BDI, MBI | Attention, visual-auditory memory, verbal memory, executive function | Significant improvement in the experimental group in the constructive recall test, which measures visuospatial working memory and recalls in visuospatial tasks There were no significant interactions in the other tests | Mixed Reality-based cognitive training may benefit visuospatial working memory in patients with MCI Further research with larger samples, longer sessions, and longer follow-ups is required |
Gamito et al. (2019) [65] | CT | Non-Immersive CST | Virtual cooking tasks, remembering TV news, choosing clothes and shoes arrangement | 2d × 6w × 30 min | MoCA, FAB, WCST, RCFT, d2, ECQ, BDI- II | visual-auditory memory, attention, cognitive flexibility, executive function, working memory | Statistically significant improvements in attention (d2), in visual memory (RCFT) and in two indicators of cognitive flexibility (WCST) The magnitude of improvements is highest for individuals with lower levels of cognitive functioning at baseline No effects of age or education were found | Attention improved more in people with greater impairment, making the system more efficient for training patients with signs of cognitive decline The specific functions in which significant differences were observed (attention, memory, and cognitive flexibility) are required in daily activities |
Gamito et al. (2020) [56] | CT | Non-Immersive CST | Personal hygiene, virtual cooking tasks, virtual supermarket, tasks related to TV news, clothes, shoes, art gallery visit) | EG: 2d × 6w × 30 min y ACG: 1d × 6w × 60 min | MoCA, FAB, RCFT, d2, WMS-R, GDS, SWLS, IADL | General cognition, attention, concentration, executive function, working memory, iADL | Significant improvements in EG in global cognition (14%), EF (13%), memory (WMS-R), attention (d2), and visual memory (RCF) There were no improvements in functionality or subjective well-being Results in well-being and functionality were not significant in any of the groups | The virtual SLB environment is more effective than traditional methods in improving general cognition, attention, memory, and EF in older adults No improvements in well-being or functionality were observed Further studies are needed to assess the effects on well-being and functioning in cognitively impaired adults |
Optale et al. (2010) [70] | RCT | Immersive CTR | Auditory and VR experience sessions in everyday environments | TR: 3d × 12w × 30 min; reinforcement: 2d × 12w × 30 min | MMSE, MS, DS, VSR, PVF, DTP, CET, CDT; ADL-F, ADL-M, GDS, IADL | General cognition, verbal memory, executive function, visual-auditory memory, visuospatial processing, depression, iADL | Improvements in the EG in general cognitive skills, verbal memory, and executive functions with VRMT; the CG had decreases in the same areas The booster sessions consolidated the effects of the training (MMSE, short-term and long-term memory, and DTP) with small effects No differences were found in visuospatial processing, iADL, or GDS | VRMT showed positive effects on long-term memory and stimulated cognitive abilities Improvements in executive functions soon faded, and there were no improvements in visuospatial skills |
Tarnanas et al. (2014) [54] | RCT | Non-Immersive CST | Virtual Museum | 2d × 20w × 90 min | RAVLT, ROCF, DS, SCWT, TMT-A, TMT-B, BNT, MMSE, GDS, Category fluency, Letter fluency | Memory, attention, executive function, navigation, visuospatial processing | After five months of intervention, there were significant improvements in the RAVLT, King Test, Trail-making B, and MMSE tests in the experimental group (EG) There was also an improvement in the GDS scale, although not statistically significant, and an overall improvement in the participants’ scores | The training proved effective in improving visual arrays’ textual and spatial processing. This approach also showed improvements in untrained tasks and the perceived cognitive performance of older adults with aMCI in everyday life However, it is suggested that physical exercise interventions may be more effective in addressing executive function impairment in this population |
Oliveira et al. (2021) [60] | RCT | Non-Immersive CST | Personal hygiene, virtual cooking tasks, virtual supermarket, tasks related to TV news, clothes, shoes, art gallery visit | 2d × 5w × 45 min | FAB, MMSE, IADL, TMT-A, TMT-B, CDT, GDS, CDR | Executive function, general cognition, depression, iADL | Increase in mean FAB score and a significant and large effect on global cognition between pre- and post-treatment assessments However, no improvements in executive functions iADL were found | Mixed effects on cognitive function when using VR as an intervention Despite the lack of improvements in specific cognitive functions, an improvement in global cognitive functioning was observed Cognitive reserve (CR) theory could explain individual differences in the ability to maintain cognitive function in the presence of brain pathology |