Preliminary validation of Cogniclear: a virtual reality cognitive screening tool for older adults against the Montreal Cognitive Assessment

Abstract Virtual reality (VR) offers new opportunities for cognitive assessment by enabling immersive, ecologically valid task execution and continuous behavioral monitoring. However, it remains unclear whether performance in VR-based assessments reflects underlying cognitive functioning rather than interaction-related factors. This study aimed to evaluate the validity of a VR-based cognitive assessment environment by examining its relationship with the Montreal Cognitive Assessment (MoCA). Forty older adults were recruited, of whom 38 completed both assessments and were included in the analyses. Cognitive status was independently assessed using the MoCA. Performance metrics derived from system interaction logs were analyzed together with measures of usability (VRSUQ), workload (NASA–TLX), age, education, and prior VR experience. Significant associations were observed between MoCA scores and VR-derived performance measures, including Global Score, Success Rate, and task duration. Domain-level analyses revealed moderate-to-strong correlations between corresponding cognitive domains measured by MoCA and the VR system. Regression analyses demonstrated that cognitive status and age remained independently associated with Global Score after accounting for participant characteristics, whereas prior VR experience, workload, and usability were not independently associated with Global Score. The findings support the validity of the proposed VR-based assessment approach and suggest that immersive environments can capture meaningful aspects of cognitive functioning. VR-based assessments may complement traditional cognitive screening by providing ecologically valid tasks and rich behavioral information derived from user interactions.