Design of computer-based non-pharmacological cognitive healthcare interventions for people afflicted by chronic neurodegenerative impairments must be soundly informed by and clearly centered on users' distinctive disabilities. In this article we present a use-oriented analysis of those cognitive interventions intended for healthcare of patients with Alzheimer's dementia and related disorders that use human-computer interaction based on virtual reality technology. The analysis identifies the

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... important strengths and weakness, and describes and assesses the main key opportunities and challenges inherent to the use of this type of cognitive healthcare interventions. The most critical specific usability concerns that considerably affect these interventions are described in order to be directly addressed during a user-centered design process. Significant evaluation issues that still trouble these interventions' general acceptance are also included. On the basis of this analysis, appropriate actions are recommended to help minimize accessibility and usability issues. Finally, concrete design guidelines, and a framework with its road map are proposed to direct the design process. The proposed framework's more outstanding features and functionalities are described in relation to user-centered design conceptualization, implementation and assessment. The use of a consistent user-centered design methodology, such as the one proposed here to tackle the main critical obstacles, could turn out to become the key that allows to achieve a substantial improvement of VR-based cognitive healthcare interventions effectiveness.