JMIR Publications

ABSTRACT

Background:

Apathy is common in people with cognitive impairment. It leads to different consequences, such as more severe cognitive deficits, rapid functional decline, and decreased quality of life. Virtual reality (VR) interventions are increasingly being used to manage apathy in individuals with cognitive impairment. However, reports on the outcomes of VR interventions are scattered across studies, which has hindered the development and utilization of the interventions.

Objective:

The aim of this study is to systematically review existing evidence on the use of VR interventions for managing apathy in people with cognitive impairment, with regard to their effectiveness, contents, and implementation.

Methods:

The PRISMA guidelines were followed. The PubMed, EMBASE, CINAHL, and PsycINFO databases were systematically searched for experimental studies published up to 31st May 2021 that reported the effects of VR interventions on apathy in older adults with cognitive impairment. The results of the included studies were synthesized using narrative synthesis. Their quality was appraised with the Effective Public Health Practice Project (EPHPP) assessment tool. However, as the VR interventions varied in duration, content, and implementation across studies, a meta-analysis was not conducted.

Results:

Twenty-one studies were identified from the databases. Five studies met the inclusion criteria and were included. Among them, two were randomized controlled trials and three were quasi-experimental studies. Individual studies showed a small to large effect from the VR interventions on reducing apathy in people with cognitive impairment. The level of immersion ranged from moderate to high. Adverse effects were rarely reported. The VR content mostly included natural scenes, followed by city views and game-based activities. A background soundtrack was often used along with natural scenes. The majority of the studies were conducted in a residential care setting and were implemented by healthcare professionals or researchers. Safety precautions were taken in most studies.

Conclusions:

Although there is preliminary evidence showing that VR interventions may be effective and feasible for use in alleviating apathy in people with cognitive impairment, methodological limitations in the included studies make it difficult to come to a firm conclusion on these points. The implementation of interventions was highlighted and discussed. More rigorous studies are encouraged. Clinical Trial: PROSPERO Registration: CRD 42021268289