Virtual reality design principles for psychophysiological interventions in dementia: A systematic review of research

Abstract

Virtual reality is increasingly explored as a therapeutic tool in dementia care, offering opportunities for cognitive stimulation, emotional engagement, and physical activity. However, the effectiveness of virtual reality interventions depends on the degree to which they are designed to meet the unique psychophysiological needs of people with dementia. This systematic review aimed to identify inclusive design principles for virtual reality systems that support accessibility, usability, and safety for this population.

A structured search of the PubMed database was conducted, focusing on studies published between 2019 and 2025 that involved people with dementia and incorporated user-centered or participatory design elements. Seventeen studies met the inclusion criteria. A thematic analysis was conducted across physiological indicators (e.g., eye-tracking, heart rate), task performance metrics (e.g., accuracy, independence), and subjective evaluations (e.g., emotional responses, ease of use).

In terms of accessibility, the review found that interventions commonly addressed sensory and cognitive impairments through simplified visual interfaces, calming and familiar environments, and options for seated interaction. For usability, systems were optimized using both objective performance data and user feedback, emphasizing intuitive interaction methods, reduced task complexity, and ergonomic hardware design. Regarding inclusive design, studies recommended the use of familiar stimuli, adaptable difficulty levels, culturally resonant content, and assistive technologies such as gaze- and motion-based input to personalize engagement.

This review presents a set of evidence-informed guidelines for the inclusive design of virtual reality interventions tailored to dementia care. These guidelines aim to support the development of meaningful, scalable interventions that improve care outcomes.