Effectiveness of technology-assisted nonpharmacological interventions for cognitive impairment in older adults: A systematic review and network meta-analysis.

BACKGROUND

Technology-assisted nonpharmacological interventions (TANPIs) are increasingly used to support cognitive and emotional health in older adults with cognitive impairment. Previous studies suggest that different technological modalities may influence outcomes through diverse neuroscientific and psychological pathways, such as enhancing attentional engagement, stimulating neuroplasticity, reducing loneliness, and promoting behavioral activation. However, the relative effectiveness of different TANPI modalities remains unclear.

METHODS

A comprehensive search of five databases was conducted to identify randomized controlled trials (RCTs) evaluating TANPIs in older adults with cognitive impairment. Pairwise and network meta-analyses were performed using a frequentist approach. Risk of bias was assessed with the Cochrane tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

RESULTS

A total of 66 RCTs were included, with most studies judged to be at low to moderate risk of bias. Pairwise analyses showed significant benefits of TANPIs for global cognition (SMD = 0.563, 95 % CI [0.358-0.769], I² = 88.9 %), depressive symptoms (SMD = -0.237, 95 % CI [-0.440 to -0.035], I² = 74.5 %), and quality of life (QOL: SMD = 0.279, 95 % CI [0.013-0.544], I² = 80.7 %). In the network meta-analysis, virtual reality-based cognitive training (VR_CT) demonstrated the strongest effect on cognitive function, while robot-based cognitive and social training (Robot_CST) appeared most beneficial for alleviating depressive symptoms. Although no intervention showed statistically significant superiority in improving QOL, computer-based cognitive training (Comp_CT) indicated promising potential in this domain. The certainty of evidence was generally moderate to high. Sensitivity analyses confirmed the robustness of results.

CONCLUSIONS

This study provides a comprehensive evidence base for guiding the selection and optimization of TANPIs in cognitively impaired older adults. Findings highlight the potential of immersive and interactive technologies, while underscoring the need for high-quality trials with standardized outcomes and longer follow-up.