Culturally Familiar Nostalgic VR Cognitive Training for Older Adults

This randomized controlled trial (RCT) examines the effectiveness of a culturally tailored, nostalgia-based virtual reality (VR) program in promoting cognitive health and emotional well-being among older adults (≥65 years) in northern Taiwan. The study is designed in response to Taiwan's rapid transition into a super-aged society, where dementia prevalence and caregiving burdens are expected to rise significantly. Mild cognitive impairment (MCI) represents a critical transitional state with cognitive plasticity, providing a valuable opportunity for early non-pharmacological intervention.

Theoretical Framework

The intervention is guided by Expectation Confirmation Theory (ECT), which emphasizes how perceptions of usefulness, ease of use, and enjoyment influence participants' satisfaction and long-term intention to adopt health-related technologies. This framework allows the study to move beyond clinical outcomes and assess the feasibility and sustainability of VR interventions among older adults.

Intervention Features

The Brain Health Nostalgic VR Program integrates reminiscence therapy with cognitive training within immersive VR. The content is uniquely designed with Taiwan-specific cultural elements, such as traditional wedding rituals, historical films, and familiar objects from everyday life, to evoke strong nostalgic responses and enhance emotional engagement.

Cognitive exercises are embedded in the VR environment and target seven domains:Attention, Memory, Reasoning, Reading comprehension, Thinking skills, Imagination and creativity, Observational skills.

Each session, scheduled twice weekly, lasts approximately 25-35 minutes, including preparation, VR exposure (15-25 minutes depending on tolerance), discussion, and breaks. The intervention continues for 12 sessions in total. Assessments are conducted at baseline, post-intervention (up to 8 weeks), and 3 months post-intervention. Sessions are delivered within participants' own care facilities to ensure safety and comfort.

Distinguishing Characteristics

Unlike conventional reminiscence therapy, which often uses photos or group conversations, the immersive VR environment minimizes external distractions and enhances the sense of presence. This approach is expected to amplify the therapeutic benefits of reminiscence by combining emotional stimulation with structured cognitive tasks.

Previous studies in Asia and Europe have shown promising results from VR-based reminiscence and cognitive training, but most were limited by small sample sizes or short-term pilot designs. This trial is one of the first large-scale, culturally adapted RCTs in Taiwan, addressing both psychological outcomes (e.g., life satisfaction, well-being, depressive symptoms) and cognitive performance in older adults with MCI or mild dementia.

Anticipated Contributions

This study aims to:

Demonstrate the efficacy of a VR-based nostalgia and cognitive training program as an innovative non-pharmacological intervention.

Provide empirical evidence on how culturally tailored VR content can enhance reminiscence, reduce depressive symptoms, and improve cognitive functioning in older adults.

Evaluate user acceptance and long-term adoption intentions, offering insights into the scalability of digital health interventions in community and institutional settings.

By integrating cultural reminiscence, cognitive stimulation, and immersive VR technology, this trial contributes to both the scientific evidence base and practical strategies for dementia prevention, elderly mental health promotion, and caregiver burden reduction.

Inclusion criteria

• Age 65 years or older
• Able to communicate in Mandarin or Taiwanese
• Capable of wearing and operating a VR headset and handheld controllers
• Sufficient vision and hearing to interact with VR content (assistive devices permitted)
• Able to provide informed consent or have a legal guardian provide consent

Exclusion criteria

• Diagnosis of severe dementia or advanced neurodegenerative disease
• Severe psychiatric disorders (e.g., schizophrenia, bipolar disorder)
• Major visual or auditory impairments that would interfere with VR use, even with assistive devices
• Unconsciousness, inability to stay awake or focused for the session duration Inability to comply with study protocol or scheduled sessions