Virtual Reality–Based Cognitive Training to Prevent Cognitive Decline in Older Adults With Mild Cognitive Impairment: A Systematic Review of Randomized Controlled Trials

Aim To synthesize randomized controlled trial evidence on the effects, feasibility, and safety of virtual reality (VR)–based cognitive training in older adults with mild cognitive impairment (MCI) or related predementia conditions. Methods A systematic review was conducted in accordance with PRISMA 2020 and prospectively registered in PROSPERO (CRD420261290617). Electronic searches were performed in MEDLINE (via PubMed), Scopus, ScienceDirect, and MDPI Journals, with additional verification searches in the Cochrane Central Register of Controlled Trials (CENTRAL). Eligible studies were randomized controlled trials published in English between 2020 and 2025 involving adults aged ≥ 60 years who received VR‐based cognitive or cognitive–motor training. Outcomes included cognitive and functional performance, adherence, and safety. Results Eight randomized controlled trials were included. VR‐based interventions were associated with the maintenance or attenuation of decline in selected cognitive and functional domains, particularly executive function, memory, and visuospatial ability. Effects varied across cognitive domains, immersion levels, and intervention protocols. Adherence was generally high, and reported adverse events were infrequent and mild, most commonly dizziness or visual fatigue. No serious adverse events were reported. Conclusions VR‐based cognitive training may represent a feasible and well‐tolerated non‐pharmacological approach for older adults with MCI. Although evidence suggests potential benefits in sustaining cognitive function, substantial heterogeneity across interventions and limited geographical diversity restrict broader generalizability. Larger multicenter trials with standardized outcome measures and longer follow‐up are needed.