Cognitive and Physical Effects of Virtual Rehabilitation in Mild Cognitive Impairment and Subjective Cognitive Decline: A Systematic Review and Meta-Analysis.

Abstract

Purpose: To compare the effects of immersive and nonimmersive clinical virtual reality (CVR) on cognitive and physical outcomes in older adults with mild cognitive impairment (MCI) or subjective cognitive decline (SCD), and to examine the influence of intervention duration.

Data sources: Seven databases were searched for randomized controlled trials up to February 2026.

Review methods: The review followed PRISMA guidelines. Standardized mean differences (Hedges' g) were calculated using random-effects models.

Results: Twenty-one randomized controlled trials involving 1,110 participants were included. CVR produced a significant large effect on global cognitive function (SMD = 0.89; 95% CI, 0.45-1.32; p = 0.001) and memory (SMD = 0.90; 95% CI, 0.50-1.31; p = 0.001). Effects on processing speed and sustained attention were large but not statistically significant (SMD = 0.84; 95% CI, -0.01-1.69; p = 0.052). Executive function showed a significant moderate effect (SMD = 0.54; 95% CI, 0.06-1.02; p = 0.003). Verbal learning and verbal fluency showed moderate, non-significant effects. No significant overall effect was found for physical function (SMD = 0.36; 95% CI, 0.00-0.71; p = 0.050). Nonimmersive CVR showed a larger effect on global cognition than immersive CVR, although the subgroup difference was not significant. Programs lasting at least 900 minutes showed a large effect on global cognition, with no significant difference compared with shorter programs.

Conclusion: CVR may improve global cognition and memory in older adults with MCI or SCD and may complement conventional cognitive rehabilitation.