“Speaking into the Virtual Void?”—An Evidence Review of Virtual Reality for Communication Assessment, Interaction and Training in Dementia

Background/Objectives: Communication decline is a hallmark of dementia, yet speech-language outcomes remain marginal in much of the virtual reality (VR) dementia literature. This evidence review synthesises empirical work on how VR has been used to support, train, or assess communication in dementia, positioning VR as a communication platform rather than only a cognitive tool. Methods: A structured search (2000–2025) across CINAHL, PubMed, PsycINFO, Scopus, and Web of Science was supplemented by reference list checking. Eleven empirical studies met eligibility criteria, spanning immersive and non-immersive VR used with people living with dementia, and VR-based communication training for caregivers, care staff, and clinicians. Findings were synthesised thematically through an explicit communication lens. Results: Evidence most consistently supports VR as a scaffold for communicative engagement and participation. Immersive and shared VR experiences commonly elicited increased verbal involvement, shared attention, and interactional responsiveness during or immediately after sessions, particularly when content was socially meaningful and appropriately paced. A second strand of work uses VR simulation to train communication partners, with participants reporting high acceptability and perceived improvements in confidence and strategy use, although behavioural transfer to real-world care is rarely measured. Assessment-oriented studies and stakeholder perspectives highlight VR’s potential to elicit functional behaviour in context and to complement clinic-based assessment, but communication validity is typically inferred rather than operationalised using standardised measures. Conclusions: VR shows early promise for dementia communication care, especially as an adjunct that structures interaction, supports participation, and scales communication training. Progress now depends on communication-specific intervention design, agreed outcome metrics capturing discourse and functional participation, and implementation studies addressing accessibility, cultural-linguistic diversity, and transfer to everyday care.