# Immersive virtual reality for older adults with mild cognitive impairment, dementia, or cognitive frailty: a systematic review and narrative synthesis (2019–2025)

## TL;DR

Immersive virtual reality may help improve cognition and mobility in older adults with mild cognitive issues or cognitive frailty, but more research is needed.

## Contribution

A systematic review and narrative synthesis of VR studies for older adults with cognitive impairments from 2019–2025.

## Key findings

- VR improved executive function and processing speed in participants with MCI or cognitive frailty.
- VR showed modest gains in global cognition and better balance outcomes compared to controls.
- Immersive VR reduced anxiety and apathy in residential care settings with high adherence and low adverse events.

## Abstract

Immersive virtual reality (VR) is increasingly used to support cognition, mobility, and emotional well‑being in older adults with mild cognitive impairment (MCI), dementia, or frailty. Evidence is expanding but fragmented across small randomized and feasibility trials. We synthesized recent studies to clarify benefits, risks, and implementation considerations.

Following PRISMA 2020, we searched PubMed and CINAHL from 1 January 2019 to 15 October 2025. Eligible studies enrolled adults aged ≥ 65 years with MCI, dementia, or frailty/cognitive frailty; delivered immersive or semi‑immersive VR via head‑mounted display or large‑screen projection (interactive tasks or 360° content); and reported cognitive, mobility, or emotional/behavioral outcomes in randomized, quasi‑experimental, or pre–post designs. Two reviewers independently screened and extracted data. Risk of bias was appraised with RoB 2 (randomized trials) or JBI tools (non‑randomized). Heterogeneity precluded meta‑analysis; we conducted a structured narrative synthesis.

Seventy records were identified (PubMed 28; CINAHL 42); after removing 9 duplicates, 61 records were screened, 24 full texts were assessed, and 13 studies were included (10 randomized; 3 feasibility/mixed‑methods). The most consistent improvements occurred in executive function and processing speed among participants with MCI or cognitive frailty; several trials also reported modest gains in global cognition. Multiple trials showed better Timed Up & Go and Berg Balance outcomes and enhanced anticipatory postural adjustments versus comparators. In residential care, immersive reminiscence and group VR reduced anxiety and apathy and were well tolerated. Adverse events were uncommon and mild; adherence was high with supervised delivery. Most randomized trials had some concerns for bias; one was at overall low risk.

Immersive and semi-immersive VR interventions appear feasible for supervised delivery in older adults with MCI or cognitive frailty and may be associated with improvements in cognitive and mobility outcomes. Evidence for emotional and behavioral outcomes in institutional settings is promising but preliminary. Programs with adequate exposure (2–3 sessions/week for 8–12 weeks; ≥ 15 total hours), adaptive challenge, and supervision were most frequently associated with positive outcomes. Larger multicenter randomized trials with standardized outcomes and embedded implementation and economic evaluations are needed.

The online version contains supplementary material available at 10.1186/s12877-025-06957-8.