VR-based gamma sensory stimulation: a pilot feasibility study

Alzheimer's disease (AD) presents a critical global health challenge, with current therapies offering limited efficacy and safety in halting disease progression. Gamma sensory stimulation (GSS) has emerged as a promising non-invasive neuromodulation technique that enhances gamma neural synchrony, potentially counteracting AD pathology by promoting glymphatic clearance, reducing neuroinflammation and improving synaptic plasticity. However, existing GSS delivery methods rely on simplistic sensory stimuli that lack user engagement, potentially creating adherence barriers and limiting the full therapeutic potential of this approach. To address this, we investigated whether GSS delivered through virtual reality (VR) could safely and effectively evoke gamma-band neural activity while providing an engaging and tolerable user experience. Sixteen cognitively healthy older adults participated in a single-session, within-subject feasibility study consisting of three VR-based experiments. In each, 40 Hz auditory and/or visual stimuli were presented, and neural responses were recorded using electroencephalography (EEG). Tolerability and safety were assessed via digital questionnaires. Source-level analysis from Experiment 1 confirmed that unimodal auditory and visual stimulation at 40 Hz reliably increased gamma power in their respective sensory cortices. Sensor-level analyses from Experiments 2 and 3 showed that multimodal audiovisual stimulation enhanced both gamma power and inter-trial phase coherence-whether delivered through passive video viewing or integrated into an active cognitive task. Participants reported high comfort and engagement, with no serious adverse events. The findings of this study validate VR as a scalable tool for delivering engaging and cognitively relevant GSS, paving the way for personalized therapies that maximize adherence and therapeutic outcomes. By integrating interactive elements, VR-based GSS may uniquely target memory-related neural networks, offering a novel approach to mitigate neurotoxicity and cognitive decline in AD.