Effects of a dual intervention (motor and virtual reality-based cognitive) on cognition in patients with mild cognitive impairment: a single-blind, randomized controlled trial.

Only 26 of the 34 randomised participants finished, leaving 12 controls and 14 in the VR group, and the paper does not report how the dropouts were handled in the analysis. Both groups did the same twice-weekly motor exercise and the same group socialising, so the trial cannot separate the VR training from the exercise or from simply being in an active group. Therapists and participants were not blinded, and the paper notes that the card task allowed more informal conversation with the therapist, which may explain why the control group looked slightly better on cognition and mood. There was no follow-up assessment, which had been planned for four months but could not be done because participants stopped attending. The six-week duration and the small sample limit confidence in the effects. Everyone came from one day-care centre in Patate, Ecuador, and had to be living at home, non-institutionalised and free of disability, so the results do not extend to patients with stroke, dementia, hearing or vision loss, or those in residential care. Education was very low (about five years on average, only two participants finishing high school), and education correlated with cognitive scores, which may shape how the test scores should be read. The trial was registered in March 2024, after the study period, so the paper does not establish which outcome was pre-specified as primary; the authors say the main focus was cognition with depression and daily living as secondary.

The paper reports no funding source and no conflict of interest declaration in the text supplied. The VR application was developed by the research team using the Unity game engine, and the authors are also the people who delivered the intervention and supervised the sessions, though the outcome assessor was blinded.

Do not conclude that VR-based cognitive training outperformed the pencil-and-paper version. The paper reports slightly larger within-group gains for cognition and depression in the card group, and the only result favouring VR is a between-group difference on daily-living scores that neither group improved significantly within itself. Do not read any of the changes as caused by the headset either: every participant also did twice-weekly balance, strength, aerobic and conversation-based group exercise.