Authors
Bomyi Jeon, Chi Hyeon Noh, Soo Rim Noh, Yerin Shim, Seung Bin Cho, Sungkun Cho
Published in
JMIR serious games. Volume 14. Pages e92334. Sep 16, 2026. Epub Sep 16, 2026.
Abstract
Many existing digital cognitive assessments rely on isolated or abstract tasks, and primarily use accuracy-based outcome measures, despite recent advances in the field. Few have been culturally adapted to reflect the familiar daily-life experiences of Korean older adults. Integrating culturally meaningful scenarios with task-specific accuracy and reaction time (RT) measures may provide a more ecologically grounded approach to mild cognitive impairment (MCI) screening.
This study aimed to develop and preliminarily evaluate a tablet-based, scenario-based serious game for community-based MCI screening among Korean older adults.
In this cross-sectional diagnostic accuracy study, community-dwelling adults aged 60-84 years were recruited through convenience sampling from a senior welfare center in Daejeon, South Korea, between July 2024 and June 2025. Of 87 participants who underwent eligibility assessment, 67 participants were included in the analysis: 47 cognitively normal participants, and 20 participants with MCI. Clinical classification was determined according to Petersen criteria based on the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease battery, second edition, structured clinical interviews, and clinician judgment blinded to the serious game results. The serious game initially comprised 5 culturally familiar and ecologically grounded daily-life tasks, from which task-specific accuracy and RT features were extracted. A reduced 4-task model informed by exploratory misclassification analysis served as the primary classification model and was evaluated using random forest classification with out-of-bag validation. A full 5-task model and a demographic-adjusted model were also evaluated. Convergent validity and perceived workload were assessed.
The group with MCI was older (77.3 vs 74.5 y; P=.002) and had fewer years of education (9.4 vs 11.2 y; P=.04). The primary 4-task model achieved an overall accuracy of 82.1% (55/67), balanced accuracy of 80.1%, sensitivity of 75% (15/20), specificity of 85.1% (40/47), and an area under the receiver operating characteristic curve of 0.787 (95% CI 0.643-0.932). The demographic-adjusted model showed broadly comparable discrimination (area under the receiver operating characteristic curve 0.794, 95% CI 0.654-0.934). Accuracy and RT measures from the sale items task ranked among the most important predictors. Digital composite scores were significantly correlated with the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease battery, second edition total score (r=.655 and r=.447; both P<.001). Perceived workload did not significantly differ between groups (P=.97).
This study provides preliminary evidence for the diagnostic utility and feasibility of a tablet-based serious game integrating culturally familiar daily-life scenarios with task-specific accuracy and RT measures, thereby capturing both performance accuracy and potential differences in processing efficiency. The automated format may offer a scalable and accessible screening option for community settings without specialized equipment. Independent, multisite, and longitudinal validation is required to establish its generalizability and predictive utility.
PMID:
42748403
Bibliographic data and abstract were imported from PubMed on 17 Sep 2026.
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