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This article was written on 21 Mar 2025, and is filled under Volume 20 2025, Volume 20 No 1.

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Charis Marie Juan, cognitive function, Daisy Lopez, Dementia, Frances Claud, intervention, Lorelyn Cendaña, Mary Jane Villanueva, mild cognitive impairment (MCI), nursing care, patient outcomes, Roison Andro Narvaez, virtual reality

The Effects of Virtual Reality on Care of Patients with Dementia: An Integrative Review

by Mary Jane Villanueva, RN

Lorelyn Cendaña, RN

Frances Claud, RN

Charis Marie Juan, RN

Daisy Lopez, RN

Roison Andro Narvaez, MSN RN

St. Paul University Philippines

Citation: Villanueva, M. J., Cendaña, L., Claud, F., Juan, C. M., Lopez, D., & Narvaez, R. A.. (2025). The effects of virtual reality on care of patients with dementia: An integrative review. Canadian Journal of Nursing Informatics, 20(1). https://cjni.net/journal/?p=14292

Abstract

Background: Virtual Reality (VR) is an emerging tool that can be used to enhance the rehabilitation process for both physical and cognitive functions. VR therapies are beneficial for persons with dementia or Mild Cognitive Impairment (MCI), with minor to moderate benefits on cognitive functions.

Aim: To examine in detail the therapeutic effects of virtual reality on the care of patients with dementia. Specifically, to explore how VR interventions can be integrated into nursing care practice for optimal patient outcomes and provide evidence-based recommendations for future practice.

Design: An integrative review using Whittemore and Knafl’s (2005) method.

Results: Twenty two studies deemed eligible on the effects of VR for patients with dementia. The review revealed positive therapeutic effects and cognitive benefits of VR interventions for dementia patients. The research shows VR’s potential in enhancing patients’ psychological well-being, improving cognitive function, and reducing depressive symptoms. Additionally, VR’s adaptability allows for personalized care, accommodating patients’ comfort and familiarity with VR devices. However, the effectiveness varies based on individual factors, and caution is needed due to small sample sizes or the preliminary nature of some studies.

Conclusions: VR interventions have been observed to offer an abundance of therapeutic and cognitive benefits for patients suffering from dementia. As VR technology continues to evolve, it is essential for our understanding and implementation of these interventions in dementia care to evolve alongside it.

Implication for Practice: The application of VR interventions for patients with dementia could have significant implications for practice. It can provide a non-pharmaceutical method to enhance cognitive and motor functions, which can reduce the reliance on medication and its associated side effects. However, it’s crucial to understand how to implement these interventions effectively and safely within different care settings.

Background

The term “dementia” refers to a broad range of long-term neurodegenerative conditions marked by a progressive loss of cognitive and goal-directed behaviour (D’Cunha et al., 2019; Aruanno & Garzotto, 2019). However, mild cognitive impairment (MCI) is recognized as an early indicator of dementia (Gauthier et al., 2006) and represents a stage marked by cognitive symptoms that cannot be fully explained by normal aging (Grueso & Viejo-Sobera, 2021). The occurrence of MCI in people aged 60 years and above varies between 6.7% and 25.2% depending on age and years of education attained (Petersen et al., 2018; Langa & Levine, 2014). Normal aging is associated with declines in cognitive functions such as divided attention, verbal fluency, learning ability, and reaction time. However, the diagnostic criteria for mild cognitive impairment (MCI) include changes that exceed what is expected for a person’s age or educational background. These criteria also require evidence of impaired cognitive function, difficulties with daily activities, and the absence of dementia (Nelson & O’Connor, 2008). In addition, dementia is also related to the economic growth of the countries, since mild-income countries tend to have higher incidences of dementia than high-income countries (Domiguez et al., 2021).

Early detection and appropriate interventions for MCI can slow down the progress of dementia or alleviate its symptoms (Wild et al., 2008). Physical exercise combined with cognitive training is a recommended non-pharmacological intervention for individuals with MCI (Daviglus et al., 2010; Park et al., 2019). Despite that, some studies have emerged related to virtual reality (VR) use in preventing or treating MCI (Zucchella et al., 2018). A combination of exercise together with VR has exhibited substantial improvements not just in terms of bodily function but also in terms of cognitive capacities among healthy older adults favoring this combination over general exercise alone (Htut et al., 2018; Optale et al., 2010).

In addition, Virtual Reality (VR) is an emerging tool that can be used to enhance the rehabilitation process for both physical and cognitive functions (Tieri et al., 2018). VR has been shown to have therapeutic effects on people with MCI. Numerous studies revealed that VR cognitive training improved visuospatial performance, apathy, affect, and quality of life in people with MCI (Kim et al., 2022), and physical function (Zhu et al., 2021). Similarly, VR has considerable favorable impacts on cognitive function in stroke survivors. Data also suggests that VR can be used as a adjuvant tool for stroke therapy. (Aminov et al., 2018). Another meta-analysis found that semi-immersive VR therapies are beneficial for persons with dementia or MCI, with minor to moderate benefits on cognitive and physical fitness (Kim et al., 2019). VR recollection treatment has also been shown to increase feelings of pleasure and maintain cognitive performance among patients with advanced aged, but the long-term consequences are unknown (Huang & Yang, 2022). VR-based reminiscence treatment has been demonstrated to enhance well-being and cognitive ability in elderly dementia patients (Tominari et al., 2021). Moreover, cognitive-motor therapies using VR and day-to-day activities have been shown to have relatively low to significant effects on older adults with dementia and MCI’s overall cognitive abilities, including attention, motor, memory ability (Buele, 2023). However, some studies found that VR has no beneficial effects on improving psychological functions with cognitive impairment (Oliveira et al., 2021).

Nurses’ clinical competency has become an increasing concern in contemporary healthcare (Karami et al., 2017; Westbrook et al., 2011). The growing integration of technology in nursing practice highlights limitations in applying traditional approaches within technologically advanced settings (Pepito & Locsin, 2018). As the expectations of the nursing profession evolve, it is essential to recognize the technological demands of modern healthcare environments. Embracing technology-enhanced nursing practice—while adhering to safety protocols and evidence-based interventions—supports legitimate, secure, and effective care delivery (Vasquez et al., 2023). However, maintaining and advancing clinical competency among nurses requires ongoing effort (Afshar et al., 2020; Ajuebor et al., 2019). To meet these challenges, expanded training and professional development opportunities are imperative (Simone et al., 2018).

Therefore, this review aims to examine in detail the therapeutic effects and cognitive benefits associated with virtual reality (VR) interventions for patients with dementia. Specifically, it seeks to explore how VR can be integrated into nursing practice to enhance patient outcomes, assess the technology’s ease of use, acceptability, and potential side effects, and offer evidence-based recommendations for future practice. The novelty of this study lies in its comprehensive review and interpretation of existing literature on the application of VR interventions in dementia care.

Method

Design

An integrative review design was utilized for this study. The integrative review process is a specialized methodology for literature reviews because it enables the incorporation of a wide range of evidence, from empirical research to theoretical papers, which can offer a more thorough grasp of the subject being studied. Defining the review’s objective, doing a literature search, assessing data from primary sources, interpreting the data, and presenting the findings are standard steps in the process (Whittemore & Knafl, 2005).

Search Strategy

The search for this review was conducted between February and March 2024. The researchers developed a comprehensive search strategy, outlining the databases, search terms, and inclusion criteria. Articles published between January 2012 and December 2023 were considered. The databases searched included PubMed, Google Scholar, SAGE, the National Library of Medicine, and Frontiers. Keywords used in the search included ‘virtual reality,’ ‘dementia,’ and ‘cognitive benefits.’ Boolean operators and truncation were applied appropriately to refine and expand search results.

In this search, 1500 studies were identified initially in various platform including the PubMed, the Google Scholar, National Library of Medicine, SAGE, and Frontiers. After this identification, 100 abstracts were identified for review. Applying the inclusion and exclusion criteria, only 28 studies were eventually included, with 72 being excluded for reasons such as ineligible participants, lack of VR interventions, non-English language, or publication more than 10 years old. The selected studies were then examined with an expert reviewer. Finally, twenty-two (22) studies were eligible for this integrative review (see Figure 1).

Figure 1.

PRISMA FLOW Diagram of the Effects of Virtual Reality on Care of Patients with Dementia.

Inclusion and Exclusion Criteria

The researchers applied a PICOTS format to the eligibility criteria, as outlined in Table 1.

Table 1.

Inclusion and Exclusion

Data Evaluation/ Quality Appraisal

A data collection tool (Sparbel & Anderson, 2020) was used to classify the data that had been extracted from the databases with the following information: author(s), setting, year of publication, aim/objective, research design, population and sampling, data analysis, findings, recommendations, and level of evidence. (see Table 2). The researchers’ strategy for data evaluation and review involved: inviting the expert reviewers to independently validate the data presented in the table, employing a narrative synthesis approach to compare the collected data, and conducting frequent meetings to discuss and resolve any disagreements to reach a consensus on the findings.

Table 2.

Matrix table Template using Sparbel & Anderson (2020)

To evaluate the worth of the evidence from each selected study, the researchers employed the Level of Evidence (LOE) taxonomy by Melnyk & Fineout-Overholt (2023):

Level 1: Systematic review & meta-analysis of randomized controlled trials; clinical guidelines based on systematic review or meta-analysis.

Level 2: Randomized controlled trial

Level 3: Controlled trial (no randomization)

Level 4: Case-control or cohort study

Level 5: Systematic review of descriptive & qualitative studies

Level 6: Single descriptive or qualitative study

Level 7: Expert opinion.

This method was applied to identify the highest quality evidence available for inclusion in the review. Although the Level of Evidence (LOE) was used to indicate the strength of the included studies, it was not used as an exclusion criterion.

Results

Characteristics of the Selected Studies

Table 3 presents an overview of the various selected studies focused on the application of VR interventions in the treatment and care of adults with dementia and MCI. Studies span several geographic locations, including China, Hong Kong, Portugal, Canada, Poland, Japan, Jordan, Korea, Cyprus, Australia, The United States, and Taiwan, indicating the global interest in this area of research. The “aim and objective of the study” varied from study to study, reflecting the diverse ways in which VR was used to alleviate symptoms in dementia patients, to evaluate the feasibility and safety of VR experiences, or to facilitate VR for cognitive training for dementia patients. Several studies also focused on reminiscence therapy using VR, while others investigated the potential of VR in enhancing the practical competency of caregivers.

Table 3.

Matrix table using Sparbel & Anderson (2020)

Villanueva-Table3-1 Download

The research designs used in these studies were diverse, including Randomized Controlled Trials (RCT), Pilot studies, Mixed Methods, Non-Randomized Controlled Trials (Non-RCT), Feasibility Studies, and Case-Control Studies. This diversity indicates that VR in dementia care has been examined from multiple angles and through various research methodologies. The sample sizes in the studies ranged from as small as two participants to as large as 150 participants, which included nursing home residents, elderly people with dementia, medical experts, and caregivers.

The interventions used in the studies primarily involved VR programs designed to improve the psychological well-being and cognitive function of dementia patients. Common features of these programs included reminiscence therapy, which used VR to stimulate patients’ memories, and immersive experiences, which used VR to engage patients in activities they may no longer be able to do due to their condition. The diversity of interventions underscored the adaptability of VR to meet the specific likings and needs of the individual with dementia.

Despite the general positive results, some studies also emphasized the need for further research, hardware and software modifications, and caution in interpreting results due to small sample sizes or the preliminary nature of the research. Large-scale studies and controlled trials were often recommended to validate preliminary findings and examine the effectiveness of VR interventions in various settings and populations. Some studies also recommended more research to explore new applications of VR in dementia care and to optimize the design of VR interventions. Moreover, the Level of evidence (LOE) ranged from L2, L3, L4 and L6, indicating varying degrees of confidence in the results of studies.

Furthermore, the studies collectively indicated that VR has significant potential as a tool for improving dementia care. The positive effects on cognitive function, depressive symptoms, and patient satisfaction suggested that VR can enhance the well-being for patients with dementia and assist caregivers and health professionals in providing effective care. However, the need for further research is consistently emphasized, highlighting the ongoing journey to fully understand and optimize the use of VR in dementia care.

Therapeutic effects

This review aims to examine in detail the therapeutic effects and cognitive benefits that are associated with VR intervention among patients with dementia. Specifically, to explore how VR interventions can be integrated into nursing care practice for optimal patient outcomes and provide evidence-based recommendations for future practice

The therapeutic effects and benefits of Virtual Reality (VR) interventions on patients suffering from dementia can be categorized into three themes: Function, Virtual Reality Intervention, and Impact.
The ‘Function’ category is divided into three parts: Cognitive function, Motor function, and Memory function. These refer to cognition, physical fitness, and the process of encoding, storing, and retrieving information, respectively.

The Virtual Reality Intervention is categorized by the level of immersion: Low immersion involves basic graphic workstations like a computer monitor, keyboard, and mouse. Semi-immersion utilizes interactive devices like motion trackers, haptic gloves, and balance platforms. Full immersion combines sophisticated graphics systems, such as head-mounted displays or surround screens, with other sensory information inputs like sound, touch, and even smell.

Finally, the Impact theme refers to the outcomes of the VR intervention. The intervention is effective by improving mild cognitive impairment and dementia.

Discussion

This review aims to examine in detail the therapeutic effects and cognitive benefits that are associated with VR intervention among patients with dementia. Specifically, to go through all selected studies on dementia care employing VR interventions, explore how these interventions can be integrated into nursing care practice to optimize patient outcomes and provide recommendations for future practice based on synthesized evidence. This integrative review synthesized a total of n=22 studies, classified as LOE III (n=9), LOE II (n=7), LOE VI (n=5), and LOE 4 (n=1).

There are several findings to discuss from these selected studies regarding VR interventions for patients with dementia. This includes the therapeutic and cognitive effects of VR interventions, accessibility of VR technology for these patients, the ease of use, potential side effects, and integration of VR intervention into nursing care practice.

Therapeutic and Cognitive Effects of VR Interventions

The review of selected studies indicates that virtual reality (VR) interventions have the potential to improve psychological well-being, cognitive function, and depressive symptoms in patients with dementia (Tominari et al., 2020; Zhu et al., 2021; Oliveira et al., 2021). Patients with mild cognitive impairment (MCI) who received VR therapy also demonstrated modest to significant improvements in motor performance, visuoconstruction, attention, memory, and global cognition (Papaioannou et al., 2022). Similarly, VR interventions were associated with enhanced objective memory performance (Man et al., 2012). Buele et al. (2023) further suggested that daily engagement with VR could support cognitive functioning in individuals with various types of dementia and MCI. However, one study found no significant improvements in executive function, working memory, attention, global cognition, or memory performance (Kim et al., 2022). Overall, the findings supported the therapeutic and cognitive benefits of VR for individuals with dementia and MCI, particularly in enhancing psychological well-being, memory, attention, and global cognition, although not all cognitive domains demonstrated consistent improvement.

Ease of Use, Acceptability, and Potential Side Effects of VR Technology

This review provides evidence that VR technology has been increasingly adopted in dementia care research and practice. While VR offers notable advantages, there are also challenges related to ease of use, acceptability, and potential side effects. In terms of usability, VR systems are generally designed to be user-friendly, even for individuals with limited technological experience. However, some older adults may struggle to adapt to the technology and often require assistance during use (Kim et al., 2021). Despite these challenges, studies have reported widespread acceptance of VR during cognitive sessions, with manageable side effects among elderly users (Lu et al., 2023). People living with dementia and MCI have shown a preference for VR over non-VR interventions, citing improvements in mood and reduced apathy (D’Cunha et al., 2019). Similarly, a study conducted in Australia found that VR use among dementia and MCI patients enhanced mood, reduced apathy, and increased alertness compared to traditional interventions (Moyle et al., 2018). Nevertheless, some users may experience side effects such as nausea, dizziness, and disorientation (Chang et al., 2020). Therefore, it is essential to carefully consider these factors when designing and implementing VR-based interventions in dementia care.

Integration of VR Interventions into Nursing Care Practice

The integration of virtual reality (VR) interventions into nursing practice has demonstrated promising outcomes. VR can be a powerful tool for optimizing patient care, particularly in dementia settings, and has the potential to enhance the caregiving skills of healthcare providers in a safe and effective manner (Wang et al., 2023). In nursing education, VR has been shown to increase empathy among students, especially in the context of dementia care. This innovative approach equips future healthcare professionals with the skills needed to deliver more compassionate and patient-centered care (Abdalrahim et al., 2023).

To support the development of clinically competent nurses who can deliver high-quality, safe care, nursing schools are encouraged to incorporate VR into their curricula (Forsberg et al., 2011; Tseng et al., 2011). Investing in high-quality nursing education is critical, as it has a direct impact on patient outcomes and overall healthcare quality. Furthermore, it is essential for nursing professionals to become familiar with various VR interventions and their potential benefits. By understanding how these technologies can support improvements in cognition, motor function, and memory, nurses can more effectively integrate VR into individualized care plans.

Implication for Practice

The application of virtual reality (VR) therapies holds significant potential for enhancing dementia care, with benefits ranging from improved motor and cognitive function in elderly patients to advancements in nursing education and the management of behavioral and psychological symptoms of dementia (BPSDs). The evidence reviewed supports the integration of VR technology into dementia care practices. However, it is essential that these interventions are implemented effectively and safely across diverse care settings to ensure their success and sustainability.

The use of virtual reality (VR) in dementia care also carries important implications for nursing informatics. VR interventions require the collection, analysis, and interpretation of patient outcome data, underscoring the need for robust data management systems. Nursing informatics professionals play a critical role in supporting this process by developing and delivering training programs to ensure nurses are proficient in the use of VR technology. Additionally, they are essential in addressing data security and patient privacy concerns associated with VR applications. Ultimately, nursing informatics can drive innovation in care delivery by contributing to the design and refinement of VR interventions tailored to the specific needs of individuals with dementia.

Limitations

This review has several notable limitations. First, restricted access to relevant studies may have limited the comprehensiveness of the findings. Additionally, methodological differences across the included studies made it challenging to synthesize results and draw consistent conclusions. The narrow focus of some studies may have also reduced the generalizability of the review’s findings to broader populations or care settings. Another important limitation is the lack of consideration for the accessibility of VR technology, particularly in developing countries, where the high cost of VR hardware and software may limit its adoption and exclude underrepresented populations from the evidence base. Furthermore, limiting the review to studies published in a single language may introduce language bias and omit valuable insights from non-English sources. Lastly, the study selection criteria may have inadvertently excluded relevant research, thereby reducing the overall thoroughness and inclusivity of the review.

Recommendations

Future research should aim to address the limitations identified in this review. Greater consistency in research methodologies is encouraged to facilitate more effective synthesis of findings and enable stronger, more generalizable conclusions. Additionally, conducting longitudinal studies is recommended to examine trends and changes over time, offering deeper insights into the long-term effects and potential of VR interventions in dementia care.

Conclusion

Virtual reality (VR) interventions demonstrate considerable potential in dementia care, offering therapeutic and cognitive benefits such as improved psychological well-being, reduced depressive symptoms, and enhanced cognitive function. The technology is generally user-friendly and well-accepted by patients, indicating the potential for broader implementation. However, side effects such as nausea and dizziness must be carefully monitored to ensure patient safety. Integrating VR into nursing practice also presents opportunities to strengthen caregiving skills and enhance empathy training among nursing students. Nonetheless, existing research gap, particularly the lack of longitudinal studies and diverse participant samples must be addressed. As VR technology continues to evolve, ongoing research, clinical application, and educational strategies must adapt to ensure its effective and ethical integration into dementia care.

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