Fully Immersive Virtual Reality-Based Cognitive Remediation for Adults with Psychosocial Disabilities: A Systematic Scoping Review of Methods Intervention Gaps and Meta-Analysis of Published Effectiveness Studies

An Integrated Cognitive Remediation and Recovery-Oriented Program for Individuals with Bipolar Disorder Using a Virtual Reality-Based Intervention: 6- and 12-Month Cognitive Outcomes from a Randomized Feasibility Trial

INTRODUCTION

Achieving long-term impacts from cognitive remediation (CR) interventions is a key goal in rehabilitative care. Integrating virtual reality (VR) with psychoeducational approaches within CR programs has shown promise in enhancing user engagement and addressing the complex needs of individuals with bipolar disorder (BD). A previous randomized controlled crossover feasibility trial demonstrated the viability of a fully immersive VR-CR intervention for BD, reporting low dropout rates, high acceptability, and significant cognitive improvements. This secondary analysis aimed to evaluate the stability of these outcomes over time.

METHODS

This paper presents a 6- to 12-month follow-up of the initial trial. Secondary cognitive outcomes were assessed, including visuospatial abilities, memory, attention, verbal fluency, and executive function, using validated assessment tools. Statistical analyses were conducted using Friedman's test.

RESULTS

A total of 36 participants completed the 6- to 12-month follow-up. Overall, cognitive functions showed a trend toward stability or improvement over time, except for visuospatial and executive functions, which demonstrated inconsistent trajectories. Significant improvements were observed in language (p = 0.02).

CONCLUSION

This study highlights the overall stability of cognitive functions 12 months after a fully immersive VR-CR program for individuals with BD. To sustain long-term clinical benefits, an integrated approach, such as incorporating psychoeducational strategies within cognitive remediation interventions, may be essential. Further follow-up studies with control groups and larger sample sizes are needed to validate these findings.

The Effectiveness of Immersive Virtual Reality-Based Treatment for Mental Disorders: A Systematic Review With Meta-Analysis

BACKGROUND

The increasing number of studies of immersive virtual reality (VR) interventions for mental disorders call for an examination of the current level of evidence on their effectiveness. The findings may guide scalability and contribute to the advancement and optimization of immersive VR-based interventions for mental disorders.

METHODS

A systematic literature search across four databases screened 2443 studies. Outcomes were disorder-specific symptoms, cognition, function, and quality of life. The study is registered on PROSPERO (CRD42023465845) and follows the reporting standards outlined in the PRISMA guidelines.

RESULTS

Fifty-five studies involving a total of 3031 participants covering 10 mental disorders were included in the analysis. VR interventions demonstrated statistically significant effects of post-treatment compared to active control conditions for alcohol use disorder (reduced state anxiety, g = 0.89, 95% CI[0.24, 1.55]) and schizophrenia spectrum disorders (reduced psychotic symptoms, g = 0.37, 95% CI[0.04, 0.70]). Compared to passive control conditions, statistically significant effects of VR interventions were observed for panic and agoraphobia (g = 1.28, 95% CI [0.47, 2.10]), social anxiety disorder (g = 0.83, 95% CI [0.49, 1.17]), specific phobias (g = 1.07, 95% CI[0.22, 1.92]), depression symptoms in PTSD (g = 0.67, 95% CI [0.22;1.13]). In contrast, no significant differences were found between VR interventions and active control conditions for functioning and quality of life in schizophrenia spectrum disorder and panic or agoraphobia. No meta-analyses were conducted on cognition due to insufficient data. Over 50% of the included studies were assessed as having a high risk of bias. According to the GRADE assessment, evidence for VR-based interventions across various mental disorders was generally of low to very low certainty, with a few exceptions rated as moderate certainty.

CONCLUSION

VR interventions may potentially have benefits, particularly when compared to passive control conditions, however, the evidence remains uncertain necessitating more large-scale, methodologically robust studies. Current findings can thus only be considered indicative. Recommendations on future directions of the VR field are discussed.

Cognitive rehabilitation in schizophrenia research: a bibliometric and visualization analysis

Objective

Cognitive impairment is notably prevalent among schizophrenic individuals and is acknowledged as one of the core features of the disorder. Despite the proliferation of literature on cognitive rehabilitation treatments for schizophrenia in recent years, there remains a dearth of systematic reviews and selections of research in this area. From a bibliometric perspective, this study aims to analyze and discuss the current state, developmental trends, and potential research hotspots of cognitive rehabilitation in schizophrenia over the past two decades.

Methods

The Core database of Web of Science was utilized to retrieve articles on cognitive rehabilitation in Schizophrenia that were published from 2004 to 2024. Bibliometrics was applied to perform both quantitative and qualitative analyses of authors, institutions, countries, journals, references, and keywords, leveraging tools such as CiteSpace, VOSviewer, and the R software package Bibliometrix.

Results

A total of 2,413 articles were encompassed in this study, comprising 1,774 regular articles and 373 review articles. The United States emerged as the country with the highest productivity and citation counts, engaging in academic collaborations with over 40 nations. This was followed by the United Kingdom and Spain. King's College London stood out as the leading institution in the field. However, the article with the highest average citation rate was authored by Susan R. McGurk from the Dartmouth Centre for Psychiatric Research in the United States. Schizophrenia Research proved to be the most influential journal in this domain, with its articles being cited over 10,000 times.

Conclusion

This study provides a comprehensive review of research achievements in cognitive rehabilitation for schizophrenia spanning from 2004 to 2024, and outlines global research hotspots and trends with future projections. Currently, methods for cognitive rehabilitation in schizophrenia and neural plasticity in the brain represent the cutting-edge of research. The safety, efficacy, and standardization of virtual reality are poised to emerge as potential future hotspots and trends in research. Additionally, the neurobiological foundations of cognitive remediation therapy constitute an unexplored territory ripe for further investigation.

Clinical and neurocognitive profiles of a combined clinical high risk for psychosis and clinical control sample: latent class analysis

BACKGROUND

The clinical high-risk (CHR) state for psychosis demonstrates considerable clinical heterogeneity, presenting challenges for clinicians and researchers alike. Basic symptoms, to date, have largely been ignored in explorations of clinical profiles.

AIMS

We examined clinical profiles by using a broader spectrum of CHR symptoms, including not only (attenuated) psychotic, but also basic symptoms.

METHOD

Patients (N = 875) of specialised early intervention centres for psychosis in Germany and Switzerland were assessed with the Schizophrenia Proneness Instruments and the Structured Interview for Psychosis-Risk Syndromes. Latent class analysis was applied to CHR symptoms to identify clinical profiles. Additionally, demographics, other symptoms, current non-psychotic DSM-IV axis I disorders and neurocognitive variables were assessed to further describe and compare the profiles.

RESULTS

A three-class model was best fitting the data, whereby basic symptoms best differentiated between the profiles (η2 = 0.08-0.52). Class 1 had a low probability of CHR symptoms, the highest functioning and lowest other psychopathology, neurocognitive deficits and transition-to-psychosis rate. Class 2 had the highest probability of basic and (attenuated) positive symptoms (excluding hallucinations), lowest functioning, highest symptom load, most neurocognitive deficits and highest transition rate (55.1%). Class 3 was mostly characterised by attenuated hallucination, and was otherwise intermediate between the other two classes. Comorbidity rates were comparable across classes, with some class differences in diagnostic categories.

CONCLUSIONS

Our profiles based on basic and (attenuated) psychotic symptoms provide clinically useful entities by parsing out heterogeneity in clinical presentation. In future, they could guide class-specific intervention.

Ecological virtual reality-based cognitive remediation among inpatients with schizophrenia: A pilot study

Schizophrenia presents a considerable clinical challenge due to limited progress in promoting daily-life functioning among diagnosed individuals. Although cognitive remediation (CR) has emerged as a promising approach to improving cognitive and functional outcomes in schizophrenia, its effectiveness among inpatients and within hospital environments-where opportunities to practice skills in real-world contexts are limited-remains unclear. Here, we aimed to establish the feasibility and initial efficacy of a short, ecological virtual reality-based CR training (CR-EVR) in acute mental health inpatient settings. Efficacy was assessed at four levels: training engagement, near transfer, far transfer, and ecological transfer. Twenty-three inpatients with schizophrenia (Male: 33.3 ± 8.5; 4 Female) completed 8, 20-min CR-EVR sessions, with exercises training the cognitive abilities of inhibition, planning, working memory, shifting, self-initiation, persistence, and attention. Their cognitive functioning, schizophrenia symptoms, functional capacity, and participation in occupations were evaluated pre- and post-training to address four levels of effectiveness. Of the recruited participants, 25.8 % dropped out. Inpatients who completed the full protocol reported high rates of satisfaction (1-not satisfied; 5-very satisfied)) from the intervention (Median = 4, IQR:3.5-5). Post-training, significant improvements were found in the trained cognitive components (intervention engagement: -6.58 < t/Z < 2.02, p < .05), general cognitive functioning (-2.59 < t/Z < 2.29, p < .05), functional capacity (t = -2.9, p < .05), and diversity of participation in everyday activities (t = -3.36, p < .05). This preliminary study suggests that CR-EVR may be a feasible and practical tool to enhance cognitive and ecological outcomes in short-stay acute inpatient settings. Subject to further research, such intervention may be considered an add-on to current practices that promote recovery and health among inpatient populations.

Virtual reality cognitive remediation tool for individuals with mild cognitive impairment: study protocol for a feasibility randomized clinical trial

Introduction

With the growing older adult population, the European Union emphasizes the need to promote research in healthy aging trough multidisciplinary and innovative approaches, including the integration of advanced technologies like virtual reality (VR) in cognitive rehabilitation. This reflects the increasing awareness of the importance of addressing challenges related to neurodegenerative diseases in the older adult population. Our study aims to present a protocol that will assess the feasibility and provide a preliminary measure of effectiveness for an intervention using immersive CR technology for cognitive remediation (CR) in individuals with Mild Cognitive Impairment (MCI).

Methods

A feasibility randomized controlled clinical study will involve 30 individuals who are over 65 years old, both sex, who meet the diagnostic criteria for MCI from the University Hospital of Cagliari, randomly assigned to either the experimental condition or control group. Both groups will continue to receive standard pharmacological therapy. The experimental group will undergo a 3-months cognitive remediation program using fully immersive VR with two sessions per week. Each session will last a maximum of 60 min and will be supervised by expert health professionals. In contrast, the control group will continue with standard care. The intervention program will be carried out by s psychiatric rehabilitation technicians and speech therapists, emphasizing a comprehensive framework aligned with healthcare needs. Feasibility will be assessed based on tolerability, including dropout rates and acceptability, which considers the proportion of recruited participants among those considered eligible and on side effects and level of satisfaction. The preliminary measures of effectiveness will be evaluated on quality of life, cognitive functions, biological and social rhythms, depressive symptoms and anxiety.

Results

The trial findings will be submitted for publication in international peer-reviewed journals and shared at international meetings and conferences.

Discussion

This study aiming to assess the feasibility and preliminary effectiveness of a fully immersive VR/CR program for MCI in order to give data for a subsequent confirmatory trial. The results of the pilot RCT are expected to significantly contribute to research on the prevention of neurocognitive degeneration, with a specific emphasis on enhancing the application of technologies. The strengths of this work are the high technological innovation program for mental health treatments for healthy aging and multidisciplinary approach emphasizing a holistic framework aligned with health needs.

Virtual Reality Interventions and Psychosocial Functioning in Schizophrenia Spectrum Disorders: A Systematic Review

OBJECTIVE

The objective of this study is to evaluate the effectiveness of virtual reality (VR) intervention programs that aim to improve psychosocial functioning in schizophrenia spectrum disorders and evaluate the quality assessment of these studies.

METHODS

PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline was followed to conduct this systematic review. The literature search was performed in Web of Science (WoS) and PubMed, by two independent researchers on two occasions, on 1 March 2023 and 20 August 2023. Risk of bias of the studies was evaluated by The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies.

RESULTS

Fifteen studies met inclusion criteria, targeting social skills (n = 5), social cognitive skills (n = 7) and vocational training (n = 3). In these studies, a total of 292 participants enrolled in VR interventions and a total of 258 participants enrolled in control groups. In this systematic review, there were eight cohort studies, where seven were with a single-group pretreatment and posttreatment evaluation and one was with a control group, and one controlled trial and six randomized controlled trials were included. Several studies reported significant improvements in both psychosocial functioning and clinical symptoms, whereas others found improvements only in either psychosocial functioning or clinical symptoms, and still others found no improvements at all. The limitations of the studies include small sample sizes and standardized intervention methods. There is a very high variability in session duration, frequency and total treatment period.

CONCLUSION

Although VR intervention programs offer unique opportunities for psychosocial improvement, heterogeneity in methodologies and mixed results highlight the need for further research.

Alexithymia and Bipolar Disorder: Virtual Reality Could Be a Useful Tool for the Treatment and Prevention of These Conditions in People with a Physical Comorbidity

Background: Alexithymia, a predictor in chronic illnesses, like cardiovascular and bipolar disorder (CD-BD), could be improved with a virtual reality (VR) cognitive remediation program. This secondary analysis of a previous randomized controlled trial (RCT) evaluates alexithymia improvement and its factors in an experimental group versus a control group, exploring extensions to individuals with comorbid non-psychiatric chronic conditions. Methods: A feasibility cross-over RCT (ClinicalTrials.gov NCT05070065) enrolled individuals aged 18-75 with mood disorders (BD, DSM-IV), excluding those with relapses, epilepsy, or severe eye conditions due to potential risks with VR. Alexithymia levels were measured using the Toronto Alexithymia Scale with 20 items (TAS-20). Results: The study included 39 individuals in the experimental group and 25 in the control group, with no significant age or sex differences observed. Significantly improved alexithymia scores were noted in the experimental group compared to controls (F = 111.9; p < 0.0001) and in subgroups with chronic non-psychiatric comorbidities (F = 4.293, p = 0.048). Scores were particularly improved for difficulty in identifying feelings (F = 92.42; p < 0.00001), communicating feelings (F = 61.34; p < 0.00001), and externally oriented thinking (F = 173.12; p < 0.00001). Conclusions: The findings highlight alexithymia enhancement in BD, even with comorbid non-psychiatric chronic diseases. Given its impact on BD progression and related conditions, like CD, developing and evaluating VR-based tools in this context is suggested by these findings.

Virtual Reality Cognitive Remediation in Older Adults with Bipolar Disorder: The Effects on Cognitive Performance and Depression in a Feasibility Randomized Controlled Trial

INTRODUCTION

Dementia, depression, and cardiovascular disease are major public health concerns for older adults, requiring early intervention. This study investigates whether a virtual reality cognitive remediation program (VR-CR) can improve cognitive function and depressive symptoms in older adults, and determines the necessary sample size for future studies. Integrated VR and CR interventions have shown promising outcomes in older adults with neurodegenerative and mental health disorders.

METHODS

This secondary analysis of a randomized controlled trial involves adults aged 58-75 years with bipolar disorder, excluding those with acute episodes, epilepsy, or severe eye diseases. The experimental group received standard treatment plus VR-CR, while the control group received only standard treatment.

RESULTS

No baseline differences were found between the experimental and control groups. No significant improvement was observed in the overall cognitive function test (p = 0.897) or in depressive symptoms (p = 0.322). A phase III efficacy study requires a sample size of 28 participants (alpha = 0.05, beta = 0.20).

CONCLUSIONS

VR-CR can potentially treat depressive symptoms in adults and older adults, but the results support conducting phase III studies to further investigate these outcomes. However, the improvement in cognitive performance in the elderly is less pronounced than in younger individuals.

Treatment of Cognitive Impairment Associated with Schizophrenia Spectrum Disorders: New Evidence, Challenges, and Future Perspectives

Cognitive impairment associated with schizophrenia (CIAS) represents one of the core features of the disorder and has a significant impact on functional and rehabilitation outcomes of people living with schizophrenia spectrum disorders (SSD). The aim of this critical review is to highlight the most recent evidence on effective treatments available for CIAS, to discuss the current challenges in this field, and to present future perspectives that may help to overcome them. Concerning psychopharmacological approaches, among the most indicated strategies for the management and prevention of CIAS is to favor second-generation antipsychotic medications and avoid long-term and high-dose treatments with anticholinergic medications and benzodiazepines. Moreover, non-pharmacological approaches such as cognitive remediation and physical exercise-based programs represent evidence-based interventions in the treatment of CIAS that have shown reliable evidence of effectiveness on both cognitive and functional outcomes. These treatments, however, are still delivered to people accessing mental health services with a diagnosis of CIAS in an uneven manner, even in high-income countries. Academic and clinical partnership and collaboration, as well as advocacy from service users, families, carers, and stakeholders' organizations could help to reduce the bench to bedside gap in the treatment of CIAS. Future perspectives include the development of novel pharmacological agents that could be effective in the treatment of CIAS, the implementation of novel technologies such as telemedicine and virtual reality in the delivery of evidence-based interventions to improve accessibility and engagement, and further research in the field of non-invasive brain stimulation.

Improving Social and Personal Rhythm Dysregulation in Young and Old Adults with Bipolar Disorder: Post-Hoc Analysis of a Feasibility Randomized Controlled Trial Using Virtual Reality-Based Intervention

Introduction: Rehabilitative interventions employing technology play a crucial role in bipolar disorder (BD) treatment. The study aims to appraise the virtual reality (VR)-based cognitive remediation (CR) and the interpersonal rhythm approaches to treatment outcomes of BD across different age groups. Methods: Post-hoc analysis of a 12-week randomizedcontrolled cross-over feasibility trial involving people with mood disorders (BD, DSM-IV) aged 18-75 years old: thirty-nine exposed to the experimental VR-based CR vs 25 waiting list controls. People with BD relapse, epilepsy or severe eye diseases (due to the potential VR risks exposure) were excluded. Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) was used to measure the outcome. Results: Cases and controls did not statistically significantly differ in age and sex distributions. Personal rhythm scores improved over the study follow-up in the experimental vs the control group (APC = 8.7%; F = 111.9; p < 0.0001), both in young (18-45 years) (APC = 5.5%; F = 70.46; p < 0.0001) and, to a lesser extent, older (>46 years) adults (APC = 10.5%; F = 12.110; p = 0.002). Conclusions: This study observed improved synchronization of personal and social rhythms in individuals with BD after a virtual reality cognitive remediation intervention, particularly in social activity, daily activities, and chronotype, with greater benefits in the younger population.

An e-Health Psychoeducation Program for Managing the Mental Health of People with Bipolar Disorder during the COVID-19 Pandemic: A Randomized Controlled Study

Background: Social rhythm dysregulation has been identified as a determining factor in bipolar disorder (BD) relapses. It directly impacts individuals' quality of life (QoL). This study aims to present preliminary data on the efficacy of an e-health psychoeducational intervention for BD for improving clinical outcomes. Methods: This study used an open-label, crossover, randomized controlled trial design. The inclusion criteria consisted of a BD diagnosis, affiliation with the Consultation Psychiatry and Psychosomatic Center at the University Hospital in Cagliari, Italy, age over 18, and the obtaining of informed consent. Anxiety and depressive symptoms, QoL, and social and biological rhythms were measured using standardized instruments validated in Italian. Results: A total of 36 individuals were included in the experimental group (EG) and 18 in the control group (CG). The final sample consisted of 25 in the EG and 14 in the CG. A statistically significant improvement in QoL was found in the EG post-treatment (p = 0.011). Significant correlations were found between QoL and the dysregulation of biorhythms in the EG at T0 (p = 0.0048) and T1 (p = 0.0014). Conclusions: This study shows that, during extreme distress, an e-health group psychoeducation intervention for people with BD could significantly improve the perception of QoL. The results must be confirmed by studies conducted with larger-sized samples.

Virtual reality-based training may improve visual memory and some aspects of sustained attention among healthy older adults - preliminary results of a randomized controlled study

BACKGROUND/AIMS

Older age and cognitive inactivity have been associated with cognitive impairment, which in turn is linked to economic and societal burdens due to the high costs of care, especially for care homes and informal care. Emerging non-pharmacological interventions using new technologies, such as virtual reality (VR) delivered on a head-mounted display (HMD), might offer an alternative to maintain or improve cognition. The study aimed to evaluate the efficacy and safety of a VR-based Digital Therapeutics application for improving cognitive functions among healthy older adults.

METHODS

Seventy-two healthy seniors (experimental group N = 35, control group N = 37), aged 65-85 years, were recruited by the Medical University of Lodz (Poland). Participants were randomly allocated to the experimental group (a VR-based cognitive training which consists of a warm-up module and three tasks, including one-back and dual-N-back) or to the control group (a regular VR headset app only showing nature videos). The exercises are performed in different 360-degree natural environments while listening to a preferred music genre and delivered on a head-mounted display (HMD). The 12-week intervention of 12 min was delivered at least three times per week (36 sessions). Compliance and performance were followed through a web-based application. Primary outcomes included attention and working memory (CNS-Vital Signs computerized cognitive battery). Secondary outcomes comprised other cognitive domains. Mixed linear models were constructed to elucidate the difference in pre- and post-intervention measures between the experimental and control groups.

RESULTS

The users performed, on average, 39.8 sessions (range 1-100), and 60% performed more than 36 sessions. The experimental group achieved higher scores in the visual memory module (B = 7.767, p = 0.011) and in the one-back continuous performance test (in terms of correct responses: B = 2.057, p = 0.003 and omission errors: B = -1.950, p = 0.007) than the control group in the post-test assessment. The results were independent of participants' sex, age, and years of education. The differences in CNS Vital Signs' global score, working memory, executive function, reaction time, processing speed, simple and complex attention, verbal memory, cognitive flexibility, motor speed, and psychomotor speed were not statistically significant.

CONCLUSIONS

VR-based cognitive training may prove to be a valuable, efficacious, and well-received tool in terms of improving visual memory and some aspect of sustainability of attention among healthy older adults. This is a preliminary analysis based on part of the obtained results to that point. Final conclusions will be drawn after the analysis of the target sample size.

TRIAL REGISTRATION

Clinicaltrials.gov ID NCT05369897.

An exploratory study of the effect of age and gender on face scanning during affect recognition in immersive virtual reality

A person with impaired emotion recognition is not able to correctly identify facial expressions represented by other individuals. The aim of the present study is to assess eyes gaze and facial emotion recognition in a healthy population using dynamic avatars in immersive virtual reality (IVR). For the first time, the viewing of each area of interest of the face in IVR is studied by gender and age. This work in healthy people is conducted to assess the future usefulness of IVR in patients with deficits in the recognition of facial expressions. Seventy-four healthy volunteers participated in the study. The materials used were a laptop computer, a game controller, and a head-mounted display. Dynamic virtual faces randomly representing the six basic emotions plus neutral expression were used as stimuli. After the virtual human represented an emotion, a response panel was displayed with the seven possible options. Besides storing the hits and misses, the software program internally divided the faces into different areas of interest (AOIs) and recorded how long participants looked at each AOI. As regards the overall accuracy of the participants' responses, hits decreased from the youngest to the middle-aged and older adults. Also, all three groups spent the highest percentage of time looking at the eyes, but younger adults had the highest percentage. It is also noteworthy that attention to the face compared to the background decreased with age. Moreover, the hits between women and men were remarkably similar and, in fact, there were no statistically significant differences between them. In general, men paid more attention to the eyes than women, but women paid more attention to the forehead and mouth. In contrast to previous work, our study indicates that there are no differences between men and women in facial emotion recognition. Moreover, in line with previous work, the percentage of face viewing time for younger adults is higher than for older adults. However, contrary to earlier studies, older adults look more at the eyes than at the mouth.Consistent with other studies, the eyes are the AOI with the highest percentage of viewing time. For men the most viewed AOI is the eyes for all emotions in both hits and misses. Women look more at the eyes for all emotions, except for joy, fear, and anger on hits. On misses, they look more into the eyes for almost all emotions except surprise and fear.

Effects of immersive and non-immersive virtual reality-based rehabilitation training on cognition, motor function, and daily functioning in patients with mild cognitive impairment or dementia: A systematic review and meta-analysis

OBJECTIVE

To examine the effectiveness of virtual reality (VR)-based rehabilitation training in improving cognition, motor function, and daily functioning in patients with mild cognitive impairment and dementia.

DATA SOURCES

A systematic review of published literature was conducted using PubMed, Web of Science, Elsevier, Embase, Cochrane, CNKI, Networked Digital Library of Theses and Dissertations.

METHODS

The search period was from inception to 7 October 2023. Eligible studies were randomized controlled trials evaluating the efficacy of VR-based rehabilitation training in patients with mild cognitive impairment or dementia versus control subjects. Methodologic quality was assessed with the Cochrane risk of bias tool, and outcomes were calculated as the standard mean difference between participant groups with 95% confidence interval.

RESULTS

A total of 21 randomized controlled trials with 1138 patients were included. The meta-analysis showed that VR-based rehabilitation training had significant effects on Montreal Cognitive Assessment (SMD: 0.50; 95%CI: 0.05 to 0.95; P = 0.030), Trail-making test A (SMD: -0.38; 95%CI: -0.61 to -0.14; P = 0.002), and Berg Balance Scale scores (SMD: 0.79; 95%CI: 0.13 to 1.45; P = 0.020). A subgroup analysis revealed that the type of VR, and duration and frequency of interventions had statistically significant effects on cognition and motor function.

CONCLUSION

VR-based rehabilitation training is a beneficial nonpharmacologic approach for managing mild cognitive impairment or dementia. Immersive VR-based training had greater effects on cognition and motor function than non-immersive VR-based training, but non-immersive VR-based training was more convenient for patients with limitations imposed by their disease. Also, an intervention lasting 5-8 weeks and for >30 min at a frequency of ≥3 times/week achieved the best results. It indicated that a longer intervention cycle may not achieve the best intervention effect and training duration and schedule should be carefully considered when managing patients.

Crossing the digital frontier: are older adults ready for virtual reality workouts?

In the dynamic web of our digital age, virtual reality (VR) is crystallizing as a promising medium for promoting physical activity in older adults, overcoming age-old barriers. This perspective article explores the intricate synergy between VR and physical activity in older adults and highlights the many challenges of aging within a virtual environment. While VR heralds the potential for multisensory interaction and cognitive enhancement, a thorough assessment of its impact is paramount. The reach of VR goes beyond immediate applications and permeates the emotional and psychological realms of the human journey. Such an exploration requires a comprehensive perspective that goes beyond a purely technical assessment. The aim of this article is not to present clear-cut solutions, but to encourage reflection on the diverse impact of VR on our aging population. We argue for a future in which technology complements, rather than eclipses, the depth of human experience.

Effect of immersive virtual reality-based cognitive remediation in patients with mood or psychosis spectrum disorders: study protocol for a randomized, controlled, double-blinded trial

BACKGROUND

Cognitive impairments are prevalent across mood disorders and psychosis spectrum disorders, but there is a lack of real-life-like cognitive training programmes. Fully immersive virtual reality has the potential to ensure motivating and engaging cognitive training directly relevant to patients' daily lives. We will examine the effect of a 4-week, intensive virtual reality-based cognitive remediation programme involving daily life challenges on cognition and daily life functioning in patients with mood disorders or psychosis spectrum disorders and explore the neuronal underpinnings of potential treatment efficacy.

METHODS

The trial has a randomized, controlled, double-blinded, parallel-group design. We will include 66 symptomatically stable outpatients with mood disorders or psychosis spectrum disorders aged 18-55 years with objective and subjective cognitive impairment. Assessments encompassing a virtual reality test of daily life cognitive skills, neuropsychological testing, measures of daily life functioning, symptom ratings, questionnaires on subjective cognitive complaints, and quality of life are carried out at baseline, after the end of 4 weeks of treatment and at a 3-month follow-up after treatment completion. Functional magnetic resonance imaging scans are performed at baseline and at the end of treatment. The primary outcome is a broad cognitive composite score comprising five subtasks on a novel ecologically valid virtual reality test of daily life cognitive functions. Two complete data sets for 54 patients will provide a power of 80% to detect a clinically relevant between-group difference in the primary outcome. Behavioural data will be analysed using linear mixed models in SPSS, while MRI data will be analysed with the FMRIB Expert Analysis Tool (FEAT). Treatment-related changes in neural activity from baseline to end of treatment will be investigated for the dorsal prefrontal cortex and hippocampus as the regions of interest.

DISCUSSION

The results will provide insight into whether virtual reality-based cognitive remediation has beneficial effects on cognition and functioning in symptomatically stable patients with mood disorders or psychosis spectrum disorders, which can aid future treatment development.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06038955. Registered on September 15, 2023.