Commercially available apps for the treatment of people living with dementia and mild cognitive impairment: a systematic review. What evidence and what urgencies from a public health perspective?

Background Digital cognitive-oriented therapies (COTs) delivered through commercially available apps are increasingly used for individuals with mild cognitive impairment (MCI) or dementia, yet evidence regarding their effectiveness and classification remains fragmented. Methods A systematic review was performed searching on PubMed, Embase, and ISI Web of Science up to 7th January 2026. Randomized Controlled Trials (RCTs) and non-randomized studies assessing commercial apps were included. Interventions were categorized (training, stimulation, rehabilitation) using predefined criteria. Quality of RCTs was assessed using Cochrane Risk of Bias tool. Results Sixty publications referring to 30 apps were included. Most reported statistically significant cognitive improvements (MMSE, MoCA), though effect sizes were small-to-moderate and clinical relevance was inconsistently addressed. Sample size calculations were often absent, caregiver outcomes were scarcely assessed, and most trials showed a high risk of bias. Conclusions Although promising, evidence is limited by methodological weaknesses and the lack of a clear and harmonized regulatory framework. More rigorous trials with clinically meaningful outcomes are needed.