Effects of virtual reality cognitive training on executive function and prospective memory in Parkinson's disease and healthy aging

Background: Neurocognitive disturbances in Parkinson's disease (PD) are common and can impact several aspects of daily functioning and quality of life. This multicenter study evaluated the efficacy of a novel immersive virtual reality (iVR) cognitive training (CT) targeting executive functions (EF)—planning, shifting, and updating abilities—to improve prospective memory (PM) in PD patients with mild cognitive impairment (PD-MCI). Potential transfer effects were also examined in healthy older adults (HC). Methods: In this double-blind randomized controlled trial, 30 PD-MCI were randomized into a 4-week EF-training (PD-CT) or active placebo (PD-AP), delivered at home through a combined approach of telemedicine and iVR. Similarly, 30 age- and education-matched HC were assigned to the EF-training (HC-CT) or active placebo (HC-AP). Results: The PD-CT group exhibited significant improvements in PM (in time-based and verbal-response tasks) and in EF, particularly in inhibition abilities (in the Stroop test), with effects sustained at 2-month follow-up. These gains were absent in the PD-AP group. Regression analyses revealed that PM enhancements were primarily driven by improved inhibition and shifting abilities. The EF-training was effective also in the older adults, the HC-CT group showed improvements in planning abilities (in the Zoo Map test) at post-intervention and 2-month follow-up, while no cognitive gains were observed in the HC-AP group. Conclusions: This innovative iVR-based EF-training effectively enhances PM and inhibition in PD-MCI, and planning abilities in healthy older adults, demonstrating its potential for improving cognition in both populations. These findings support the use of iVR and telemedicine for accessible, personalized non-pharmacological cognitive interventions.