Integrating virtual reality and exergaming in cognitive rehabilitation of patients with Parkinson disease: a systematic review of randomized controlled trials

INTRODUCTION: In recent years, growing attention is rising to virtual reality (VR) tools and exergaming in rehabilitation management of patients with Parkinson disease (PD). However, no strong evidence supports the effectiveness of these cutting-edge technologies on cognitive function and the integration of these promising tool in the rehabilitation framework of PD patients is still challenging. Therefore, the present systematic review of randomized controlled trials (RCTs) aimed at assessing the effects of VR and exergames/telerehabilitation in the cognitive rehabilitation management of patients with PD. EVIDENCE ACQUISITION: PubMed, Scopus and Web of Science databases were systematically searched up to February 14^th, 2022, to identify RCTs assessing patients with PD undergoing cognitive rehabilitation including VR or exergames/telerehabilitation. The intervention was compared to conventional rehabilitation protocols. The primary outcome was cognitive function. The quality assessment was performed following the Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). PROSPERO registration code: CRD42022319788. EVIDENCE SYNTHESIS: Out of 1419 identified studies, 66 articles were assessed for eligibility, and, at the end of the screening process, 10 studies were included in the present systematic review. Five RCTs (50%) assessed the exergaming devices, reporting significant positive results on cognitive outcomes scales (Trail Making test scale, Digit Span backward, MoCA, and MyCQ score). The other 5 RTCs (50%) assessed VR approaches, reporting significant improvement in executive functions. The RoB 2 showed an overall high risk of bias for the 40% of studies included. CONCLUSIONS: Exergaming and VR might be considered promising rehabilitation interventions in the cognitive rehabilitation framework of PD patients. Further high-quality studies are needed to define the role of exergames and VR in a comprehensive rehabilitation approach aiming at improving the multilevel cognitive impairment characterizing patients with PD.