Currently submitted to: JMIR Serious Games
Date Submitted: Apr 23, 2026
Open Peer Review Period: Apr 27, 2026 - Jun 22, 2026
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Feasibility and Preliminary Efficacy of a Gardening-Based Immersive Virtual Reality Cognitive Training Program for Older Adults with Dementia: A Pilot Study
ABSTRACT
Background:
Non-pharmacological interventions play a critical role in dementia care, yet maintaining engagement and adherence remains challenging. Immersive virtual reality (VR) provides a promising platform for cognitive training, particularly when integrated with personally meaningful leisure activities that may enhance therapeutic resonance.
Objective:
This study aimed to examine the feasibility, usability, and preliminary cognitive effects of a leisure-based immersive VR cognitive training program in older adults with dementia.
Methods:
A single-arm pre–post pilot study was conducted with 16 older adults with mild to moderate dementia recruited from a hospital and a dementia day care center. Participants completed a 15-session VR intervention over 5 weeks, involving gardening-based activities targeting multiple cognitive domains. Feasibility outcomes included VR acceptance (QAVREE), simulator sickness (SSQ), usability (SUS), and emotional responses (OERS). Cognitive, functional, and psychosocial outcomes were assessed using the Montreal Cognitive Assessment (MoCA), Stroop test, Color Trails Test (CTT), Frontal Assessment Battery (FAB), Barthel Index, Instrumental Activities of Daily Living (IADL), Cornell Scale for Depression in Dementia (CSDD), measures of Behavioral and Psychological Symptoms of Dementia (BPSD), Dementia Quality of Life (DQoL), and the Short Warwick–Edinburgh Mental Well-being Scale (SWEMWBS). Paired t-tests were used to examine pre–post differences.
Results:
Sixteen participants completed feasibility assessments, and fifteen completed the intervention. VR acceptance significantly increased after the first session (p < .001), while simulator sickness significantly decreased (p = .009). Emotional responses indicated high levels of pleasure and alertness with minimal negative affect. Usability was rated as acceptable (SUS = 70.5 ± 12.17). A significant improvement in global cognitive function was observed (MoCA, p = .001, d = 1.03); however, no significant changes were found in domain-specific cognitive measures, activities of daily living, quality of life, or psychosocial outcomes.
Conclusions:
Leisure-based immersive VR cognitive training appears to be feasible, acceptable, and well tolerated in older adults with dementia. These preliminary findings suggest that aligning technology with meaningful life experiences may enhance global cognitive function and engagement. Further randomized controlled trials with larger samples are warranted to confirm the long-term effectiveness and functional impact of this approach. Clinical Trial: ClinicalTrials.gov Identifier NCT07033468. (08/01/2024)
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