Virtual reality and dementia: what the evidence says and how to run a session

RVer is not only for people with dementia: it is used with people aged 10 to 100, in hospitals, care homes and palliative care. But this is one of the questions we are asked most, and it deserves its own answer.

Short answer

As a non-pharmacological complement, led by someone from the team, virtual reality has been studied mainly for wellbeing, mood, engagement and reminiscence in people with mild cognitive impairment or dementia. Most studies are small and short. What they support is a modest role: a good moment, a conversation, a place brought back.

What research has studied

The RVer study library holds dozens of references on virtual reality and quality of life, and a large share of them concern people with cognitive impairment or dementia. Some examples:

• A meta-analysis on the effectiveness of virtual reality for people with mild cognitive impairment or dementia (Kim, 2019).
• A scoping review on virtual reality to promote wellbeing in people with dementia (Appel, 2021).
• A pilot study on reminiscence with virtual reality headsets in people with dementia (Coelho, 2020).
• A pilot study of a virtual forest with people with dementia (Moyle, 2018).
• A scoping review on fully immersive virtual reality in reminiscence interventions with older adults (Lu, 2023).
• A paper by the RVer team on cognitive impairment and depression in older adults (Ferreira, 2022), flagged as such in the library.

What is not known matters too. The measures used vary a great deal between studies, interventions last weeks and follow-up is short. There is also little research that separates the stages of dementia and the settings (home, care home, hospital). Anyone promising you clinical results on this basis is overstating it.

Reminiscence: the most natural use

Reminiscence therapy uses old memories as a starting point for conversation. In dementia, the oldest memories tend to last longest, and that is where an immersive video helps: instead of a photograph, the person is back on the beach where they spent their summers, at the village festival, at the shrine they visited every year. Among RVer's content, Fátima is one of the most requested places.

What makes a good reminiscence session is not the equipment, it is the preparation:

• Know where the person comes from. The life story form, filled in with the family, tells you which places to choose and which to avoid.
• Talk during and after. “Have you been here?”, “Who came with you?”. Cognitive stimulation through reminiscence happens in the conversation, not in the video.
• Accept whatever comes. A memory can bring joy or sadness. Both are legitimate, and the team is there for that.

Agitation, apathy and difficult moments

The behavioural and psychological symptoms of dementia, such as agitation, apathy or wandering, are among the most demanding parts of care. Virtual reality has been studied as one of the possible non-pharmacological approaches, mostly for apathy and mood.

In practice, there are three simple rules:

• Choose the moment. A session works better at a calm time than at the height of a crisis. Putting a headset on someone who is very agitated can make things worse.
• Watch the face, not the clock. If the person tenses up, tries to take the headset off or does not understand where they are, the session ends there. No insisting.
• Repeat what works. When a place works for someone, it is worth going back to it. In dementia, familiarity counts for more than novelty.

Adapting the session to the stage of dementia

There is no single virtual reality session for “dementia”: there are people at different stages, with different presentations. We wrote about this in types of dementia and what changes in a session. In short:

• Mild stage. The person understands what the experience is and can choose where to go. The conversation is richer.
• Moderate stage. Shorter sessions, always with the same member of the team, a simple explanation before putting the headset on, and very familiar content.
• Advanced stage. Calm environments, no request to interact, and extra attention to the reaction. Sometimes the best choice is not to do it.

At every stage: seated or lying down, never standing, and with someone alongside from start to finish. The general precautions, from cybersickness to epilepsy, are in is virtual reality bad for you?

How RVer helps the team

The team chooses the content on a tablet or computer on the local network, sees what is playing, and can pause or stop at any moment. During the session, the family can join by video call and see the same place, which gives the reminiscence one more voice. The call is not recorded, and no personal or clinical data about the person leaves the device.

The base product, the video library, is a Class I medical device registered in EUDAMED and with INFARMED (Portugal), CE marked. It is used as a complement, under the supervision of the team, and does not replace clinical assessment or care.

There is more about this setting on virtual reality for care homes. And because dementia also reaches hospitals and palliative care, the same system serves those settings too, with people aged 10 to 100.