The effects of virtual reality-based interventions on cognitive function, depressive symptoms, and daily functioning in older adults with mild cognitive impairment: a systematic review and meta-analysis of randomized controlled trials

Objective To evaluate the efficacy of virtual reality (VR) interventions in improving cognitive function, depressive symptoms, and daily living ability in older adults with mild cognitive impairment (MCI). Methods Eligible randomized controlled trials (RCTs) were systematically retrieved from eight databases and quantitatively synthesized in a meta-analysis. Study quality was appraised using the Cochrane Risk of Bias tool and the GRADE framework. Results A total of 24 RCTs involving 1,381 participants were included. VR interventions were associated with moderate improvements in overall cognitive function (SMD = 0.55, 95% CI: 0.36–0.73, p < 0.0001), although the certainty of this evidence was rated as low. Subgroup analyses showed that immersive VR and purely cognitive VR were more effective than other types. VR also significantly improved attention (Digit Span Forward: MD = 0.39, p = 0.004), processing speed (TMT-A: MD = −4.34, p = 0.01), and executive function (TMT-B: MD = −15.76, p = 0.009; Digit Span Backward: MD = 0.33, p < 0.001). Statistical analysis indicated an absence of significant improvement in daily living performance (SMD = 0.58, p = 0.19) and depressive symptoms (SMD = −0.75, p = 0.18). Conclusion VR interventions, particularly immersive and cognitive-focused types, may enhance cognitive performance in individuals with MCI, especially in attention, processing speed, and executive function. However, current evidence does not support clear benefits for daily functioning or depressive symptoms. Further high-quality studies with long term follow up are needed. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/ CRD420251002107, ID: CRD420251002107.