Effects of virtual reality-based cognitive training on cognitive function, instrumental activities of daily living, and depressive symptoms in older people with mild cognitive impairment: a systematic review with meta-analysis of randomized controlled trials

Background This systematic review and meta-analysis aimed to synthesize and critically evaluate the available scientific evidence on the effects of virtual reality based cognitive training on cognitive function, instrumental activities of daily living (IADL) performance, and depressive symptoms in older peoples with mild cognitive impairment (MCI). Methods A systematic review and meta-analysis of RCTs was conducted following PRISMA guidelines. Seven electronic databases (PubMed, EBSCOhost, CINAHL Complete, Cochrane, ProQuest, Scopus, and Web of Science) were searched through March 2026. Additional sources included the reference lists of relevant studies. Study quality was assessed using the Oxford Centre for Evidence-Based Medicine scale, RoB 2, and GRADEpro tools. Eligible studies included RCTs that evaluated immersive and non-immersive VR-based cognitive training interventions in older peoples with MCI, reporting outcomes on cognitive function, IADLs, or depressive symptoms. The review was registered in PROSPERO (CRD42024558108). Results Of 2,433 screened records, 19 studies met the inclusion criteria. Pooled analyses revealed significant effects of VR-based cognitive training on cognitive function (Montreal Cognitive Assessment: p 0.003; Trail Making Test–B: p 0.000), IADLs ( p 0.000), and depressive symptoms (Geriatric Depression Scale: p = 0.002). Conclusion VR-based cognitive training was associated with improvements in cognitive performance, instrumental activities of daily living, and depressive symptoms in older people with mild cognitive impairment. However, these findings should be interpreted with caution due to heterogeneity across studies, mixed risk of bias, and the moderate certainty of the evidence. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024558108 , identifier (CRD42024558108).