A key element in providing future dementia patients with sufficient care is the early detection of cognitive impairment. Using augmented reality (AR) and virtual reality (VR), the project “Smart Cognition & Behaviour Screening powered by Augmented Reality” (SCOBES-AR) seeks to create a multimodal screening tool (MST) for the early and easy detection of cognitive impairment. The MST focusses on non-pharmacological prevention by assessing behavioral and lifestyle-associated risk factors and identifying personal resources. First, a validation study was carried out utilizing the established Cognitive Functions Dementia (CFD) test battery to evaluate a set of selected test procedures. The validated test procedures were implemented in an MST prototype based on AR/VR techniques. Using observational summative evaluation and the co-discovery method, the usability and applicability of the validated test methods for therapists and subjects were further assessed in a subsequent cross-over study with 98 healthy individuals (age 60-75 years). 310 people were involved in the validation study (age 60-75 years). Among other things, the assessment of olfactory performance (r = 0.09, p = 0.003), reaction time (r = -0.47, p<0.001), and activities of daily living (r = 0.29, p<0.001) revealed a particularly high agreement with the CFD. Further, the MST prototype, that includes a tablet PC, AR head-mounted display with smartphone, VR head-mounted display, and Flic Buttons as input devices, was developed (see fig. 1). It allows the therapist to have control and direction over the screening process (see fig. 2). The focus of the MST is on non-clinical cognitive and physical functionalities, as it integrates tests from multiple health professions and is low-threshold viable. The development of the MST prototype enables the determination of ideal procedures for multimodal AR/VR-based testing to measure cognitive impairment in older people. To bolster the findings and advance research, clinical trials involving people with cognitive decline and those who already have dementia would be required.

Background: The early diagnosis of cognitive impairments is an important step in the adequate management of dementia. The project "Smart Cognition & Behaviour Screening powered by Augmented Reality" (SCOBES-AR) aims to develop a multimodal screening tool (MST) for the early detection of cognitive impairments using augmented and virtual reality. The first project phase selected validated assessments for combination with the MST and tested it in 300 healthy older adults. Objective: This study established a protocol for the implementation and usability of a mixed reality (MR)-enhanced multidisciplinary screening tool for the early detection of cognitive impairments in older adults. The developed MST will be partially enhanced by MR, which is a combination of augmented reality (AR) and virtual reality (VR). This MR-enhanced prototype of the screening tool (MR-MST) will be tested and compared to the previously developed MST. The usability of the prototype will also be examined. Methods: This single-center observational crossover design study screens 100 healthy participants (aged 60-75 years) for cognitive decline using a specially developed MST (assessment of cognitive functions, olfactory sensitivity, nutritional preferences, gait parameters, reaction times, and activities of daily living) and an MR-enhanced MST in which the assessments of cognitive functions, reaction time, activities of daily living, and gait will be performed using tailor-made software and AR and VR hardware. The results of the MR-enhanced MST will be compared to those without MR. The usability of the developed MR-enhanced MST will be tested on 10 investigators and 10 test participants using observed summative evaluation and the codiscovery method, and on 2 usability experts using the codiscovery and cognitive walkthrough methods. Results: This study was funded by the Austrian Research Promotion Agency (grant 866873) and received approval from the ethics committee of the Medical University of Graz. The MR-MST and the experimental protocol for this study were developed. All participants gave written informed consent. As of July 15, 2022, a total of 70 participants have been screened. Data analysis and dissemination are scheduled for completion by September 2023. Conclusions: The development and testing of the MR-MST is an important step toward the establishment of the best practice procedure for the implementation of AR and VR in the screening of cognitive declines in older adults. It will help improve our knowledge of the usability and applicability of the developed prototype and promote further advancement in AR and VR technologies to be used in therapeutic settings. International Registered Report Identifier (IRRID): DERR1-10.2196/39513