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

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Evidence is expanding but fragmented across small randomized and feasibility trials. We synthesised recent studies to clarify benefits, risks, and implementation considerations. Methods 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/behavioural 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. Results 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. Conclusions Immersive VR appears feasible and potentially beneficial for mentation and mobility in older adults with MCI or cognitive frailty and may reduce anxiety and apathy in institutional settings. Programmes with adequate exposure (2–3 sessions/week for 8–12 weeks; ≥15 total hours), adaptive challenge, and supervision show the most consistent benefits. Larger multicentre randomized trials with standardised outcomes and embedded implementation and economic evaluations are needed. virtual reality mild cognitive impairment dementia cognitive frailty older adults executive function dual‑task mobility anxiety systematic review Figures Figure 1 Background Population ageing is accelerating the need for engaging, scalable, and safe interventions that support both cognitive health and functional mobility in later life. Older adults with MCI, dementia, or frailty experience executive dysfunction, slowed processing, and impaired dual‑tasking that together reduce independence and elevate fall risk. Symptoms such as anxiety, apathy, and other behavioural changes further erode quality of life for individuals and caregivers and add to the burden on health and social care systems. VR offers controlled, multisensory environments where cognitive tasks, motor practice, wayfinding, and personalised content can be combined and titrated. In recent years, immersive and semi‑immersive VR programmes have been tested in outpatient rehabilitation, community settings, and residential aged care. Meta‑analyses suggest small‑to‑moderate gains in global cognition and attention and relatively larger effects on executive function when exposure is adequate [ 1 – 4 ]. VR may also enhance dual‑task performance, a determinant of falls in later life [ 5 ]. However, interventions vary widely in immersion level, content, dose, and delivery setting, and the evidence base is fragmented across small trials. We therefore conducted a focused, up‑to‑date synthesis of immersive and semi‑immersive VR interventions for older adults with MCI, dementia, or cognitive frailty. Our objectives were to summarise effects on cognition, mobility, and emotional/behavioural outcomes; appraise risk of bias; and discuss practical considerations for nurse‑led, age‑friendly implementation. Methods Protocol and reporting This systematic review followed PRISMA 2020 guidance. A protocol was not registered. The review window was prespecified to capture contemporary VR technologies (1 January 2019 to 15 October 2025). The PRISMA 2020 checklist and the PRISMA‑S extension (full search strategies and logs) are provided as Additional files. Eligibility criteria We included studies that: - enrolled adults with mean or minimum age ≥ 65 years with mild cognitive impairment (MCI), dementia, or frailty/cognitive frailty; - delivered immersive or semi‑immersive virtual reality (VR) via head‑mounted displays or large‑screen projection (interactive tasks or 360° immersive content such as reminiscence); - reported outcomes in cognition (for example, Montreal Cognitive Assessment [MoCA], Mini‑Mental State Examination [MMSE], Trail Making Test, Digit Symbol, Stroop), mobility (for example, Timed Up & Go [TUG], Berg Balance Scale [BBS], gait speed, anticipatory postural adjustments), or emotional/behavioural health (for example, Geriatric Depression Scale, Hospital Anxiety and Depression Scale, anxiety or apathy measures); - used randomized, quasi‑experimental, or pre–post designs. We excluded augmented or mixed reality, non‑VR exergames, purely diagnostic or cross‑sectional studies, and populations outside scope (for example, acquired brain injury or Parkinson’s disease without cognitive impairment). We restricted inclusion to English‑language publications. Information sources and search strategy We systematically searched PubMed and CINAHL for records published from 1 January 2019 to the last search date (15 October 2025). Search strategies were piloted to balance precision and recall and required “virtual reality” in the title to reduce off‑target retrieval. Filters for date and English language were applied when available and otherwise enforced during screening. The executable queries were: - PubMed (searched 15 Oct 2025) "virtual reality"[ti] AND (cognit*[tiab] OR memory[tiab] OR depression[tiab] OR anxiety[tiab] OR balance[tiab] OR gait[tiab]) AND (moca[tiab] OR mmse[tiab] OR "trail making"[tiab] OR "digit symbol"[tiab] OR stroop[tiab] OR "n-back"[tiab] OR gds[tiab] OR "phq-9"[tiab] OR hads[tiab] OR tug[tiab] OR "berg balance"[tiab] OR sppb[tiab] OR "chair stand"[tiab] OR "gait speed"[tiab]) AND (randomized[tiab] OR randomised[tiab] OR trial[tiab] OR pilot[tiab] OR feasibility[tiab]) AND ("2019/01/01"[dp] : "2025/12/31"[dp]) AND ("mild cognitive impairment"[tiab] OR MCI[tiab] OR dementia[tiab] OR frail*[tiab]) NOT (protocol[tiab] OR augmented[tiab] OR "mixed reality"[tiab] OR AR[tiab]) - CINAHL (EBSCOhost; searched 15 Oct 2025) TI ("virtual reality") AND AB (cognit* OR memory OR depression OR anxiety OR balance OR gait) AND AB (moca OR mmse OR "trail making" OR "digit symbol" OR stroop OR "n-back" OR gds OR "phq-9" OR hads OR tug OR "berg balance" OR sppb OR "chair stand" OR "gait speed") AND AB (randomized OR randomised OR trial OR pilot OR feasibility) AND AB ("mild cognitive impairment" OR MCI OR dementia OR frail*) NOT AB (protocol OR augmented OR "mixed reality" OR AR) Limits applied: publication date 2019–2025; English (where available). The searches returned 28 records from PubMed and 42 from CINAHL. All results were exported on the search date, de‑duplicated automatically and manually, and entered into the screening workflow. Selection process Two reviewers independently screened titles/abstracts and then full texts in duplicate; disagreements were resolved by consensus. Interrater agreement was monitored; a formal kappa was not calculated. The PRISMA 2020 flow diagram is shown in Fig. 1 . Data collection and data items Two reviewers independently extracted design and setting, sample characteristics, VR modality and device, dose (session length, frequency, duration), comparator, outcomes and timepoints, adherence, adverse events, and main findings using a piloted form. Risk of bias assessment Randomized trials were appraised using the Cochrane Risk of Bias 2 tool (domains D1–D5). Non‑randomized or single‑group studies were appraised using Joanna Briggs Institute (JBI) critical appraisal tools. Overall judgement followed the highest domain risk across applicable domains. Study‑level assessments are summarised in Table 2. Synthesis methods Given heterogeneity in interventions, comparators, and outcome measures, we did not perform a meta‑analysis. A structured narrative synthesis was conducted, organised by domain (cognition, mobility, emotional/behavioural) within populations (MCI, dementia, cognitive frailty). Direction of effects was summarised using vote counting based on statistical significance and consistency across outcomes/timepoints. Reported effect sizes were described narratively where available. Results Study selection The searches identified 70 records. After removing 9 duplicates, 61 records were screened at title/abstract; 24 full‑text reports were assessed for eligibility; 11 were excluded with reasons; and 13 studies were included (Fig. 1 ). Study characteristics (Table 1) Of the 13 included studies, 10 were randomized trials and three were feasibility or mixed‑methods studies. Studies were conducted across Asia, Europe, and Australia in outpatient rehabilitation, community programmes, and residential aged care. Most interventions used fully immersive head‑mounted displays; several used semi‑immersive large displays for group sessions. Typical dosing was 2–3 sessions per week, 20–45 minutes per session, for 4–12 weeks. Cognitive outcomes included MoCA/MMSE, Trail Making Test A/B, Digit Symbol, and Stroop; mobility measures included TUG, BBS, gait speed, and anticipatory postural adjustments; emotional/behavioural outcomes included anxiety, apathy, and behavioural symptoms. Full characteristics are provided in Table 1. Risk of bias (Table 2) Most randomized trials had some concerns, driven by allocation concealment, lack of participant blinding, and outcome measurement; one trial was at overall low risk. Non‑randomized studies were at higher risk due to design limitations. Detailed assessments are shown in Table 2. Cognitive outcomes Across randomized trials in MCI or cognitive frailty, immersive or semi‑immersive VR generally improved executive function and processing speed relative to controls. VR‑augmented physical and cognitive training improved dual‑task executive performance and global cognition in MCI [ 6 , 7 ]. A randomized controlled study reported enhanced motivation with cognitive gains using VR‑based cognitive‑motor rehabilitation [ 8 ], and a randomized pilot trial demonstrated feasibility and better attention/visuospatial performance with culture‑based immersive content [ 9 ]. A single‑blind randomized trial combining motor training with VR‑based cognitive tasks showed advantages across multiple domains [ 10 ]. In a multicentre randomized trial of cognitive frailty, motor‑cognitive VR training improved cognitive measures compared with usual activities [ 11 ]; a pilot randomized trial in community‑dwelling participants supported feasibility and suggested benefit [ 12 ]. In predementia, fully immersive training improved visuospatial function with concurrent changes in functional connectivity [ 13 ]. These findings align with meta‑analytic evidence of small‑to‑moderate improvements in global cognition and attention and relatively larger effects on executive function with adequate exposure [ 1 – 4 ]. Mobility outcomes Mobility benefits were also observed. In randomized trials involving older adults with cognitive and motor deficits, VR training enhanced anticipatory postural adjustments versus comparison activities [ 14 ]. In MCI, programmes integrating VR with physical training reduced TUG times and improved BBS relative to controls [ 6 , 7 ]. In cognitive frailty, motor‑cognitive VR training improved functional mobility in a multicentre randomized trial [ 11 ]. These results accord with evidence that VR can improve dual‑task performance in older adults [ 5 ]. Emotional and behavioural outcomes In residential aged care, immersive reminiscence reduced anxiety in a randomized crossover study of the oldest‑old and was well tolerated without serious adverse effects [ 15 ]. Group‑based immersive sessions were feasible and associated with reductions in behavioural and psychological symptoms over multiple sessions [ 16 ]. A mixed‑methods study in nursing homes reported improved apathy and engagement following immersive VR [ 17 ]. Early feasibility work in mild dementia demonstrated the safety and acceptability of instrumental activities of daily living training using fully immersive VR [ 18 ]. Overall, emotional outcomes are promising but based on small samples and, in some cases, non‑randomized designs. Adherence, acceptability, and safety Adherence was generally high in supervised programmes, aided by structured onboarding and group formats. Adverse events were uncommon and mild—mainly transient nausea, dizziness, or eye strain. Semi‑immersive large‑screen delivery tended to reduce cybersickness while maintaining engagement among frailer residents. Synthesis summary (Table 3) The strongest and most consistent benefits were seen in executive function and dual‑task mobility in MCI or cognitive frailty, with modest gains in global cognition in several trials. In residential care, immersive reminiscence and group VR showed promising reductions in anxiety and apathy with good acceptability. A domain‑by‑population overview is provided in Table 3. Discussion This review suggests that immersive and semi‑immersive VR can be useful adjuncts for older adults living with MCI, dementia, or cognitive frailty. Improvements in executive function and processing speed are clinically meaningful because they underpin planning, attentional control, and safe ambulation. Gains in TUG, BBS, and anticipatory postural adjustments indicate potential to mitigate fall risk, complementing evidence that VR can enhance dual‑task performance [ 5 , 6 – 8 , 11 , 14 ]. In institutional settings, immersive reminiscence and other engaging VR content appear acceptable and can reduce anxiety and apathy, aligning with non‑pharmacological approaches to behavioural and psychological symptoms of dementia [ 15 – 17 ]. Across domains, benefits were more apparent when programmes provided adequate exposure (2–3 sessions weekly over 8–12 weeks, accumulating ≥ 15 total hours), adaptive challenge, and supervision, consistent with prior meta‑analyses [ 1 – 4 ]. Implementation in age‑friendly systems can begin with nurse‑led group programmes featuring structured onboarding, safety screening (vestibular sensitivity, fall risk, visual/hearing needs), and infection control for shared headsets. Semi‑immersive large‑screen delivery can broaden reach for participants who do not tolerate head‑mounted displays. Future research should prioritise larger and longer multicentre randomized trials with active comparators, standardised outcome batteries (for example, MoCA/MMSE, Trail Making Test, Digit Symbol, TUG, BBS), adequate dose (for example, ≥ 24 sessions or ≥ 15 total hours), and 6–12‑month follow‑up. Implementation science frameworks and economic evaluations in community and long‑term care should be embedded to inform scale‑up and sustainability. Limitations This review has several limitations. First, we searched two databases (PubMed and CINAHL) and restricted inclusion to English‑language publications. Relevant studies indexed in other databases or published in other languages may have been missed, introducing selection and language bias. We also required “virtual reality” to appear in the article title to improve precision; this decision likely reduced sensitivity and may have excluded eligible trials that described VR only in the abstract or methods. Grey literature and trial registries were not searched, so publication and time‑lag bias cannot be ruled out. Second, interventions, comparators, and outcomes were heterogeneous. Programmes varied by immersion level (head‑mounted versus semi‑immersive), content (cognitive tasks, motor‑cognitive training, reminiscence), dose, and supervision. Many trials combined VR with concurrent physical or cognitive training, making it difficult to isolate the specific contribution of VR. Outcome measures and timepoints were inconsistently reported, and follow‑up was generally short. Because of this heterogeneity we did not pool effects; our vote‑counting approach summarises direction but not magnitude and is sensitive to small‑study findings. Third, the overall certainty is limited by study quality and size. Most randomized trials had “some concerns” for risk of bias (for example, unclear allocation concealment, lack of participant blinding), and the non‑randomized studies were at higher risk due to design limitations. Samples were small and often single‑centre, limiting precision and generalisability—particularly to people with more advanced dementia, to community settings without supervision, and to health systems outside the study regions. Adherence and adverse events were variably reported, so tolerability may be under‑ or over‑estimated. Fourth, although our original eligibility emphasised interactive VR, we included some studies using 360° immersive reminiscence. We clarified this decision a priori during screening, but it introduces conceptual heterogeneity across interventions. In addition, hardware and software generations differed across studies; findings may not directly translate to newer devices. Finally, the review protocol was not registered, and we did not conduct a formal GRADE assessment of evidence certainty or explore small‑study/publication bias quantitatively. These factors should be considered when interpreting the conclusions and underscore the need for larger, well‑reported, and longer‑term randomized trials with standardised outcomes and follow‑up. Conclusions Immersive VR shows promise for improving executive function and dual‑task mobility in older adults with MCI or cognitive frailty and for reducing anxiety and apathy in residential care. With nurse‑facilitated delivery, careful dosing, and attention to safety and tolerability, VR can align with age‑friendly, person‑centred care. Larger, longer randomized trials with standardised outcomes and embedded implementation and economic evaluations are needed to guide responsible scale‑up. Abbreviations BBS: Berg Balance Scale HADS: Hospital Anxiety and Depression Scale HMD: Head‑mounted display IADL: Instrumental activities of daily living JBI: Joanna Briggs Institute MCI: Mild cognitive impairment MMSE: Mini‑Mental State Examination MoCA: Montreal Cognitive Assessment PRISMA: Preferred Reporting Items for Systematic Reviews and Meta‑Analyses RCT: Randomized controlled trial RoB 2: Cochrane Risk of Bias 2 tool TMT: Trail Making Test TUG: Timed Up & Go VR: Virtual reality Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials All data supporting the findings of this study are contained within the article. The PRISMA 2020 checklist and two CSV files (exported database results) are provided as supplementary materials. Additional materials (e.g., search logs, full‑text exclusion lists with reasons, and risk‑of‑bias matrices) are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not‑for‑profit sectors. Authors’ contributions TK, KK, and KT conceived and designed the review; KT and KK conducted the searches and screening with support from KS; KK and KT extracted data with assistance from LA; KK and TK appraised risk of bias; KT, KK, TK, and RT analysed and interpreted the data; KK, TK, KT, and LA drafted the manuscript; YI, KS, and RT provided critical revisions. All authors approved the final manuscript. KK, TK, and KT contributed equally as co‑first authors. Acknowledgements None. Clinical trial number Not applicable References Ren Y, Wang Q, Liu H, Wang G, Lu A. 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Ann Palliat Med. 2023;12(2):280–90. 10.21037/apm-22-847 . Tables Tables are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files 20251019VRforElderlypaperTable1.docx 20251019VRforElderlypaperTable2.docx 20251019VRforElderlypaperTable3.docx 20251019PRISMA2020checklistVRforElderlystudy.pdf 20251019EBSCOCSV.csv 20251019PubmedCSV.csv Cite Share Download PDF Status: Published Journal Publication published 13 Jan, 2026 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 26 Dec, 2025 Reviews received at journal 25 Dec, 2025 Reviews received at journal 24 Dec, 2025 Reviewers agreed at journal 21 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviewers agreed at journal 15 Dec, 2025 Reviewers agreed at journal 14 Dec, 2025 Reviewers invited by journal 11 Dec, 2025 Editor invited by journal 28 Nov, 2025 Editor assigned by journal 25 Oct, 2025 Submission checks completed at journal 25 Oct, 2025 First submitted to journal 18 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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17:04:30","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":181483,"visible":true,"origin":"","legend":"","description":"","filename":"20251019PRISMA2020checklistVRforElderlystudy.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7895384/v1/ec801d041f7d6b43633b2cf3.pdf"},{"id":98439794,"identity":"1c557b50-4ffd-412d-a928-120139bf0787","added_by":"auto","created_at":"2025-12-17 17:02:57","extension":"csv","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":64281,"visible":true,"origin":"","legend":"","description":"","filename":"20251019EBSCOCSV.csv","url":"https://assets-eu.researchsquare.com/files/rs-7895384/v1/23fb6eb1cc6df540ddc20fd9.csv"},{"id":98377349,"identity":"d5619ed0-7eea-45d4-9637-dbdbc13d6a57","added_by":"auto","created_at":"2025-12-17 07:12:37","extension":"csv","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":11509,"visible":true,"origin":"","legend":"","description":"","filename":"20251019PubmedCSV.csv","url":"https://assets-eu.researchsquare.com/files/rs-7895384/v1/6d4583ce3a08513be807b5d9.csv"}],"financialInterests":"No competing interests reported.","formattedTitle":"Immersive virtual reality for older adults with mild cognitive impairment, dementia, or cognitive frailty: a systematic review and narrative synthesis (2019–2025)","fulltext":[{"header":"Background","content":"\u003cp\u003ePopulation ageing is accelerating the need for engaging, scalable, and safe interventions that support both cognitive health and functional mobility in later life. Older adults with MCI, dementia, or frailty experience executive dysfunction, slowed processing, and impaired dual‑tasking that together reduce independence and elevate fall risk. Symptoms such as anxiety, apathy, and other behavioural changes further erode quality of life for individuals and caregivers and add to the burden on health and social care systems.\u003c/p\u003e\u003cp\u003eVR offers controlled, multisensory environments where cognitive tasks, motor practice, wayfinding, and personalised content can be combined and titrated. In recent years, immersive and semi‑immersive VR programmes have been tested in outpatient rehabilitation, community settings, and residential aged care. Meta‑analyses suggest small‑to‑moderate gains in global cognition and attention and relatively larger effects on executive function when exposure is adequate [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. VR may also enhance dual‑task performance, a determinant of falls in later life [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, interventions vary widely in immersion level, content, dose, and delivery setting, and the evidence base is fragmented across small trials.\u003c/p\u003e\u003cp\u003eWe therefore conducted a focused, up‑to‑date synthesis of immersive and semi‑immersive VR interventions for older adults with MCI, dementia, or cognitive frailty. Our objectives were to summarise effects on cognition, mobility, and emotional/behavioural outcomes; appraise risk of bias; and discuss practical considerations for nurse‑led, age‑friendly implementation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eProtocol and reporting\u003c/p\u003e\n\u003cp\u003eThis systematic review followed PRISMA 2020 guidance. A protocol was not registered. The review window was prespecified to capture contemporary VR technologies (1 January 2019 to 15 October 2025). The PRISMA 2020 checklist and the PRISMA‑S extension (full search strategies and logs) are provided as Additional files.\u003c/p\u003e\n\u003cp\u003eEligibility criteria\u003c/p\u003e\n\u003cp\u003eWe included studies that:\u003c/p\u003e\n\u003cp\u003e- enrolled adults with mean or minimum age\u0026thinsp;\u0026ge;\u0026thinsp;65 years with mild cognitive impairment (MCI), dementia, or frailty/cognitive frailty;\u003c/p\u003e\n\u003cp\u003e- delivered immersive or semi‑immersive virtual reality (VR) via head‑mounted displays or large‑screen projection (interactive tasks or 360\u0026deg; immersive content such as reminiscence);\u003c/p\u003e\n\u003cp\u003e- reported outcomes in cognition (for example, Montreal Cognitive Assessment [MoCA], Mini‑Mental State Examination [MMSE], Trail Making Test, Digit Symbol, Stroop), mobility (for example, Timed Up \u0026amp; Go [TUG], Berg Balance Scale [BBS], gait speed, anticipatory postural adjustments), or emotional/behavioural health (for example, Geriatric Depression Scale, Hospital Anxiety and Depression Scale, anxiety or apathy measures);\u003c/p\u003e\n\u003cp\u003e- used randomized, quasi‑experimental, or pre\u0026ndash;post designs.\u003c/p\u003e\u003cp\u003eWe excluded augmented or mixed reality, non‑VR exergames, purely diagnostic or cross‑sectional studies, and populations outside scope (for example, acquired brain injury or Parkinson\u0026rsquo;s disease without cognitive impairment). We restricted inclusion to English‑language publications.\u003c/p\u003e\u003cp\u003eInformation sources and search strategy\u003c/p\u003e\u003cp\u003eWe systematically searched PubMed and CINAHL for records published from 1 January 2019 to the last search date (15 October 2025). Search strategies were piloted to balance precision and recall and required \u0026ldquo;virtual reality\u0026rdquo; in the title to reduce off‑target retrieval. Filters for date and English language were applied when available and otherwise enforced during screening. The executable queries were:\u003c/p\u003e\u003cp\u003e- PubMed (searched 15 Oct 2025)\u003c/p\u003e\u003cp\u003e\"virtual reality\"[ti] AND (cognit*[tiab] OR memory[tiab] OR depression[tiab] OR anxiety[tiab] OR balance[tiab] OR gait[tiab]) AND (moca[tiab] OR mmse[tiab] OR \"trail making\"[tiab] OR \"digit symbol\"[tiab] OR stroop[tiab] OR \"n-back\"[tiab] OR gds[tiab] OR \"phq-9\"[tiab] OR hads[tiab] OR tug[tiab] OR \"berg balance\"[tiab] OR sppb[tiab] OR \"chair stand\"[tiab] OR \"gait speed\"[tiab]) AND (randomized[tiab] OR randomised[tiab] OR trial[tiab] OR pilot[tiab] OR feasibility[tiab]) AND (\"2019/01/01\"[dp] : \"2025/12/31\"[dp])\u003c/p\u003e\u003cp\u003eAND (\"mild cognitive impairment\"[tiab] OR MCI[tiab] OR dementia[tiab] OR frail*[tiab])\u003c/p\u003e\u003cp\u003eNOT (protocol[tiab] OR augmented[tiab] OR \"mixed reality\"[tiab] OR AR[tiab])\u003c/p\u003e\u003cp\u003e- CINAHL (EBSCOhost; searched 15 Oct 2025)\u003c/p\u003e\u003cp\u003eTI (\"virtual reality\") AND AB (cognit* OR memory OR depression OR anxiety OR balance OR gait) AND AB (moca OR mmse OR \"trail making\" OR \"digit symbol\" OR stroop OR \"n-back\" OR gds OR \"phq-9\" OR hads OR tug OR \"berg balance\" OR sppb OR \"chair stand\" OR \"gait speed\") AND AB (randomized OR randomised OR trial OR pilot OR feasibility) AND AB (\"mild cognitive impairment\" OR MCI OR dementia OR frail*)\u003c/p\u003e\u003cp\u003eNOT AB (protocol OR augmented OR \"mixed reality\" OR AR) Limits applied: publication date 2019\u0026ndash;2025; English (where available).\u003c/p\u003e\u003cp\u003eThe searches returned 28 records from PubMed and 42 from CINAHL. All results were exported on the search date, de‑duplicated automatically and manually, and entered into the screening workflow.\u003c/p\u003e\u003cp\u003eSelection process\u003c/p\u003e\u003cp\u003eTwo reviewers independently screened titles/abstracts and then full texts in duplicate; disagreements were resolved by consensus. Interrater agreement was monitored; a formal kappa was not calculated. The PRISMA 2020 flow diagram is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eData collection and data items\u003c/p\u003e\u003cp\u003eTwo reviewers independently extracted design and setting, sample characteristics, VR modality and device, dose (session length, frequency, duration), comparator, outcomes and timepoints, adherence, adverse events, and main findings using a piloted form.\u003c/p\u003e\u003cp\u003eRisk of bias assessment\u003c/p\u003e\u003cp\u003eRandomized trials were appraised using the Cochrane Risk of Bias 2 tool (domains D1\u0026ndash;D5). Non‑randomized or single‑group studies were appraised using Joanna Briggs Institute (JBI) critical appraisal tools. Overall judgement followed the highest domain risk across applicable domains. Study‑level assessments are summarised in Table\u0026nbsp;2.\u003c/p\u003e\u003cp\u003eSynthesis methods\u003c/p\u003e\u003cp\u003eGiven heterogeneity in interventions, comparators, and outcome measures, we did not perform a meta‑analysis. A structured narrative synthesis was conducted, organised by domain (cognition, mobility, emotional/behavioural) within populations (MCI, dementia, cognitive frailty). Direction of effects was summarised using vote counting based on statistical significance and consistency across outcomes/timepoints. Reported effect sizes were described narratively where available.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eStudy selection\u003c/p\u003e\u003cp\u003eThe searches identified 70 records. After removing 9 duplicates, 61 records were screened at title/abstract; 24 full‑text reports were assessed for eligibility; 11 were excluded with reasons; and 13 studies were included (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStudy characteristics (Table\u0026nbsp;1)\u003c/p\u003e\u003cp\u003eOf the 13 included studies, 10 were randomized trials and three were feasibility or mixed‑methods studies. Studies were conducted across Asia, Europe, and Australia in outpatient rehabilitation, community programmes, and residential aged care. Most interventions used fully immersive head‑mounted displays; several used semi‑immersive large displays for group sessions. Typical dosing was 2\u0026ndash;3 sessions per week, 20\u0026ndash;45 minutes per session, for 4\u0026ndash;12 weeks. Cognitive outcomes included MoCA/MMSE, Trail Making Test A/B, Digit Symbol, and Stroop; mobility measures included TUG, BBS, gait speed, and anticipatory postural adjustments; emotional/behavioural outcomes included anxiety, apathy, and behavioural symptoms. Full characteristics are provided in Table\u0026nbsp;1.\u003c/p\u003e\u003cp\u003eRisk of bias (Table\u0026nbsp;2)\u003c/p\u003e\u003cp\u003eMost randomized trials had some concerns, driven by allocation concealment, lack of participant blinding, and outcome measurement; one trial was at overall low risk. Non‑randomized studies were at higher risk due to design limitations. Detailed assessments are shown in Table\u0026nbsp;2.\u003c/p\u003e\u003cp\u003eCognitive outcomes\u003c/p\u003e\u003cp\u003eAcross randomized trials in MCI or cognitive frailty, immersive or semi‑immersive VR generally improved executive function and processing speed relative to controls. VR‑augmented physical and cognitive training improved dual‑task executive performance and global cognition in MCI [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A randomized controlled study reported enhanced motivation with cognitive gains using VR‑based cognitive‑motor rehabilitation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and a randomized pilot trial demonstrated feasibility and better attention/visuospatial performance with culture‑based immersive content [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A single‑blind randomized trial combining motor training with VR‑based cognitive tasks showed advantages across multiple domains [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In a multicentre randomized trial of cognitive frailty, motor‑cognitive VR training improved cognitive measures compared with usual activities [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]; a pilot randomized trial in community‑dwelling participants supported feasibility and suggested benefit [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In predementia, fully immersive training improved visuospatial function with concurrent changes in functional connectivity [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These findings align with meta‑analytic evidence of small‑to‑moderate improvements in global cognition and attention and relatively larger effects on executive function with adequate exposure [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMobility outcomes\u003c/p\u003e\u003cp\u003eMobility benefits were also observed. In randomized trials involving older adults with cognitive and motor deficits, VR training enhanced anticipatory postural adjustments versus comparison activities [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In MCI, programmes integrating VR with physical training reduced TUG times and improved BBS relative to controls [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In cognitive frailty, motor‑cognitive VR training improved functional mobility in a multicentre randomized trial [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These results accord with evidence that VR can improve dual‑task performance in older adults [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEmotional and behavioural outcomes\u003c/p\u003e\u003cp\u003eIn residential aged care, immersive reminiscence reduced anxiety in a randomized crossover study of the oldest‑old and was well tolerated without serious adverse effects [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Group‑based immersive sessions were feasible and associated with reductions in behavioural and psychological symptoms over multiple sessions [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A mixed‑methods study in nursing homes reported improved apathy and engagement following immersive VR [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Early feasibility work in mild dementia demonstrated the safety and acceptability of instrumental activities of daily living training using fully immersive VR [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Overall, emotional outcomes are promising but based on small samples and, in some cases, non‑randomized designs.\u003c/p\u003e\u003cp\u003eAdherence, acceptability, and safety\u003c/p\u003e\u003cp\u003eAdherence was generally high in supervised programmes, aided by structured onboarding and group formats. Adverse events were uncommon and mild\u0026mdash;mainly transient nausea, dizziness, or eye strain. Semi‑immersive large‑screen delivery tended to reduce cybersickness while maintaining engagement among frailer residents.\u003c/p\u003e\u003cp\u003eSynthesis summary (Table\u0026nbsp;3)\u003c/p\u003e\u003cp\u003eThe strongest and most consistent benefits were seen in executive function and dual‑task mobility in MCI or cognitive frailty, with modest gains in global cognition in several trials. In residential care, immersive reminiscence and group VR showed promising reductions in anxiety and apathy with good acceptability. A domain‑by‑population overview is provided in Table\u0026nbsp;3.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis review suggests that immersive and semi‑immersive VR can be useful adjuncts for older adults living with MCI, dementia, or cognitive frailty. Improvements in executive function and processing speed are clinically meaningful because they underpin planning, attentional control, and safe ambulation. Gains in TUG, BBS, and anticipatory postural adjustments indicate potential to mitigate fall risk, complementing evidence that VR can enhance dual‑task performance [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In institutional settings, immersive reminiscence and other engaging VR content appear acceptable and can reduce anxiety and apathy, aligning with non‑pharmacological approaches to behavioural and psychological symptoms of dementia [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAcross domains, benefits were more apparent when programmes provided adequate exposure (2\u0026ndash;3 sessions weekly over 8\u0026ndash;12 weeks, accumulating\u0026thinsp;\u0026ge;\u0026thinsp;15 total hours), adaptive challenge, and supervision, consistent with prior meta‑analyses [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Implementation in age‑friendly systems can begin with nurse‑led group programmes featuring structured onboarding, safety screening (vestibular sensitivity, fall risk, visual/hearing needs), and infection control for shared headsets. Semi‑immersive large‑screen delivery can broaden reach for participants who do not tolerate head‑mounted displays.\u003c/p\u003e\u003cp\u003eFuture research should prioritise larger and longer multicentre randomized trials with active comparators, standardised outcome batteries (for example, MoCA/MMSE, Trail Making Test, Digit Symbol, TUG, BBS), adequate dose (for example, \u0026ge;\u0026thinsp;24 sessions or \u0026ge;\u0026thinsp;15 total hours), and 6\u0026ndash;12‑month follow‑up. Implementation science frameworks and economic evaluations in community and long‑term care should be embedded to inform scale‑up and sustainability.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis review has several limitations. First, we searched two databases (PubMed and CINAHL) and restricted inclusion to English‑language publications. Relevant studies indexed in other databases or published in other languages may have been missed, introducing selection and language bias. We also required \u0026ldquo;virtual reality\u0026rdquo; to appear in the article title to improve precision; this decision likely reduced sensitivity and may have excluded eligible trials that described VR only in the abstract or methods. Grey literature and trial registries were not searched, so publication and time‑lag bias cannot be ruled out.\u003c/p\u003e\u003cp\u003eSecond, interventions, comparators, and outcomes were heterogeneous. Programmes varied by immersion level (head‑mounted versus semi‑immersive), content (cognitive tasks, motor‑cognitive training, reminiscence), dose, and supervision. Many trials combined VR with concurrent physical or cognitive training, making it difficult to isolate the specific contribution of VR. Outcome measures and timepoints were inconsistently reported, and follow‑up was generally short. Because of this heterogeneity we did not pool effects; our vote‑counting approach summarises direction but not magnitude and is sensitive to small‑study findings.\u003c/p\u003e\u003cp\u003eThird, the overall certainty is limited by study quality and size. Most randomized trials had \u0026ldquo;some concerns\u0026rdquo; for risk of bias (for example, unclear allocation concealment, lack of participant blinding), and the non‑randomized studies were at higher risk due to design limitations. Samples were small and often single‑centre, limiting precision and generalisability\u0026mdash;particularly to people with more advanced dementia, to community settings without supervision, and to health systems outside the study regions. Adherence and adverse events were variably reported, so tolerability may be under‑ or over‑estimated.\u003c/p\u003e\u003cp\u003eFourth, although our original eligibility emphasised interactive VR, we included some studies using 360\u0026deg; immersive reminiscence. We clarified this decision a priori during screening, but it introduces conceptual heterogeneity across interventions. In addition, hardware and software generations differed across studies; findings may not directly translate to newer devices.\u003c/p\u003e\u003cp\u003eFinally, the review protocol was not registered, and we did not conduct a formal GRADE assessment of evidence certainty or explore small‑study/publication bias quantitatively. These factors should be considered when interpreting the conclusions and underscore the need for larger, well‑reported, and longer‑term randomized trials with standardised outcomes and follow‑up.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eImmersive VR shows promise for improving executive function and dual‑task mobility in older adults with MCI or cognitive frailty and for reducing anxiety and apathy in residential care. With nurse‑facilitated delivery, careful dosing, and attention to safety and tolerability, VR can align with age‑friendly, person‑centred care. Larger, longer randomized trials with standardised outcomes and embedded implementation and economic evaluations are needed to guide responsible scale‑up.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBBS: Berg Balance Scale\u003c/p\u003e\n\u003cp\u003eHADS: Hospital Anxiety and Depression Scale\u003c/p\u003e\n\u003cp\u003eHMD: Head‑mounted display\u003c/p\u003e\n\u003cp\u003eIADL: Instrumental activities of daily living\u003c/p\u003e\n\u003cp\u003eJBI: Joanna Briggs Institute\u003c/p\u003e\n\u003cp\u003eMCI: Mild cognitive impairment\u003c/p\u003e\n\u003cp\u003eMMSE: Mini‑Mental State Examination\u003c/p\u003e\n\u003cp\u003eMoCA: Montreal Cognitive Assessment\u003c/p\u003e\n\u003cp\u003ePRISMA: Preferred Reporting Items for Systematic Reviews and Meta‑Analyses\u003c/p\u003e\n\u003cp\u003eRCT: Randomized controlled trial\u003c/p\u003e\n\u003cp\u003eRoB 2: Cochrane Risk of Bias 2 tool\u003c/p\u003e\n\u003cp\u003eTMT: Trail Making Test\u003c/p\u003e\n\u003cp\u003eTUG: Timed Up \u0026amp; Go\u003c/p\u003e\n\u003cp\u003eVR: Virtual reality\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data supporting the findings of this study are contained within the article. The PRISMA 2020 checklist and two CSV files (exported database results) are provided as supplementary materials. Additional materials (e.g., search logs, full‑text exclusion lists with reasons, and risk‑of‑bias matrices) are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not‑for‑profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTK, KK, and KT conceived and designed the review; KT and KK conducted the searches and screening with support from KS; KK and KT extracted data with assistance from LA; KK and TK appraised risk of bias; KT, KK, TK, and RT analysed and interpreted the data; KK, TK, KT, and LA drafted the manuscript; YI, KS, and RT provided critical revisions. All authors approved the final manuscript. KK, TK, and KT contributed equally as co‑first authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRen Y, Wang Q, Liu H, Wang G, Lu A. Effects of immersive and non\u0026ndash;immersive virtual reality\u0026ndash;based rehabilitation training on cognition, motor function, and daily functioning in patients with mild cognitive impairment or dementia: a systematic review and meta\u0026ndash;analysis. 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Immersive virtual reality reminiscence reduces anxiety in the oldest old without causing serious side effects: a single\u0026ndash;center, pilot, randomized crossover study. Front Hum Neurosci. 2021;14:598161. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fnhum.2020.598161\u003c/span\u003e\u003cspan address=\"10.3389/fnhum.2020.598161\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrimelow RE, Thangavelu K, Beattie R, Dissanayaka NN. Feasibility of group\u0026ndash;based multiple virtual reality sessions to reduce behavioral and psychological symptoms in persons living in residential aged care. 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Ann Palliat Med. 2023;12(2):280\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21037/apm-22-847\u003c/span\u003e\u003cspan address=\"10.21037/apm-22-847\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"virtual reality, mild cognitive impairment, dementia, cognitive frailty, older adults, executive function, dual‑task, mobility, anxiety, systematic review","lastPublishedDoi":"10.21203/rs.3.rs-7895384/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7895384/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eImmersive 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 synthesised recent studies to clarify benefits, risks, and implementation considerations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eFollowing PRISMA 2020, we searched PubMed and CINAHL from 1 January 2019 to 15 October 2025. Eligible studies enrolled adults aged\u0026thinsp;\u0026ge;\u0026thinsp;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\u0026deg; content); and reported cognitive, mobility, or emotional/behavioural outcomes in randomized, quasi‑experimental, or pre\u0026ndash;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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSeventy 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 \u0026amp; 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.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eImmersive VR appears feasible and potentially beneficial for mentation and mobility in older adults with MCI or cognitive frailty and may reduce anxiety and apathy in institutional settings. Programmes with adequate exposure (2\u0026ndash;3 sessions/week for 8\u0026ndash;12 weeks; \u0026ge;15 total hours), adaptive challenge, and supervision show the most consistent benefits. Larger multicentre randomized trials with standardised outcomes and embedded implementation and economic evaluations are needed.\u003c/p\u003e","manuscriptTitle":"Immersive virtual reality for older adults with mild cognitive impairment, dementia, or cognitive frailty: a systematic review and narrative synthesis (2019–2025)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-17 07:12:32","doi":"10.21203/rs.3.rs-7895384/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-26T12:56:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-25T13:37:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-25T03:22:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309642100005397417613492498688956401010","date":"2025-12-21T15:09:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18688547165117888176165717326255609087","date":"2025-12-19T14:05:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75796539586116271517098684796626847199","date":"2025-12-15T17:34:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"322629136781592817530452524431365646991","date":"2025-12-14T14:53:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-11T06:44:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-28T10:21:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-25T10:50:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-25T10:49:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-10-18T19:57:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d17a0f28-5a7c-42d4-901e-ed913d91f71a","owner":[],"postedDate":"December 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T17:21:18+00:00","versionOfRecord":{"articleIdentity":"rs-7895384","link":"https://doi.org/10.1186/s12877-025-06957-8","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2026-01-13 16:29:03","publishedOnDateReadable":"January 13th, 2026"},"versionCreatedAt":"2025-12-17 07:12:32","video":"","vorDoi":"10.1186/s12877-025-06957-8","vorDoiUrl":"https://doi.org/10.1186/s12877-025-06957-8","workflowStages":[]},"version":"v1","identity":"rs-7895384","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7895384","identity":"rs-7895384","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}