Effects of virtual reality-based cognitive interventions on cognitive function and activity of daily living among stroke patients: Systematic review and meta-analysis.

AIMS: To examine the effects of virtual reality-based cognitive interventions on cognitive function and activities of daily living among stroke patients, and to identify the optimal design for such intervention. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, EMBASE, Cochrane, CINANL, JBI-EBP and Web of Science from inception to October 2023. METHODS: Methodological quality was assessed by Risk of Bias Tool. Meta-analyses were assessed by Review Manager 5.4. Subgroup analyses were conducted to explore the influence of study design. Grading of Recommendations Assessment, Development and Evaluation approach was adopted to assess the certainty of evidence. RESULTS: Twenty-five randomized controlled trials (1178 participants) were included. Virtual reality-based cognitive interventions demonstrated moderate-to-large effects in improving global cognitive function (SMD = 0.43; 95% CI [0.01, 0.85]), executive function (SMD = 0.84; 95% CI [0.25, 1.43]) and memory (SMD = 0.65; 95% CI [0.15, 1.16]) compared to control treatments. No significant effects were found on language, visuospatial ability and activities of daily living. Subgroup analyses indicated one-on-one coaching, individualized design and dynamic difficulty adjustment, and interventions lasting ≥ 6 weeks had particularly enhanced effects, especially for executive function. CONCLUSIONS: Virtual reality-based cognitive interventions improve global cognitive function, executive function and memory among stroke patients. IMPLICATIONS FOR THE PATIENT CARE: This review underscores the broad cognitive advantages offered by virtual technology, suggesting its potential integration into standard stroke rehabilitation protocols for enhanced cognitive recovery. IMPACT: The study identifies key factors in virtual technology interventions that effectively improve cognitive function among stroke patients, offering healthcare providers a framework for leveraging such technology to optimize cognitive outcomes in stroke rehabilitation. REPORTING METHOD: PRISMA 2020 statement. PROSPERO REGISTRATION NUMBER: CRD42022342668.

Effects of mindfulness-based interventions on neuropsychiatric symptoms and psychological well-being on people with subjective cognitive decline and mild cognitive impairment: A meta-analysis.

OBJECTIVES: Neuropsychiatric symptoms (NPS) are highly prevalent in individuals with subjective cognitive decline (SCD) and mild cognitive impairment (MCI), and are strongly linked to accelerated cognitive decline and dementia onset. While mindfulness-based interventions have shown promise in improving psychological well-being in clinical and community settings, their efficacy for individuals in these pre-dementia stages remains unclear. This meta-analysis examined the effects of mindfulness-based interventions on NPS and psychological outcomes in these preclinical cohorts. METHODS: Eligible studies were retrieved from PubMed, EMBASE, JBI EPB, Web of Science, and Cochrane library. Two independent researchers conducted the literature search and data extraction. Cochrane Risk-of-Bias Assessment Tool was used to assess the methodological quality of included studies. Quality of evidence was evaluated using the GRADE approach. Intervention effects were estimated by Hedge's g and 95% confidence interval (CI). RESULTS: A total of 18 randomized controlled trials (including 974 participants from 21 studies) were included in the meta-analysis. The results demonstrated statistically significant immediate post-intervention effects of mindfulness-based interventions on anxiety (g = -0.30, 95% CI -0.49 to -0.11), stress (g = -0.58, 95% CI -0.91 to -0.24), and quality of life (g = 0.50, 95% CI 0.12-0.87). However, no significant effects were found for depression, apathy, mindfulness, and stress-related biomarkers. Follow-up data analysis also did not reveal significant effects for depression and anxiety. CONCLUSIONS: The findings of this meta-analysis suggest that mindfulness-based interventions may improve anxiety, stress, and quality of life in individuals with SCD and MCI. However, more rigorous randomized controlled trials with larger sample sizes and evaluation using physiological parameters are needed to establish more definitive conclusions. Future interventions could consider incorporating cognitive training and health education to address the specific needs of the pre-dementia population. REGISTRATION NUMBER: PROSPERO: CRD42022359906.