This report, based on four studies with children with low-functioning autism, aimed at evaluating the effects of repetitive transcranial magnetic stimulation delivered on the left and right premotor cortices on eye–hand integration tasks; defining the long-lasting effects of high-frequency repetitive transcranial magnetic stimulation; and investigating the real efficacy of high-frequency repetitive transcranial magnetic stimulation by comparing three kinds of treatments (high-frequency repetitive transcranial magnetic stimulation, a traditional eye–hand integration training, and both treatments combined). Results showed a significant increase in eye–hand performances only when high-frequency repetitive transcranial magnetic stimulation was delivered on the left premotor cortex; a persistent improvement up to 1 h after the end of the stimulation; better outcomes in the treatment combining high-frequency repetitive transcranial magnetic stimulation and eye–hand integration training. Based on these preliminary findings, further evaluations on the usefulness of high-frequency repetitive transcranial magnetic stimulation in rehabilitation of children with autism are strongly recommended.

The loss of functional living skills (FLS) is an essential feature of major neurocognitive disorders (M-NCD); virtual reality training (VRT) offers many possibilities for improving FLS in people with M-NCD. The aim of our study was to verify the effectiveness of a non-immersive VRT on FLS for patients with M-NCD. VRT was carried out for 10 to 20 sessions, by means of four 3D apps developed in our institute and installed on a large touch screen. The experimental group (EG) and the control group (CG) included 24 and 18 patients with M-NCD, respectively. They were administered the in vivo test (in specific hospital places reproducing the natural environments) at T1 (pre-training) and T3 (post-training); at T2, only EG was administered VRT. Statistically significant differences between EG and CG in all the in vivo tests were found in the number of correct responses; during VRT, the number of correct responses increased, while the execution times and the number of clues decreased. The improvement in the in vivo tests appeared to be related to the specific VRT applied. The satisfaction of participants with the VRT was moderate to high.

Background: No standard protocols are available for cognitive rehabilitation in conditions like Major or Mild Neurocognitive disorder (M-NCD or m-NCD, respectively); however, preliminary data seem to indicate that such interventions might have cost-effective beneficial effects and are free from side effect or adverse events. Three basic approaches are known: cognitive stimulation, cognitive training, and cognitive rehabilitation. Objective: Aim of this study was to assess the efficacy of a protocol of Group Intensive Cognitive Activation (g-ICA) in patients with both M-NCD and m-NCD; the protocol was specifically arranged in our Research Institute, based on the principles of the central role of the patient and the mediation pedagogy. Subjects and Method: Sixteen patients with M-NCD and fifteen patients with m-NCD were enrolled, as well as 11 patients with M-NCD who were used as a control group. The intervention was carried-out by a clinical neuropsychologist with daily group sessions over a period of two months. Neuropsychological assessment was performed at baseline and after the completion of the rehabilitative intervention. Results: General cognitive functioning, attention, ideomotor praxis and visual memory scores were found to be significantly increased in all patients. Beneficial and significant effects were also found for constructive praxis in M-NCD and for executive functioning in m-NCD. All areas of the language function were significantly ameliorated in m-NCD, while this happened only for verbal repetition and syntax-grammar comprehension in M-NCD. No changes were detected for long- and short-term verbal memory, which were found to be worsened in controls without activation. Conclusion: Our findings seem to indicate that g-ICA might be effective in inducing beneficial changes on the general cognitive functioning and other specific functions in patients with both m-NCD and M-NCD. Moreover, the specific protocol proposed, even if susceptible of important improvement, is easy to carry out within hospital facilities and cost-effective.

Virtual reality has gained attention as an effective tool for cognitive, motor, and daily activity rehabilitation in patients with major neurocognitive disorder (M-NCD). The first objective of this study was to check for differences between M-NCD caused by degenerative and non-degenerative conditions (DC and NDC, respectively) in terms of relearning four functional living skills (FLSs), by means of a non-immersive virtual reality training (VRT). The second purpose was to verify whether spontaneous transfer from the virtual environment to the real environment occurred. Four FLS apps were developed in our institute (Information, Suitcase, Medicine, and Supermarket). A nonrandomized interventional study was carried out, comparing experimental and control groups (EG and CG, respectively). The study included three phases: in vivo test at T1; VRT at T2 only for EG; in vivo test at T3. During the in vivo test, the four FLSs were assessed in their natural environments. Both EG-DC and EG-NDC significantly improved in all of the VRT variable scores (the EG-NDC group seemed to show better outcomes than the EG-DC group). Moderate-to-high satisfaction with the VRT was reported. EG-DC and EG-NDC also enhanced their performances in the in vivo test. No statistically significant differences between them were found. CG-DC and CG-NDC improved only in the execution time of Information in the in vivo test. These findings confirm the ecological validity of VRT for FLSs.

Background: Cognitive decline across the mild cognitive impairment (MCI)–dementia continuum is a major driver of loss of independence and growing health- and social-care burden. Immersive technologies, such as virtual reality (VR), augmented reality (AR), and Cave Automatic Virtual Environment (CAVE) systems, are increasingly explored as tools to enhance engagement, personalization, and ecological validity in cognitive rehabilitation. Objective: This systematic review synthesizes current evidence on the usability, therapeutic effects, and implementation challenges of immersive technologies for cognitive rehabilitation in MCI and dementia. Methods: A systematic search of Scopus and Web of Science was conducted for peer-reviewed journal articles published between 2021 and 2026. Eligible studies investigated VR, AR, or CAVE interventions targeting cognitive rehabilitation outcomes in MCI and/or dementia and reported measures related to usability or acceptability, or cognitive, functional, or behavioral outcomes. Due to heterogeneity in technologies, intervention content, and outcome measures, findings were synthesized narratively with comparisons across modalities and study designs. Results: In total, 119 studies met the inclusion criteria. Across immersive VR interventions, signals of benefit were most consistently reported for memory, attention, and executive functioning, with several studies also targeting outcomes with higher ecological relevance (eg, everyday task performance and functional skills). AR approaches primarily support context-aware cueing and task guidance in real-world settings, aiming to strengthen daily functioning and independence. CAVE-based systems were frequently used for spatial navigation and embodied interaction, offering advantages for supervised clinical deployment. Key barriers included cybersickness and comfort issues, interface complexity, and onboarding demands in cognitively impaired users, limited accessibility and standardization of outcome measures, small samples and short follow-up periods, and practical constraints related to cost, space, staffing, and caregiver involvement. Conclusions: Immersive VR, AR, and CAVE systems are feasible and often engaging for cognitive rehabilitation in MCI and dementia, with promising therapeutic signals but substantial uncertainty driven by methodological and implementation heterogeneity. Future work should prioritize standardized reporting (intervention components, dose, and adverse events), clinically meaningful outcomes (including functional end points), adequately powered comparative trials, and explicit evaluation of scalability and real-world deployment pathways.

Virtual reality (VR) is evolving from a platform for cognitive exercises into an instrumented rehabilitation environment capable of simultaneously delivering treatment and quantifying behavior. This critical narrative review examines how behavioral, ocular, kinematic, physiological, and neurophysiological signals can be transformed into clinically meaningful digital measures, candidate biomarkers, adaptive interventions, and real-world functional outcomes. PubMed/MEDLINE, Scopus, and IEEE Xplore were searched from database inception to 20 September 2026, supplemented by backward and forward citation searching and targeted searches. Clinical, methodological, validation, and directly relevant technical studies were considered, including studies in healthy participants when methodologically informative. Of 690 records identified, 145 duplicates were removed; 545 unique records were screened and 303 formed the candidate evidence pool for critical narrative appraisal. Behavioral and interaction-derived measures are the most established, while eye tracking, kinematic sensing, autonomic monitoring, EEG, and fNIRS provide complementary information on attention, strategy, workload, and engagement. Quantitatively, combined hand- and eye-tracking features distinguished mild cognitive impairment from healthy controls with 93.3% accuracy, 100% sensitivity, and 83.3% specificity, while immersive VR life-skills training produced real-world functional gains of d = 1.00 post-training and d = 1.12 at 1-week follow-up. However, most sensor-derived variables remain digital measures or candidate biomarkers rather than clinically validated biomarkers; physiology-informed closed-loop adaptation is uncommon, and evidence that such adaptation produces sustained ADL or assisted-living benefits is lacking. Progress now depends on standardized reporting, external and multicenter validation, clinically interpretable adaptive models, and objective demonstration of real-world transfer.