Effects of different interventions based on virtual reality on cognitive and motor function in elderly people with mild cognitive impairment or dementia : a systematic review and network meta-analysis (Preprint)

BACKGROUND Virtual reality (VR)-based interventions are recognized as being promising nonpharmacological therapies for enhancing cognitive and motor function in elderly patients with cognitive impairment. However, the relative efficacy of various VR-based interventions remains undetermined. OBJECTIVE To address this research gap, a frequentist framework was utilised to conduct a network meta-analysis that integrated both direct and indirect comparative evidence. METHODS A comprehensive electronic literature search was conducted in five English databases and three Chinese databases to identify relevant randomised controlled trials (RCTs) published up to April 2025. A random effects model was selected for traditional meta-analysis to directly examine the efficacies of different nonpharmacological interventions. The consistency model was chosen to perform a network meta-analysis to evaluate the relative effects and rank probability of other nonpharmacological interventions. RESULTS A total of 43 RCTs encompassing six distinct nonpharmacological interventions were included. Network meta-analysis demonstrated that VR sport training was ranked as the most likely effective intervention for improving global cognition and executive function in older adults with cognitive impairments; additionally, VR comprehensive cognitive game + sport training was identified as being the optimal approach for enhancing motor function. CONCLUSIONS This study confirmed the efficacy of VR-based nonpharmacological interventions in ameliorating cognitive and motor functions among older adults with cognitive impairment and recommended several VR-based interventions for clinical practice. Health care professionals should be encouraged to apply promising VR-based interventions (such as VR sport training and VR comprehensive cognitive game + sport training) for older adults with cognitive impairments.