Immediate anxiety-reducing effects of multisensory virtual reality reminiscence therapy in older adults with a wide range of cognitive functions: a pilot study using electrophysiological measures

Introduction Anxiety is a prevalent behavioral and psychological symptom of dementia (BPSD) in older adults with cognitive impairment, severely diminishing their quality of life. Although reminiscence therapy (RT) is a promising non-pharmacological intervention, objective neurophysiological methods to evaluate its immediate emotional impact remain unexplored. This pilot study proposed “Smart Reminiscence Therapy (SRT)” – a novel virtual reality (VR) system integrated with synchronized multisensory stimuli – and evaluated its immediate anxiety-reducing effects and the utility of electrophysiological measures. Methods A single-session, single-arm pre-post exploratory design was adopted. Twenty older adults (aged 65 years or older) at a day service center, with Mini-Mental State Examination-Japanese (MMSE-J) scores of 11–30, participated. The intervention consisted of a 10-min SRT session featuring a 1960s Japanese townscape. The primary outcome was objective resting-state eye-closed frontal alpha asymmetry (FAA) via a wearable EEG device, while subjective state anxiety via the State-Trait Anxiety Inventory (STAI) was evaluated as a secondary outcome. Results After excluding three participants with excessive artifacts, 17 participants (mean age: 85.9 ± 5.9 years; mean MMSE-J: 23.8 ± 3.8, with 64.7% clustered in the MCI-to-mild-dementia range) were analyzed. Subjective STAI scores showed a non-significant decreasing trend with a moderate effect size ( p = 0.088, r = 0.414). Conversely, the FAA index significantly increased post-intervention ( p = 0.038, Cohen’s d = 0.55). No significant correlation was found between changes in STAI and FAA (r = −0.15, p = 0.562). Conclusion A single session of SRT was associated with an increase in FAA; however, the uncontrolled design precludes causal attribution to the intervention. The dissociation between subjective reports and neurophysiological changes suggests that FAA may complement self-reported measures by capturing aspects of acute emotional change that may be difficult to verbalize in people with cognitive impairment. The non-significant but moderate-sized reduction in STAI scores warrants confirmation in larger controlled studies.