Ecological Effects of VR-Based Cognitive Training on ADL and IADL in MCI and AD patients: A Systematic Review and Meta-Analysis

Declines in activities of daily living (ADL) and instrumental activities of daily living (IADL) performances due to cognitive impairments hinder mild cognitive impairment (MCI) and Alzheimer's disease (AD) patients' independent and safe daily lives. In order to prevent and treat this, several cognitive interventions have been implemented, but their ecological validity was not ensured due to that their contents are far from real life. Virtual reality (VR) can resemble real life with immersive stimuli, but there have been few studies confirming its ecological effects on ADL and IADL. Therefore, this study conducted a meta-analysis of VR-based cognitive training to investigate its ecological effects on ADL and IADL in MCI and AD patients. From February 2012 to February 2022, a search was conducted for articles published in PubMed, Cochrane, Science Direct, and Web of Science. Quality assessment was assessed by the PEDro scale, and the Cochrane Collaboration tool was used to assess risk of bias. Publication bias was assessed by Egger's regression. Five studies that met inclusion criteria were included in this study. The VR-based cognitive training showed significant effects on ADL and IADL in both MCI and AD patients. When comparing effects in each group, both MCI and AD patients showed significant effects on ADL and IADL, but MCI patients showed lower effects on ADL and IADL than AD patients. The results indicated that VR-based cognitive training would be beneficial to improve ADL and IADL in MCI and AD patients, suggesting that VR-based cognitive training is ecologically valid.