Objective
Over the last decades, gaming has become a popular way to spend time and connect with people worldwide, engaging millions of users. Literature has shown that games and competition in gaming are closely linked to physiological stress responses. The aim of this systematic review was to determine if cognitive virtual games are also linked with stress responses and to investigate this interplay.

Methods
Following the PRISMA protocol, five databases were used, including EMBASE, PubMed, PsycInfo, SCOPUS and Web of Science. The PICO strategy was employed to formulate the research question. The search was performed by three independent investigators using a predefined protocol registered on the PROSPERO database (CRD42022384921). 

Findings
Following these procedures, 30 eligible empirical studies were considered for the review, which included 39 cognitive games, because some studies used more than one game in their research. Fourteen of the selected studies showed significantly increased cortisol levels after playing virtual cognitive games, twelve studies reported a decrease in cortisol levels while the remaining four showed both, increase and decrease cortisol depending on variables such as gender differences, age or type of game. This highlights the complex relationship between virtual cognitive games and cortisol modulation.

Conclusion
Our results provided a comprehensive view of the intricate interplay between virtual cognitive games and cortisol dynamics, acknowledging both the potential stress-inducing and stress-alleviating effects of gaming. The implications of these findings go beyond entertainment, emphasizing the need for a nuanced understanding of the psychophysiological mechanisms involved.