Immersive virtual reality cognitive training in older adults with mild cognitive impairment: Feasibility results from a randomized controlled trial

BACKGROUND: Immersive virtual reality (VR)-based cognitive training has shown potential benefits in neuropsychiatric populations, but evidence in older adults with mild cognitive impairment (MCI) remains limited, particularly regarding feasibility and short-term effects on vulnerability factors. OBJECTIVE: To evaluate the feasibility of a 6-week immersive VR cognitive training program in older adults with MCI and to explore preliminary effects on cognitive performance, depressive symptoms, and social and behavioral rhythms. METHODS: This single center randomized controlled feasibility trial allocated participants aged ≥65 years with MCI to either an immersive VR cognitive training program (Virtual Sail 3D) or an active control intervention based on healthy lifestyle education. Feasibility outcomes included dropout rates and VR-related adverse effects. Secondary outcomes assessed changes in cognitive performance (MMSE, ACE-R), depressive symptoms (PHQ-9), and social and behavioral rhythms (Brief Social Rhythms Scale) from baseline (T0) to 6 weeks (T1). RESULTS: Forty participants were randomized. No dropouts occurred in the VR group, whereas a 30% dropout rate was observed in the control group. VR-related side effects were mild and transient. No significant between-group differences emerged in cognitive or depressive outcomes. However, social and behavioral rhythms remained stable in the VR group and worsened in the control group, with a borderline between-group difference. A significantly higher proportion of VR participants showed clinically meaningful improvement in rhythm regulation. CONCLUSIONS: Immersive VR cognitive training is feasible and well-tolerated in older adults with MCI. While short-term cognitive benefits were not observed, preservation of social and behavioral rhythms suggests a potential protective effect, supporting larger and longer phase III trials.