Virtual and Augmented Reality Games in Dementia Care: Systematic and Bibliographic Review
Abstract
1. Introduction
1.1. Background
1.2. Overview
2. Method
2.1. Strategy for Article Search and Identification
Listing 1. Search query for Pubmed and APA PsycInfo. |
((dementia) OR (alzheimers disease)) AND ((video games) OR (computer games) OR (exergames) OR (serious games)) AND ((augmented reality) OR (virtual reality)) |
2.2. Article Screening and Eligibility
2.3. Scope of Investigation
2.3.1. Bibliographic Variables
2.3.2. Medical Variables
2.3.3. Technical Variables
2.4. Data Presentation
3. Results
3.1. Bibliographic Results
3.1.1. Timeline of Publications
3.1.2. Country of Origin
3.2. Medical Results
3.2.1. Level of Advancement of Clinical Research
3.2.2. Participation in Clinical Research
3.2.3. Engagement Intensity
- The overall duration of the subject’s participation in the trial, measured in weeks, as shown in Figure 3b.
- The number of sessions per week conducted during the trial is shown in Figure 3c and referred to as the “dose”.
- The typical length of one session, expressed in minutes, is shown in Figure 3d as the single-session duration.
3.2.4. Simulator Sickness
3.3. Technical Results
3.3.1. Extent of Presence: Delivery
3.3.2. Extent of Presence: Controls
3.3.3. Reproduction Fidelity
3.3.4. Immersion Level
3.3.5. Immersion Type
3.3.6. Autonomy and Guidance
4. Discussion
4.1. Principal Findings
4.2. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ADHD | Attention Deficit Hyperactivity Disorder |
AR | Augmented reality |
APA | American Psychological Association (preceding PsycInfo) |
CNKI | China National Knowledge Infrastructure |
EP | Extent of Presence |
EWK | Extent of World Knowledge |
GBD 2019 | Global Burden of Disease 2019 study |
HMD | Head-Mounted Display |
ICD | International Classification of Diseases |
MCI | Mild Cognitive Impairment |
MeSH | Medical Subject Heading |
MR | Mixed Reality |
OSF | Open Science Framework |
PRISMA | Preferred Reporting Items for Systematic Reviews and Meta-Analyses |
PwD | People with Dementia |
RCT | Randomized clinical trial |
RF | Reproduction Fidelity |
VR | Virtual reality |
WHO | World Health Organization |
Appendix A. Table of Included Publications
Publication Title | Subjects | Device | Year |
---|---|---|---|
Exergaming as a Physical Exercise Strategy Reduces Frailty in People With Dementia: A Randomized Controlled Trial [17] | 115 | Projection Screen | 2019 |
The Aerobic and Cognitive Exercise Study (ACES) for Community-Dwelling Older Adults With or At-Risk for Mild Cognitive Impairment (MCI): Neuropsychological, Neurobiological and Neuroimaging Outcomes of a Randomized Clinical Trial [18] | 111 | Monitor | 2018 |
Effects of virtual reality-based cognitive training in older adults living without and with mild dementia: A pretest-posttest design pilot study [22] | 99 | HMD | 2019 |
Wayfinding in aging and Alzheimer’s disease within a virtual senior residence: study protocol [25] | 80 | Projection Screen | 2016 |
Exergaming and older adult cognition: A cluster randomized clinical trial [16] | 79 | Monitor | 2012 |
Does cognition-specific computer training have better clinical outcomes than non-specific computer training? A single-blind, randomized controlled trial [26] | 78 | TV | 2018 |
A Comparison of Traditional and Serious Game-Based Digital Markers of Cognition in Older Adults with Mild Cognitive Impairment and Healthy Controls [27] | 76 | Tablet/Touchscreen | 2021 |
Everyday-like memory for objects in aging and Alzheimer’s disease assessed in a visually complex environment: The role of executive functioning and episodic memory [28] | 62 | Projection Screen | 2016 |
The Effectiveness of a Virtual Reality-Based Intervention on Cognitive Functions in Older Adults with Mild Cognitive Impairment: A Single-Blind, Randomized Controlled Trial [29] | 61 | TV | 2021 |
The Effectiveness of a Virtual Reality-Based Tai Chi Exercise on Cognitive and Physical Function in Older Adults with Cognitive Impairment [30] | 60 | TV | 2018 |
Comparing data from a computer based intervention program for patients with Alzheimer’s disease [31] | 41 | Tablet/Touchscreen | 2014 |
Immersive Virtual Reality-Based Cognitive Intervention for the Improvement of Cognitive Function, Depression, and Perceived Stress in Older Adults With Mild Cognitive Impairment and Mild Dementia: Pilot Pre-Post Study [19] | 31 | HMD | 2022 |
Evaluation of a cognition-sensitive spatial virtual reality game for Alzheimer’s disease [32] | 30 | Laptop | 2024 |
Enhancing prompt perception in dementia: a comparative study of mixed reality cue modalities [23] | 22 | HMD | 2024 |
Treatment of Alzheimer’s, Cognitive, Chronic Pain Rehabilitation, Depression and Anxiety disorders in One System for Elderly Using VR [33] | 20 | Monitor | 2018 |
A Virtual Reality App for Physical and Cognitive Training of Older People With Mild Cognitive Impairment: Mixed Methods Feasibility Study [34] | 20 | HMD | 2021 |
The Long-term Effects of Immersive Virtual Reality Reminiscence in People With Dementia: Longitudinal Observational Study [35] | 20 | HMD | 2022 |
2D Virtual Reality-Based Exercise Improves Spatial Navigation in Institutionalized Non-robust Older Persons: A Preliminary Data Report of a Single-Blind, Randomized, and Controlled Study [36] | 14 | TV | 2021 |
Effect of Spatial Disorientation in a Virtual Environment on Gait and Vital Features in Patients with Dementia: Pilot Single-Blind Randomized Control Trial [20] | 13 | Projection Screen | 2020 |
Lessons Learned from a Human-Centered Design of an Immersive Exergame for People with Dementia [37] | 11 | HMD | 2021 |
Does Practicing with a Virtual Reality Driving Simulator Improve Spatial Cognition in Older Adults? A Pilot Study [38] | 11 | HMD | 2020 |
Cognitive Training Using Fully Immersive, Enriched Environment Virtual Reality for Patients With Mild Cognitive Impairment and Mild Dementia: Feasibility and Usability Study [39] | 11 | HMD | 2020 |
Feasibility study of the BrightBrainer™ integrative cognitive | Laptop | ||
rehabilitation system for elderly with dementia [40] | 10 | TV | 2015 |
Virtual Reality for Persons with Dementia: an Exergaming Experience [41] | 10 | Projection Screen | 2012 |
Effects of a virtual group cycling experience on people living with dementia: A mixed method pilot study [42] | 10 | TV | 2020 |
A pilot study and brief overview of rehabilitation via virtual environment in patients suffering from dementia [43] | 10 | HMD | 2018 |
Enabling Patients with Neurological Diseases to perform Motor-Cognitive Exergames under Clinical Supervision for Everyday Usage [44] | 8 | HMD | 2020 |
Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic [45] | 7 | HMD | 2022 |
Using exergames to train patients with dementia to accomplish daily routines [46] | 7 | HMD | 2020 |
Game Design for Users with Constraint: Exergame for Older Adults with Cognitive Impairment [47] | 6 | HMD | 2018 |
Virtual Reality Exergames for People Living with Dementia Based on Exercise Therapy Best Practices [48] | 6 | HMD | 2018 |
Participatory design and evaluation of virtual reality games to promote engagement in physical activity for people living with dementia [49] | 6 | HMD | 2020 |
Development of Serious Game Theory Framework in Virtual Reality for Alzheimer’s Patients [50] | 2 | TV | 2024 |
Two-week virtual reality training for dementia: Single case feasibility study [51] | 1 | HMD | 2014 |
An Online Cognitive Intervention Tool for the Patients with Mild Cognitive Impairment using Virtual Reality [52] | not reported | HMD | 2021 |
Memory Journalist: Creating Virtual Reality Exergames for the Treatment of Older Adults with Dementia [53] | not reported | not reported | 2020 |
Publication Title | Subjects | Device | Year |
---|---|---|---|
Exergaming as a Physical Exercise Strategy Reduces Frailty in People With Dementia: A Randomized Controlled Trial [17] | 115 | Projection Screen | 2019 |
The Aerobic and Cognitive Exercise Study (ACES) for Community-Dwelling Older Adults With or At-Risk for Mild Cognitive Impairment (MCI): Neuropsychological, Neurobiological and Neuroimaging Outcomes of a Randomized Clinical Trial [18] | 111 | Monitor | 2018 |
Effects of virtual reality-based cognitive training in older adults living without and with mild dementia: A pretest-posttest design pilot study [22] | 99 | HMD | 2019 |
Wayfinding in aging and Alzheimer’s disease within a virtual senior residence: study protocol [25] | 80 | Projection Screen | 2016 |
Exergaming and older adult cognition: A cluster randomized clinical trial [16] | 79 | Monitor | 2012 |
Does cognition-specific computer training have better clinical outcomes than non-specific computer training? A single-blind, randomized controlled trial [26] | 78 | TV | 2018 |
A Comparison of Traditional and Serious Game-Based Digital Markers of Cognition in Older Adults with Mild Cognitive Impairment and Healthy Controls [27] | 76 | Tablet/Touchscreen | 2021 |
Everyday-like memory for objects in aging and Alzheimer’s disease assessed in a visually complex environment: The role of executive functioning and episodic memory [28] | 62 | Projection Screen | 2016 |
The Effectiveness of a Virtual Reality-Based Intervention on Cognitive Functions in Older Adults with Mild Cognitive Impairment: A Single-Blind, Randomized Controlled Trial [29] | 61 | TV | 2021 |
The Effectiveness of a Virtual Reality-Based Tai Chi Exercise on Cognitive and Physical Function in Older Adults with Cognitive Impairment [30] | 60 | TV | 2018 |
Comparing data from a computer based intervention program for patients with Alzheimer’s disease [31] | 41 | Tablet/Touchscreen | 2014 |
Immersive Virtual Reality-Based Cognitive Intervention for the Improvement of Cognitive Function, Depression, and Perceived Stress in Older Adults With Mild Cognitive Impairment and Mild Dementia: Pilot Pre-Post Study [19] | 31 | HMD | 2022 |
Evaluation of a cognition-sensitive spatial virtual reality game for Alzheimer’s disease [32] | 30 | Laptop | 2024 |
Enhancing prompt perception in dementia: a comparative study of mixed reality cue modalities [23] | 22 | HMD | 2024 |
Treatment of Alzheimer’s, Cognitive, Chronic Pain Rehabilitation, Depression and Anxiety disorders in One System for Elderly Using VR [33] | 20 | Monitor | 2018 |
A Virtual Reality App for Physical and Cognitive Training of Older People With Mild Cognitive Impairment: Mixed Methods Feasibility Study [34] | 20 | HMD | 2021 |
The Long-term Effects of Immersive Virtual Reality Reminiscence in People With Dementia: Longitudinal Observational Study [35] | 20 | HMD | 2022 |
2D Virtual Reality-Based Exercise Improves Spatial Navigation in Institutionalized Non-robust Older Persons: A Preliminary Data Report of a Single-Blind, Randomized, and Controlled Study [36] | 14 | TV | 2021 |
Effect of Spatial Disorientation in a Virtual Environment on Gait and Vital Features in Patients with Dementia: Pilot Single-Blind Randomized Control Trial [20] | 13 | Projection Screen | 2020 |
Lessons Learned from a Human-Centered Design of an Immersive Exergame for People with Dementia [37] | 11 | HMD | 2021 |
Does Practicing with a Virtual Reality Driving Simulator Improve Spatial Cognition in Older Adults? A Pilot Study [38] | 11 | HMD | 2020 |
Cognitive Training Using Fully Immersive, Enriched Environment Virtual Reality for Patients With Mild Cognitive Impairment and Mild Dementia: Feasibility and Usability Study [39] | 11 | HMD | 2020 |
Feasibility study of the BrightBrainer™ integrative cognitive | Laptop | ||
rehabilitation system for elderly with dementia [40] | 10 | TV | 2015 |
Virtual Reality for Persons with Dementia: an Exergaming Experience [41] | 10 | Projection Screen | 2012 |
Effects of a virtual group cycling experience on people living with dementia: A mixed method pilot study [42] | 10 | TV | 2020 |
A pilot study and brief overview of rehabilitation via virtual environment in patients suffering from dementia [43] | 10 | HMD | 2018 |
Enabling Patients with Neurological Diseases to perform Motor-Cognitive Exergames under Clinical Supervision for Everyday Usage [44] | 8 | HMD | 2020 |
Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic [45] | 7 | HMD | 2022 |
Using exergames to train patients with dementia to accomplish daily routines [46] | 7 | HMD | 2020 |
Game Design for Users with Constraint: Exergame for Older Adults with Cognitive Impairment [47] | 6 | HMD | 2018 |
Virtual Reality Exergames for People Living with Dementia Based on Exercise Therapy Best Practices [48] | 6 | HMD | 2018 |
Participatory design and evaluation of virtual reality games to promote engagement in physical activity for people living with dementia [49] | 6 | HMD | 2020 |
Development of Serious Game Theory Framework in Virtual Reality for Alzheimer’s Patients [50] | 2 | TV | 2024 |
Two-week virtual reality training for dementia: Single case feasibility study. [51] | 1 | HMD | 2014 |
An Online Cognitive Intervention Tool for the Patients with Mild Cognitive Impairment using Virtual Reality [52] | not reported | HMD | 2021 |
Memory Journalist: Creating Virtual Reality Exergames for the Treatment of Older Adults with Dementia [53] | not reported | not reported | 2020 |
Appendix A.1. Search Query for Scopus Database
Listing A1. Search query for Scopus Database. |
TITLE-ABS-KEY((“dementia” OR “Alzheimer’s disease”) AND (“video games” OR “computer games” OR “exergames” OR “serious games”) AND (“augmented reality” OR “virtual reality”)) |
Appendix A.2. Applied Inclusion and Exclusion Criteria
Criterion Type | Description |
---|---|
Exclusion Criteria |
|
Inclusion Criteria |
|
Appendix A.3. Definition of Immersion Level
- The Extent of World Knowledge (EWK) (the real world (AR) vs. the virtually modeled world (VR)).
- The Reproduction Fidelity (RF) (the modeling quality: wireframes vs. 3D, real-time modeling).
- The Extent of Presence Metaphor (EP) (how real you feel in the world: 2D vs. 3D VR).
- The rating of the Extent of Presence: Delivery variable from 1 to 3 (low, medium, high).
- The rating of the Extent of Presence: Controls variable from 1 to 3 (low, medium, high).
- The rating of the Reproduction Fidelity from 1 to 6 (from simple to realistic).
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Variable | Description |
---|---|
Year of Publication | The year the paper was first published. |
Country of Origin | The publication’s country of origin was recorded to establish the geographic context. In cases where multiple authors and institutions were listed, the country corresponding to the first author’s primary affiliation was used. |
Variable | Description |
---|---|
Level of Advancement of Clinical Research | The type of trial conducted and referenced in the evaluated publication. |
Design Study | Small, controlled or sometimes uncontrolled intervention. It does not need to be randomized. |
Pilot Study | A limited study is carried out to examine factors like the protocol’s usability, required duration, cost, and risks. It does not evaluate the treatment’s effects. |
Feasibility Study | Evaluation of the feasibility of a clinical trial, featuring both randomization and control groups. This type of trial includes fewer participants than a randomized controlled trial (RCT), yet more than a pilot study, and is conducted in preparation for a larger RCT. |
Randomized Clinical Trial (RCT) | Participants are randomly placed into intervention groups to assess the treatment’s impacts and risks compared to a control group. |
Participation in Clinical Research | indicates the number of participants involved in a clinical trial or study. |
Engagement Intensity | A collection of measures indicating the engagement intensity for the implemented interventions. |
Overall Period of Engagement | Measured in weeks. |
Number of Weekly Sessions | The total number of weekly sessions provided. |
Average Session Duration | Duration of one session, expressed in minutes. |
Simulator Sickness | Addresses the problem of simulator sickness in AR/VR applications, which arises from the disconnect between actual body movements and visual cues. |
Variable | Description |
---|---|
Extent of Presence: Delivery | Refers to the type of device used to deliver content to the user. |
AR | Digital content overlaid on the real world in real time using 2D devices. |
HMD | Wearable display featuring stereoscopic 3D with motion tracking and spatial audio. |
Laptop Screen | Standard 2D display. Limited field of view and spatial engagement. |
TV/Monitor | Larger external 2D display, larger field of view than laptop. |
Projector | Projects content onto a wall or flat surface for a larger field of view. |
Tablet/Touchscreen | Interactive 2D device with touch input for interaction but limited immersion due to lack of spatial depth and limited field of view. |
Extent of Presence: Controls | Refers to the type of controller used to interact with the application. |
Game | Consumer-grade game controller, joystick. |
Hand | Wireless handtracker, IR handtracker, VR handheld remote, touchscreen. |
Physical | Treadmill, stationary bike. |
Camera | Body movement tracker (e.g., Kinect). |
Misc | Driving simulator, 3D-printed camera controller. |
RF: Reproduction Fidelity | Rates the maturity and quality of the application on a scale from 1 to 6. A score of 1 represents simple sounds and graphics, while 6 represents a realistic real-time simulation. |
Immersion Level | The Extent of Presence (EP) and Reproduction Fidelity (RP) values are used to classify the immersion level, plotted on a grid as seen in the Immersion Level subsection. |
Immersion Type | Category of user engagement in the digital environment. |
2D | This is 2D content rendered on a 2D screen (e.g., completing a quiz on a flat screen). |
2D VR | Virtual reality content rendered on a 2D screen, tablet, or phone (e.g., biking in a virtual world on a 2D screen). |
3D VR | Virtual reality content rendered inside VR headsets, with positional tracking, stereoscopic view, and interactive input. |
AR/MR | Augmented reality and mixed reality: real-world surroundings with a virtual overlay. |
Autonomy and Guidance | Represents the patient’s autonomy while using the application. |
Supervised | The patient uses the application under supervision. |
Unsupervised | The patient uses the application without supervision. |
Country | Publications | Country | Publications | Country | Publications |
---|---|---|---|---|---|
Canada | 8 | Germany | 5 | Greece | 4 |
USA | 4 | South Korea | 2 | Taiwan | 2 |
Australia | 1 | Brazil | 1 | China | 1 |
France | 1 | Italy | 1 | Malaysia | 1 |
The Netherlands | 1 | Poland | 1 | Thailand | 1 |
Turkey | 1 |
Study Type | Publications |
---|---|
Design Study | 2 |
Pilot Study | 13 |
Feasibility Study | 13 |
Randomized Clinical Trial (RCT) | 8 |
Display Type | Publications |
---|---|
HMD | 17 |
TV | 7 |
Projector | 5 |
Computer Monitor | 3 |
Laptop Screen | 2 |
Tablet/Touchscreen | 2 |
Controller Type | Publications |
---|---|
Hand | 16 |
Game | 7 |
Physical | 6 |
Misc | 4 |
Camera | 3 |
RF | Number of Publications |
---|---|
1 | 0 |
2 | 4 |
3 | 14 |
4 | 12 |
5 | 5 |
6 | 1 |
Immersion Type | Publications |
---|---|
2D | 2 |
2D VR | 11 |
3D VR | 22 |
AR/MR | 1 |
Supervision Status | Publications |
---|---|
Supervised | 35 |
Not Supervised | 1 |
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© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Eckert, M.; Radhakrishnan, V.; Ostermann, T.; Ehlers, J.P.; Hohenberg, G. Virtual and Augmented Reality Games in Dementia Care: Systematic and Bibliographic Review. Healthcare 2025, 13, 2013. https://doi.org/10.3390/healthcare13162013
Eckert M, Radhakrishnan V, Ostermann T, Ehlers JP, Hohenberg G. Virtual and Augmented Reality Games in Dementia Care: Systematic and Bibliographic Review. Healthcare. 2025; 13(16):2013. https://doi.org/10.3390/healthcare13162013
Chicago/Turabian StyleEckert, Martin, Varsha Radhakrishnan, Thomas Ostermann, Jan Peter Ehlers, and Gregor Hohenberg. 2025. "Virtual and Augmented Reality Games in Dementia Care: Systematic and Bibliographic Review" Healthcare 13, no. 16: 2013. https://doi.org/10.3390/healthcare13162013
APA StyleEckert, M., Radhakrishnan, V., Ostermann, T., Ehlers, J. P., & Hohenberg, G. (2025). Virtual and Augmented Reality Games in Dementia Care: Systematic and Bibliographic Review. Healthcare, 13(16), 2013. https://doi.org/10.3390/healthcare13162013