A Virtual Reality-Based Puzzle Game for Visuospatial Cognitive Training in Older Adults with Non-Amnestic Mild Cognitive Impairment: Protocol for a Single-Arm Feasibility Study (Preprint)

2026-02-06

<sec> <title>BACKGROUND</title> Mental rotation, the ability to mentally transform visuospatial representations, supports everyday spatial behaviors (e.g., navigation) and can be vulnerable in later life. Older adults with mild cognitive impairment (MCI) often show greater difficulties in visuospatial processing than cognitively unimpaired peers, including lower accuracy and higher variability in mental rotation tasks. Because MCI represents a prodromal stage associated with elevated risk for subsequent dementia, the critical period occurring before rapid cognitive decline to dementia, it may be an important window for interventions that target specific cognitive vulnerabilities. In non-amnestic forms of MCI (MCI-NA), visuospatial and/or executive deficits can be prominent, and longitudinal outcomes are heterogeneous, varying in part by underlying neuropathology. Accordingly, interventions that are explicitly designed to engage visuospatial processes relevant to MCI-NA may be a useful, deficit-targeted approach to evaluate in feasibility studies and to inform future controlled trials for cognitive training programs aiming to prolong daily functioning and reduce suffering. </sec> <sec> <title>OBJECTIVE</title> This study aims to evaluate the feasibility and acceptability of the Virtual Reality-Visuospatial Cognitive Training (VR-VCT) program in older adults with MCI-NA and to estimate preliminary within-subject changes in visuospatial cognition to inform a future randomized trial. Participants (n=40) will meet eligibility criteria consistent with commonly used definitions of MCI-NA, including subjective cognitive concerns, preserved basic activities of daily living, absence of dementia, and objective impairment on standardized measures emphasizing visuospatial and/or executive functioning. This study aims to: (1) quantify the feasibility and acceptability of VR-VCT in older adults with MCI-NA, and (2) estimate preliminary within-subject change on visuospatial cognitive outcomes following VR-VCT. </sec> <sec> <title>METHODS</title> 40 Participants with MCI-NA will be enrolled in a structured VR Cubism program using the Meta Quest 3 VR headset. The intervention will involve three 30-minute sessions per week for 12 weeks, with tasks progressing in difficulty over time. Cognitive and visuospatial outcomes will be assessed at baseline (T0), immediately post-intervention (T1), and at follow-up (T2; 12 weeks post-intervention) to evaluate whether observed changes are maintained. Global cognition will be assessed using the Montreal Cognitive Assessment (MoCA). Visuospatial construction will be assessed using the Wechsler Adult Intelligence Scale (WAIS) Block Design subtest, and mental rotation will be assessed using the Vandenberg Mental Rotation Test (VMRT). Changes in performance across time points will be analyzed using repeated-measures models (e.g., linear mixed models) to estimate within-subject change, with effect sizes and confidence intervals reported to inform future controlled trials. </sec> <sec> <title>RESULTS</title> Participants will be recruited from local assisted living facilities, memory care settings, and community outreach programs. This study has been approved by the University of Utah School of Medicine Institutional Review Board. The data collection will be started in March 2026. Data analysis is anticipated to be concluded by August 2026. </sec> <sec> <title>CONCLUSIONS</title> The findings will inform the study design, outcome measurement, and power calculations of a future randomized controlled trial. If feasible and acceptable, VR-VCT may represent a scalable, engaging, and deficit-targeted intervention approach with the potential to support visuospatial cognitive functioning during a critical window prior to dementia onset. </sec>

Exploring the health benefits of a mobile-based multidomain lifestyle program for older adults living in assisted living facilities: a qualitative study

BMC Geriatrics · 2026-04-30

BACKGROUND: Cognitive decline stands as a significant factor contributing to disability and dependency among older adults. Multi-domain lifestyle (MDL) interventions are widely recognized for their effectiveness in preserving cognitive functioning in older adults with dementia. However, little is known about MDL interventions using technology-based approaches in older adults residing in assisted living facilities. This qualitative study aimed to explore both the perceived health benefits and challenges of using a mobile-based multidomain Silvia Program among older adults residing in assisted living facilities. METHODS: We conducted semi-structured, in-depth interviews to capture the health-related benefits and perspectives of the Silvia Program after a 12-week period. Ten participants (70% female; age range 66-93), all at risk of dementia (with MoCA scores between 18 and 25), were recruited from two local community assisted living facilities in the Midwestern area. Interviews were transcribed and analyzed by using Creswell's five-step qualitative data analysis. A constant comparative method was used to refine themes and ensure data saturation. Synthesized Member-Checking (SMC) and expert reviews were employed to validate findings. FINDINGS: We identified five salient themes resulting from Silvia Program participation. Participants reported three categories of perceived benefits: (a) Cognitive benefits, (b) psychological wellbeing, (c) Health-related behavior management, and two categories of challenges (d) Technology anxiety, and (e) Content issues. CONCLUSIONS: The present study provided suggestive evidence for supporting cognitive engagement, activities supporting psychological wellbeing, and health behavior regulation among residents in ALFs. Early technology anxiety and content-related challenges highlight the need for program refinement and tailored support to enhance usability and engagement in ALF settings. These findings addressed a critical gap in literature by demonstrating the feasibility and perceived value of a mobile-based MDL intervention for ALF residents and providing insights to inform future controlled trials.

Effects of a mindfulness-based virtual reality intervention on life satisfaction, happiness, and flourishing in college students: A pilot study

Journal of Happiness and Health · 2025-11-05

College students experience a wide range of academic, developmental, and societal stressors, placing them at increased risk for psychological distress and poor mental health. Mindfulness-based virtual reality (MBVR) interventions have shown growing promise in supporting student mental well-being. Recent research has called for a shift from solely reducing psychological symptoms toward promoting positive psychological outcomes. Therefore, this pilot study examined the effectiveness of an MBVR program in enhancing life satisfaction, happiness, and flourishing among college students. This study utilized TRIPP, a commercially available VR application. A total of 19 college students participated in eight 15-minute sessions over the course of one month. Survey instruments were administered at two time points: prior to the intervention (T1) and after its completion (T2). Paired samples t-tests revealed statistically significant improvements in participants’ life satisfaction, happiness, and flourishing levels following the intervention. The findings suggest that MBVR holds promise as a proactive and engaging tool for promoting mental well-being in non-clinical, preventive settings such as college campuses. Furthermore, while prior research has primarily focused on alleviating symptoms such as anxiety and depression, this study contributes to the literature by demonstrating that MBVR can also enhance positive psychological outcomes. Future research should utilize larger, more diverse samples to improve the generalizability of these findings. Several practical implications for educators and practitioners are discussed.

Feasibility and acceptability of an immersive puzzle-based virtual reality activity for community-dwelling older adults

Frontiers in Virtual Reality · 2025-11-12 · 2 citations

Background With the global rise in dementia prevalence, there is a growing interest in accessible, engaging, and preventive interventions for cognitive decline in older adults. Immersive virtual reality (VR) technologies have shown promise for delivering cognitively stimulating activities, yet limited research has examined the feasibility and acceptability of puzzle-based VR interventions among older adults. Objective This study aimed to evaluate the feasibility, usability, and acceptability of an immersive puzzle-based virtual reality (IPVR) intervention using VR Cubism among older adults, including those with mild cognitive impairment (MCI). Methods A single-arm feasibility study was conducted with 14 community-dwelling older adults (mean age = 72.3 years, SD = 5.3; 85.7% female) recruited from senior centers in Texas. Participants completed eight sessions of the IPVR program over 4 weeks. Cognitive screening was conducted using the Montreal Cognitive Assessment (MoCA), with a cutoff score of ≤18 used for exclusion. Usability, acceptability, and technology acceptance were evaluated using the System Usability Scale (SUS), Technology Acceptance and Attitudes Scale (TAAS), and Senior Technology Acceptance Model (STAM), respectively. Results Participants had MoCA scores ranging from 22 to 28 (M = 25.5, SD = 1.9); 50% scored in the normal cognitive range and 50% in the MCI range. The mean SUS score was 71.61 (SD = 15.8), indicating good usability. TAAS scores averaged 5.54/7, reflecting strong acceptability. The mean STAM score was 3.91/5, suggesting moderate to high technology acceptance, although some hesitancy and anxiety were reported. Participants expressed strong interest in using VR for future leisure activities and reported high enjoyment levels during the intervention. Conclusion Findings demonstrate that an immersive puzzle-based VR activity is feasible, usable, and acceptable for community-dwelling older adults, including those with MCI. This study supports the integration of engaging, technology-based interventions to promote cognitive health in aging populations. Practically, VR puzzle programs could be implemented in community centers, senior services, and clinical rehabilitation settings as accessible, enjoyable tools to encourage cognitive stimulation. These results highlight the potential of VR not only as a preventive wellness activity but also as a scalable adjunct to traditional cognitive health programs, warranting further evaluation in larger controlled trials.

Validation of the feasibility and usability of a mobile technology-based functional game to improve the cognitive function of community-dwelling older adults living with MCI

Digital Health · 2025-05-01

Background: With dementia cases increasing worldwide, the demand for creative and accessible strategies to support cognitive health in at-risk older populations has become urgent. Mobile applications offer a valuable method for promoting cognitive wellbeing, particularly for independently living older individuals with mild cognitive impairment (MCI). Objective: This preliminary study evaluated the feasibility and usability of a mobile-based cognitive training game among older Korean adults diagnosed with MCI. Methods: A single-arm experimental design was adopted with 40 participants aged 65 and above who met eligibility criteria on the Korean Mini-Mental State Examination (K-MMSE). Participants used the Descartes Care application three times a week for 12 weeks. Feasibility was assessed through changes in game scores and completion times, while usability was evaluated using participant satisfaction, efficiency, learnability, safety, and intention to reuse. Results: < 0.05). In terms of feasibility, 88% (23/26) of subgames showed significant score improvements and 62% (16/26) demonstrated reductions in completion time, indicating consistent gains in performance efficiency. Regarding usability, the overall satisfaction score was 6.63, and the retention rate across the 12-week program was 95%, supporting a high level of user acceptability and sustained engagement. Mean scores across all usability domains exceeded 6.0, and participants reported strong intention to continue using and recommending the app. Conclusions: Findings support the feasibility, safety, and acceptability of mobile technology-based cognitive training for older adults with MCI. This intervention shows promise as an accessible, engaging tool for cognitive health promotion. Future randomized controlled trials are needed to validate efficacy and assess long-term outcomes.

Physical Activity’s Role in Reducing Neuropsychiatric Symptoms Among Older Adults with Dementia

Innovation in Aging · 2025-12-01

Abstract Neuropsychiatric symptoms (NPS) pose significant challenges in dementia care. With limited pharmacological treatments, identifying behavioral targets is crucial for developing effective interventions. This study examines the associations between Alzheimer’s Disease and Related Dementia (ADRD) and physical activity (PA) with NPS among individuals aged 70 years and older, using data from the 2021 National Health and Aging Trends Study (NHATS). NPS assessed included depression (PHQ-2), anxiety (GAD-2) and sleeping problems (single-item question on difficulty falling asleep). ADRD was determined using the NHATS algorithm, and PA was measured through self-reported questions on walking for exercise and vigorous activities in the last month. Data from 3388 subjects (21% with ADRD) were analyzed. In multivariable logistic regression models adjusted for sociodemographic factors and medical conditions, ADRD was associated with increased risks of depression (OR, 95% CI: 2.05, 1.41-2.97) and anxiety (2.69, 1.76-4.11). Walking was associated with decreased risks of depression (0.70, 0.51-0.97) and anxiety (0.67, 0.46-0.97), while vigorous activities were associated with decreased risks of depression (0.59, 0.40-0.87) and sleep problems (0.70, 0.52-0.94). Subgroup analysis among the oldest old adults (age ≥85 years) revealed that walking reduced the risk of anxiety (0.52, 0.27-0.99). This study underscores the benefits of walking and vigorous activities in reducing NPS risk. Incorporating PA into regular care practices is highly encouraged for healthcare providers and caregivers to enhance the well-being of individuals with dementia.

Exploring the Relationships among Leisure Engagement, Life Satisfaction, Happiness, and Health Perception in Older Korean Immigrants

American Journal of Health Behavior · 2025-03-31 · 1 citations

Objectives: Older Korean immigrants encounter psychological challenges related to many barriers caused by increased levels of psychological disorders. This study examined the relationship between participating in leisure-time physical activities (LTPA) on life satisfaction, happiness, and health perception of older Korean immigrants. Methods: Data was collected using a cross-sectional design and a convenience sampling strategy. Fifty-one older Korean adults aged between 50 and 85 years were recruited through Korean community centers. Hierarchical regression analysis was employed to investigate the relationship between LTPA participation and health outcomes. Results: The study included 51 participants with an average age of 71 years, 36 of whom were female (70.6%). Regression analysis indicated that LTPA engagement showed a significant correlation with improved happiness (β = 0.54, p &lt;.05) and enhanced life satisfaction (β = 0.54, p &lt; .05). However, no significant associations were found between LTPA participation and perceived health status (β = 0.14, p &gt; .05). Engaging in LTPA appears to be associated with increased happiness and life satisfaction among older Korean immigrants. Conclusion: This study offers insights suggesting that increasing participation in LTPA could significantly enhance the life satisfaction and happiness of this demographic group. Our findings provide the evidence needed to recommend promoting participation in recreational programs that align with the values and beliefs of older Korean adults residing in the United States.

The Longitudinal Risk of Alzheimer’s Disease and Related Dementias Following Participation in Cognitively Stimulating Leisure Activities by Older Adults

Sage Open Aging · 2025-09-01

Objectives: This study investigated the longitudinal relationship between participation in Cognitively Stimulating Leisure Activities (CSLAs) and the risk of Alzheimer's Disease and Related Dementias (ADRD) in two different groups of older adults with and without Mild Cognitive Impairment (MCI). Methods: We analyzed data from the Health and Retirement Study, a nationally representative survey of adults in the United States from 2012 to 2020 (MCI = 14,280; without MCI = 13,695) using a Generalized Estimated Equation. The Telephone Interview for Cognitive Status-27 was used to identify samples with MCI, with scores ranging from 7 to 11. Results: Study findings show that CSLA participation was associated with a reduced probability of reporting the presence of ADRD in both groups. Older adults both with and without MCI who frequently participated in CSLAs were less likely to develop ADRD over an 8 year timeframe. Conclusions: Our study findings suggest that CSLAs can serve as an effective intervention to reduce the risk of developing ADRD. Importantly, our findings suggest that CSLAs have a higher probability of reducing the incidence of ADRD in older adults who are experiencing MCI than those who are not.

Mindfulness-Based Virtual Reality Intervention for Individuals at High Risk of Mental Disorders

Therapeutic Recreation Journal · 2025-07-23

While traditional meditation practices are well known for their mental health benefits, they face limitations when applied in recreational therapy. There is a need for recreation therapists to apply innovative interventions, particularly for clients at high risk of mental disorders. To address these limitations and improve meditation practices, we evaluated the preliminary effectiveness of a Mindfulness-Based Virtual Reality (MBVR) program in reducing perceived stress and improving self-perceived health among individuals at high risk for mental disorders. Twenty-two college students with high-stress levels participated in eight 15-minute MBVR sessions over the span of a month. Paired samples t-tests showed significant reductions in perceived stress and improvements in self-rated health after the MBVR sessions. These results suggest that MBVR could be a valuable tool for recreation therapists to prevent clients’ mental health issues before they develop into clinical conditions. Additionally, the findings provide important insights for future practices and research in recreational therapy.

The Mediating Role of Leisure-Time Physical Activity and Mobility in the Life Satisfaction of Older Adults

Innovation in Aging · 2025-12-01

Abstract Background Leisure Time Physical Activity (LTPA) has been associated with numerous health benefits for older adults, including enhanced physical function and life satisfaction. However, older adults often experience physical limitations that hinder participation in LTPA. While prior research has examined the direct effects of LTPA on well-being, the mechanisms underlying this relationship, particularly the mediating roles of mobility and activities of daily living (ADL) performance, remain underexplored. Methods This study utilized data from the 2022 National Health Interview Survey (NHIS) (N = 8,779) to examine the relationship between moderate LTPA, mobility, ADL performance, and life satisfaction in older adults. Path analysis was conducted to explore the mediating effects of mobility and ADL performance on the association between LTPA and life satisfaction. Results Findings revealed that LTPA participation was significantly associated with improved mobility and ADL performance, both of which were positively linked to life satisfaction. Path analysis demonstrated that mobility and ADL performance mediated the relationship between LTPA and life satisfaction (Estimate = −.010, 95% CI [−.012, −.008]; Estimate = −.004, 95% CI [−.005, −.003]). Conclusion This study highlights the importance of promoting moderate LTPA among older adults to enhance physical function and life satisfaction. Given the identified mediating effects of mobility and ADL performance, future interventions should focus on structured LTPA programs that support independence and overall well-being in aging populations. These findings provide valuable insights for policymakers and healthcare professionals in designing effective physical activity interventions for older adults.