Currently submitted to: JMIR Serious Games
Date Submitted: May 15, 2026
Open Peer Review Period: May 19, 2026 - Jul 14, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Immersive Virtual Reality Cognitive Training in Older Adults with Type 2 Diabetes and Mild Cognitive Impairment: A Pilot Study
ABSTRACT
Background:
Type 2 diabetes mellitus (T2D) is associated with an increased risk of mild cognitive impairment (MCI) and dementia. However, there are currently no effective and engaging interventions to delay the onset of dementia or reverse cognitive decline.
Objective:
To explore feasibility and cognitive outcomes of an immersive virtual reality (IVR) cognitive training program in older adults with T2D and MCI.
Methods:
Prospective pilot study including adults with T2D aged >65 years and diabetes duration >5 years. After a neuropsychological test battery (NTB) patients were allocated into three groups: normocognitive, MCI without intervention, and MCI receiving VR cognitive training. Assessments were performed at baseline and at 9 months. Cognitive outcomes were derived from were studied both at the individual test level and as domain-level summaries (using percentile-based composite scores for processing speed, attention/executive function, memory, visuo-construction, and language). Between-group differences were assessed using Kruskal–Wallis tests for continuous variables and Fisher’s exact test for categorical. To estimate the intervention effect among participants with MCI, baseline-adjusted ANCOVA models were performed.
Results:
30 adults with T2D were included (n=10 each group). Baseline clinical characteristics were broadly comparable across groups. NTB categorical status improved more frequently in the VR group: 7/10 converted from MCI to normocognition versus 1/10 in the MCI non-intervention group (Fisher p=0.020). In key NTB tests, the VR group showed a significant improvement in executive and visuo-construction domains: TMT-B performance median 512.5 to 241.0 seconds (p=0.024) and significantly higher follow-up visuo-construction performance in VR group versus standard care (adjusted β=21.55 percentile points, 95% CI 1.34 to 41.75; p=0.038).
Conclusions:
In this small pilot, immersive VR cognitive training was associated with a higher rate of cognitive status improvement and better executive and visuo-construction and executive functioning at 9 months. Larger randomized trials are warranted to confirm efficacy and assess long-term sustainability. Clinical Trial: N/A
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