Comparing Digital Cognitive Interventions to Active Controls and Usual Care for Mild Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis

Background and Objectives: Mild cognitive impairment (MCI) and dementia are prevalent public health challenges with limited pharmacological options for cognitive enhancement. Digital cognitive rehabilitative interventions (DCIs) have emerged as a promising non-pharmacological approach, offering accessibility and personalized strategies. However, their efficacy across diverse populations and contexts remains unclear. This study evaluated the effectiveness of DCIs in improving global cognitive function in individuals with MCI and dementia by comparing them to active controls and usual care. Materials and Methods: Ten databases, including Ovid-Medline, Ovid–Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, KoreaMed, KMbase, RISS, and KISS, were searched for studies published up to May 2025. Global cognitive and executive functions, along with quality of life, were assessed. Meta-analyses using Review Manager version 5.4 were conducted to evaluate global cognitive function improvements, first stratified by comparator group (active control vs. usual care) and further stratified by patient (MCI vs. dementia) and intervention (computer-based vs. virtual reality cognitive training) types. Results: This systematic review and meta-analysis analyzed 37 studies. Overall, DCIs improved global cognitive function compared to the control group (SMD = 0.44, 95% CI: 0.18, 0.69). However, subgroup analysis showed no significant effect when DCIs were compared with active controls (SMD = 0.24, 95% CI: −0.35, 0.82). Subgroup analysis showed benefits for individuals with MCI (SMD = 0.43, 95% CI: 0.16, 0.70) but yielded inconclusive results for those with dementia (SMD = 0.95, 95% CI: −0.69, 2.59). Computer-based DCIs were effective (SMD = 0.57, 95% CI: 0.20, 0.93), whereas VR-based interventions had inconsistent outcomes (SMD = 0.32, 95% CI: −0.34, 0.98). Conclusions: DCIs may improve cognitive function compared with usual care, particularly in patients with MCI. However, their added benefits overactive cognitive interventions remain uncertain. Further well-designed studies are needed to clarify the relative advantages of DCIs across patient populations and intervention formats.