Neurodegenerative diseases involve sustained, gradual degeneration of vulnerable neurons and their connections. They can affect cognition, sensation, socioemotional processing, motor function and behaviour, with progressive consequences for independence and quality of life. A recent study highlighted the scale of the challenge, reporting over 55 million people living with Alzheimer’s disease (AD) and related dementia and a global dementia cost exceeding 1.3 trillion USD (€1.2 trillion) in 2019. Against constraints in conventional care pathways, virtual reality (VR) rehabilitation has emerged as a promising intervention. The evidence summarised spans randomised controlled trials as well as systematic reviews and meta-analyses and assesses whether immersive, semi-immersive and non-immersive VR can support cognitive and motor rehabilitation across key neurodegenerative conditions.
Burden and Limits of Conventional Rehabilitation
The background links population ageing to a widening burden for health systems, patients and caregivers. A projection cited from the World Health Organization indicates neurodegenerative diseases will become the second leading cause of death in developed nations by 2040, exceeded only by cardiovascular diseases. The source also reports that the global financial burden of dementia is expected to rise further by 2030, reinforcing the importance of interventions that can be delivered consistently over long disease trajectories.
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Within the European Union, neurological disorders are reported to rank third after cardiovascular diseases and cancers, representing 13.3% (10.3–17.1) of total disability-adjusted life-years and 19.5% (18.0–21.3) of total deaths. Alongside these system-level measures, the source describes a marked decline in quality of life among people living with neurodegenerative conditions. Existing options are characterised as constrained in both effect and delivery. Pharmacotherapies and conventional rehabilitation are described as offering modest improvements, while practical barriers and the repetitive nature of many rehabilitation programmes can reduce motivation, adherence and sustained participation.
What Virtual Reality Rehabilitation Adds
VR rehabilitation is presented as an interactive approach that can simulate real-life scenarios, provide feedback and support transfer of training into everyday activities. The source distinguishes three system types by immersion and presence. Immersive VR uses head-mounted displays to create interactive synthetic environments with sensory feedback, offering moderate-to-high immersion and high presence at variable cost. Non-immersive VR uses standard screens and is described as a cost-effective solution, including for home rehabilitation. Semi-immersive VR typically combines high-resolution three-dimensional projections on large screens with stereoscopic sound, enabling patients to remain aware of their physical surroundings with a moderate sense of presence.
Across formats, the source emphasises programme design and personalisation. Tasks can be adjusted to match individual capability, optimising challenge level in ways intended to promote neuroplasticity. Gamified elements are described as improving enjoyment, motivation and adherence, addressing drawbacks associated with repetitive exercises. Presence is described as being created through task design, communication and mental involvement, positioning effective delivery as a combination of technology choice and therapeutic structure, tailored to treatment objectives and patient requirements.
Evidence Across Cognitive Impairment, Parkinson’s and Multiple Sclerosis
The evidence synthesis retrieved research from the PubMed database, the Cochrane Library and the Web of Science Core Collection, with searches conducted up to 9 October 2024. Following screening, 99 studies were incorporated, including randomised controlled trials as well as systematic reviews and meta-analyses. The synthesis focuses mainly on Parkinson’s disease (PD), cognitive impairment (CI) and multiple sclerosis (MS), evaluating immersive, semi-immersive and non-immersive VR interventions.
For CI, immersive VR was described as the principal format used in trial research. Outcomes were assessed using cognitive measures including the Montreal cognitive assessment (MoCA) and a Korean cognitive assessment. Compared with conventional methods, immersive VR cognitive training was reported to improve cognitive assessment scores, with one reported mean difference of 2.23. The source also reports reduced depression scores, including a mean difference of -1.70, alongside improvements in daily living skills, including functions such as shopping and financial management, and gains in executive function and information processing-related performance in the included trials.
For PD, evidence centred more on semi-immersive VR, with effectiveness assessed using established clinical tools including the Unified Parkinson’s Disease Rating Scale (UPDRS) for motor symptom evaluation, alongside balance and functional mobility measures. In one randomised trial, semi-immersive VR was associated with better balance than traditional rehabilitation, particularly for dynamic balance, with a reported mean difference of 4.14. Improvements in walking ability and motor symptom outcomes were also reported. The source also describes evidence that combining VR with additional therapeutic approaches and electrical stimulation was associated with further gains in balance and daily living skills and reductions in depression measures in the contexts evaluated.
For MS, semi-immersive VR was evaluated across balance, mobility, mood and cognition, including timed mobility testing and MoCA. Compared with conventional physical rehabilitation, semi-immersive VR was reported to produce superior balance outcomes, with one reported mean difference of 6.28. The source also reports benefits in fall-related outcomes, reduced fall anxiety and faster recovery of upper limb muscle strength, alongside improvements in cognitive dysfunction and depression risk measures in the included analyses.
Quality considerations are included in the synthesis. Most randomised trials were rated as high quality using the PEDro scale, with remaining trials rated as moderate, reflecting challenges such as allocation concealment, blinding and the absence of intention-to-treat analysis. Systematic reviews and meta-analyses were rated as high quality using AMSTAR, while missing grey literature searches and limited assessment of publication bias were noted.
Across Parkinson’s disease, cognitive impairment and multiple sclerosis, VR rehabilitation can support improvements in motor function, cognitive function and aspects of quality of life, with different VR formats aligning with different rehabilitation targets. Immersive systems are most developed in cognitive impairment trials, while semi-immersive and non-immersive approaches appear more frequently in balance and mobility-focused programmes. Priorities for clinical optimisation include standardising protocols and exploring underlying neurobiological mechanisms to support more consistent implementation and maximise rehabilitative efficacy in routine practice.
Source: npj Digital Medicine
Image Credit: iStock
References:
Tu T, Yang Y, Zheng T et al. (2025) Benefits of virtual reality rehabilitation on neurodegenerative diseases: a systematic review. npj Digit Med: In Press.
