A Virtual Reality Serious Game for Cognitive Assessment in Mild Cognitive Impairment and Early Alzheimer’s Disease
Resumo
Introduction: Mild Cognitive Impairment (MCI) and early-stage Alzheimer’s disease are frequently underdiagnosed in primary care despite their high prevalence. Virtual Reality (VR) serious games provide immersive environments that can enhance cognitive assessment through ecologically valid and engaging activities. Objective: This paper presents the design, implementation, and data collection strategy of a Unity-based VR serious game simulating a realistic supermarket, aimed at assessing route learning, spatial memory, and sequential task execution in older adults with suspected MCI or early Alzheimer’s disease. Methodology: The system employs a two-phase navigation task (guided route learning followed by autonomous recall) together with interaction and locomotion techniques tailored to older adults, including joystick-based continuous locomotion with head-directed turning and simplified ray-based selection, plus an optional teleport locomotion mode for participants who experience cybersickness. Results: The implemented prototype integrates a configurable supermarket environment, a two-phase NPC-guided and autonomous route-learning task, simplified locomotion and ray-based interaction, and structured telemetry export for movement, head-directed view, timing, and item-interaction events. These outputs establish a reproducible instrument for subsequent feasibility and clinical-validation studies and for future research on AI-based screening support.
Palavras-chave:
Virtual Reality, Serious Games, Mild Cognitive Impairment, Alzheimer’s Disease, Cognitive Assessment, Spatial Navigation, Human–Computer Interaction, Healthcare AI
Referências
Baker, S., Waycott, J., Robertson, E., Carrasco, R., Neves, B. B., Hampson, R., e Vetere, F. (2020). Evaluating the use of interactive virtual reality technology with older adults living in residential aged care. Information Processing & Management, 57(3):102105. DOI: 10.1016/j.ipm.2019.102105.
Costa, R. Q. M. d., Pompeu, J. E., Mello, D. D. d., Moretto, E., Rodrigues, F. Z., Santos, M. D. d., Nitrini, R., Morganti, F., e Brucki, S. M. D. (2018a). A comparison between an immersive virtual reality spatial task and its correspondent paper-and-pencil version with one’s perception of spatial abilities. Alzheimer’s & Dementia, 14(7):P427. Conference abstract. DOI: 10.1016/j.jalz.2018.06.355.
Costa, R. Q. M. d., Pompeu, J. E., Mello, D. D. d., Moretto, E., Rodrigues, F. Z., Santos, M. D. d., Nitrini, R., Morganti, F., e Brucki, S. M. D. (2018b). Two new virtual reality tasks for the assessment of spatial orientation: Preliminary results of tolerability, sense of presence and usability. Dementia & Neuropsychologia, 12(2):196–204. DOI: 10.1590/1980-57642018dn12-020013.
Costa, R. Q. M. d., Pompeu, J. E., Moretto, E., Silva, J. M. a. d., Santos, M. D. d., Nitrini, R., e Brucki, S. M. D. (2022). Two immersive virtual reality tasks for the assessment of spatial orientation in older adults with and without cognitive impairment: Concurrent validity, group comparison, and accuracy results. Journal of the International Neuropsychological Society, 28(5):460–472. DOI: 10.1017/S1355617721000655.
Ge, Y., Yin, J., Chen, C., Yang, S., Han, Y., Ding, C., Zheng, J., Zheng, Y., e Zhang, J. (2025). An EEG-based framework for automated discrimination of conversion to Alzheimer’s disease in patients with amnestic mild cognitive impairment: An 18-month longitudinal study. Frontiers in Aging Neuroscience, 16:1470836. DOI: 10.3389/fnagi.2024.1470836.
Han, K., Yue, X., Qiu, S., Yang, F., e Li, G. (2024). Diagnosis of early mild cognitive impairment in type 2 diabetes mellitus by deep learning of multimodal images and metadata. In 2024 IEEE International Symposium on Biomedical Imaging (ISBI), pages 1–4. DOI: 10.1109/ISBI56570.2024.10635257.
Hořejší, P., Lochmannová, A., Jezl, V., e Dvořák, M. (2025). Virtual reality locomotion methods differentially affect spatial orientation and cybersickness during maze navigation. Scientific Reports, 15:26255. DOI: 10.1038/s41598-025-12143-y.
Iliadou, P., Paliokas, I., Zygouris, S., Lazarou, E., Votis, K., Tzovaras, D., e Tsolaki, M. (2021). A comparison of traditional and serious game-based digital markers of cognition in older adults with mild cognitive impairment and healthy controls. Journal of Alzheimer’s Disease, 79(4):1747–1759. DOI: 10.3233/JAD-201300.
Kurbalija, V., Geler, Z., Vujanić Stankov, T., Petrušić, I., Ivanović, M., Kononenko, I., Semnic, M., Daković, M., Semnic, R., e Bosnić, Z. (2023). Analysis of neuropsychological and neuroradiological features for diagnosis of Alzheimer’s disease and mild cognitive impairment. International Journal of Medical Informatics, 178:105195. DOI: 10.1016/j.ijmedinf.2023.105195.
Li, Y., Shiyanov, I., e Muschalla, B. (2025). Assessing cybersickness in a virtual reality intervention among older adults living in nursing homes: A feasibility study. Disability and Rehabilitation: Assistive Technology, 20(7):2339–2347. DOI: 10.1080/17483107.2025.2503909.
Liu, L., Li, Y., e Yang, K. (2025). Dynamically weighted graph neural network for detection of early mild cognitive impairment. PLOS ONE, 20(6):e0323894. DOI: 10.1371/journal.pone.0323894.
Liu, Y., Jun, H., Becker, A., Wallick, C., e Mattke, S. (2024). Detection rates of mild cognitive impairment in primary care for the United States Medicare population. The Journal of Prevention of Alzheimer’s Disease, 11(1):7–12. DOI: 10.14283/jpad.2023.131.
Parsons, T. D. (2015). Virtual reality for enhanced ecological validity and experimental control in the clinical, affective and social neurosciences. Frontiers in Human Neuroscience, 9:660. DOI: 10.3389/fnhum.2015.00660.
Petersen, R. C., Caracciolo, B., Brayne, C., Gauthier, S., Jelic, V., e Fratiglioni, L. (2014). Mild cognitive impairment: A concept in evolution. Journal of Internal Medicine, 275(3):214–228. DOI: 10.1111/joim.12190.
Porcino, T., Rodrigues, E. O., Bernardini, F., Trevisan, D., e Clua, E. (2022). Identifying cybersickness causes in virtual reality games using symbolic machine learning algorithms. Entertainment Computing, 41:100473. DOI: 10.1016/j.entcom.2021.100473.
Porffy, L. A., Mehta, M. A., Patchitt, J., Boussebaa, C., Brett, J., D’Oliveira, T., Mouchlianitis, E., e Shergill, S. S. (2022). A novel virtual reality assessment of functional cognition: Validation study. Journal of Medical Internet Research, 24(1):e27641. DOI: 10.2196/27641.
Salari, N., Lotfi, F., Abdolmaleki, A., Heidarian, P., Rasoulpoor, S., Fazeli, J., Najafi, H., e Mohammadi, M. (2025). The global prevalence of mild cognitive impairment in geriatric population with emphasis on influential factors: A systematic review and meta-analysis. BMC Geriatrics, 25(1):313. DOI: 10.1186/s12877-025-05967-w.
Santos, M. D. d., Silva, J. M. a. d., Costa, R. Q. M. d., Viveiro, L. A. P. d., Moretto, E. G., Lopes, R. d. D., Brucki, S. M. D., e Pompeu, J. E. (2022). Applicability of an immersive virtual reality system for assessing route learning in older adults. Dementia & Neuropsychologia, 16(2):220–227. DOI: 10.1590/1980-5764-DN-2021-0006.
Silva, J. M. a. d., Santos, M. D. d., Costa, R. Q. M. d., Moretto, E. G., Viveiro, L. A. P. d., Lopes, R. d. D., Brucki, S. M. D., e Pompeu, J. E. (2023). Applicability of an immersive virtual reality system to assess egocentric orientation of older adults. Arquivos de Neuro-Psiquiatria, 81(1):19–26. DOI: 10.1055/s-0042-1759762.
Ward, A., Tardiff, S., Dye, C., e Arrighi, H. M. (2013). Rate of conversion from prodromal alzheimer’s disease to alzheimer’s dementia: A systematic review of the literature. Dementia and Geriatric Cognitive Disorders Extra, 3(1):320–332. Available: 10.1159/000354370.
World Health Organization (2026). Dementia. Fact sheet, 3 July 2026. Available: [link]. Accessed: 27 July 2026.
Yan, M., Yin, H., Meng, Q., Wang, S., Ding, Y., Li, G., Wang, C., e Chen, L. (2021). A virtual supermarket program for the screening of mild cognitive impairment in older adults: Diagnostic accuracy study. JMIR Serious Games, 9(4):e30919. DOI: 10.2196/30919.
Zhang, Z., Gao, L., Jin, G., Guo, L., Yao, Y., Dong, L., e Han, J. (2021). THAN: Task-driven hierarchical attention network for the diagnosis of mild cognitive impairment and Alzheimer’s disease. Quantitative Imaging in Medicine and Surgery, 11(7):3338–3354. DOI: 10.21037/qims-21-91.
Zygouris, S., Giakoumis, D., Votis, K., Doumpoulakis, S., Ntovas, K., Segkouli, S., Karagiannidis, C., Tzovaras, D., e Tsolaki, M. (2015). Can a virtual reality cognitive training application fulfill a dual role? using the virtual supermarket cognitive training application as a screening tool for mild cognitive impairment. Journal of Alzheimer’s Disease, 44(4):1333–1347. DOI: 10.3233/JAD-141260.
Costa, R. Q. M. d., Pompeu, J. E., Mello, D. D. d., Moretto, E., Rodrigues, F. Z., Santos, M. D. d., Nitrini, R., Morganti, F., e Brucki, S. M. D. (2018a). A comparison between an immersive virtual reality spatial task and its correspondent paper-and-pencil version with one’s perception of spatial abilities. Alzheimer’s & Dementia, 14(7):P427. Conference abstract. DOI: 10.1016/j.jalz.2018.06.355.
Costa, R. Q. M. d., Pompeu, J. E., Mello, D. D. d., Moretto, E., Rodrigues, F. Z., Santos, M. D. d., Nitrini, R., Morganti, F., e Brucki, S. M. D. (2018b). Two new virtual reality tasks for the assessment of spatial orientation: Preliminary results of tolerability, sense of presence and usability. Dementia & Neuropsychologia, 12(2):196–204. DOI: 10.1590/1980-57642018dn12-020013.
Costa, R. Q. M. d., Pompeu, J. E., Moretto, E., Silva, J. M. a. d., Santos, M. D. d., Nitrini, R., e Brucki, S. M. D. (2022). Two immersive virtual reality tasks for the assessment of spatial orientation in older adults with and without cognitive impairment: Concurrent validity, group comparison, and accuracy results. Journal of the International Neuropsychological Society, 28(5):460–472. DOI: 10.1017/S1355617721000655.
Ge, Y., Yin, J., Chen, C., Yang, S., Han, Y., Ding, C., Zheng, J., Zheng, Y., e Zhang, J. (2025). An EEG-based framework for automated discrimination of conversion to Alzheimer’s disease in patients with amnestic mild cognitive impairment: An 18-month longitudinal study. Frontiers in Aging Neuroscience, 16:1470836. DOI: 10.3389/fnagi.2024.1470836.
Han, K., Yue, X., Qiu, S., Yang, F., e Li, G. (2024). Diagnosis of early mild cognitive impairment in type 2 diabetes mellitus by deep learning of multimodal images and metadata. In 2024 IEEE International Symposium on Biomedical Imaging (ISBI), pages 1–4. DOI: 10.1109/ISBI56570.2024.10635257.
Hořejší, P., Lochmannová, A., Jezl, V., e Dvořák, M. (2025). Virtual reality locomotion methods differentially affect spatial orientation and cybersickness during maze navigation. Scientific Reports, 15:26255. DOI: 10.1038/s41598-025-12143-y.
Iliadou, P., Paliokas, I., Zygouris, S., Lazarou, E., Votis, K., Tzovaras, D., e Tsolaki, M. (2021). A comparison of traditional and serious game-based digital markers of cognition in older adults with mild cognitive impairment and healthy controls. Journal of Alzheimer’s Disease, 79(4):1747–1759. DOI: 10.3233/JAD-201300.
Kurbalija, V., Geler, Z., Vujanić Stankov, T., Petrušić, I., Ivanović, M., Kononenko, I., Semnic, M., Daković, M., Semnic, R., e Bosnić, Z. (2023). Analysis of neuropsychological and neuroradiological features for diagnosis of Alzheimer’s disease and mild cognitive impairment. International Journal of Medical Informatics, 178:105195. DOI: 10.1016/j.ijmedinf.2023.105195.
Li, Y., Shiyanov, I., e Muschalla, B. (2025). Assessing cybersickness in a virtual reality intervention among older adults living in nursing homes: A feasibility study. Disability and Rehabilitation: Assistive Technology, 20(7):2339–2347. DOI: 10.1080/17483107.2025.2503909.
Liu, L., Li, Y., e Yang, K. (2025). Dynamically weighted graph neural network for detection of early mild cognitive impairment. PLOS ONE, 20(6):e0323894. DOI: 10.1371/journal.pone.0323894.
Liu, Y., Jun, H., Becker, A., Wallick, C., e Mattke, S. (2024). Detection rates of mild cognitive impairment in primary care for the United States Medicare population. The Journal of Prevention of Alzheimer’s Disease, 11(1):7–12. DOI: 10.14283/jpad.2023.131.
Parsons, T. D. (2015). Virtual reality for enhanced ecological validity and experimental control in the clinical, affective and social neurosciences. Frontiers in Human Neuroscience, 9:660. DOI: 10.3389/fnhum.2015.00660.
Petersen, R. C., Caracciolo, B., Brayne, C., Gauthier, S., Jelic, V., e Fratiglioni, L. (2014). Mild cognitive impairment: A concept in evolution. Journal of Internal Medicine, 275(3):214–228. DOI: 10.1111/joim.12190.
Porcino, T., Rodrigues, E. O., Bernardini, F., Trevisan, D., e Clua, E. (2022). Identifying cybersickness causes in virtual reality games using symbolic machine learning algorithms. Entertainment Computing, 41:100473. DOI: 10.1016/j.entcom.2021.100473.
Porffy, L. A., Mehta, M. A., Patchitt, J., Boussebaa, C., Brett, J., D’Oliveira, T., Mouchlianitis, E., e Shergill, S. S. (2022). A novel virtual reality assessment of functional cognition: Validation study. Journal of Medical Internet Research, 24(1):e27641. DOI: 10.2196/27641.
Salari, N., Lotfi, F., Abdolmaleki, A., Heidarian, P., Rasoulpoor, S., Fazeli, J., Najafi, H., e Mohammadi, M. (2025). The global prevalence of mild cognitive impairment in geriatric population with emphasis on influential factors: A systematic review and meta-analysis. BMC Geriatrics, 25(1):313. DOI: 10.1186/s12877-025-05967-w.
Santos, M. D. d., Silva, J. M. a. d., Costa, R. Q. M. d., Viveiro, L. A. P. d., Moretto, E. G., Lopes, R. d. D., Brucki, S. M. D., e Pompeu, J. E. (2022). Applicability of an immersive virtual reality system for assessing route learning in older adults. Dementia & Neuropsychologia, 16(2):220–227. DOI: 10.1590/1980-5764-DN-2021-0006.
Silva, J. M. a. d., Santos, M. D. d., Costa, R. Q. M. d., Moretto, E. G., Viveiro, L. A. P. d., Lopes, R. d. D., Brucki, S. M. D., e Pompeu, J. E. (2023). Applicability of an immersive virtual reality system to assess egocentric orientation of older adults. Arquivos de Neuro-Psiquiatria, 81(1):19–26. DOI: 10.1055/s-0042-1759762.
Ward, A., Tardiff, S., Dye, C., e Arrighi, H. M. (2013). Rate of conversion from prodromal alzheimer’s disease to alzheimer’s dementia: A systematic review of the literature. Dementia and Geriatric Cognitive Disorders Extra, 3(1):320–332. Available: 10.1159/000354370.
World Health Organization (2026). Dementia. Fact sheet, 3 July 2026. Available: [link]. Accessed: 27 July 2026.
Yan, M., Yin, H., Meng, Q., Wang, S., Ding, Y., Li, G., Wang, C., e Chen, L. (2021). A virtual supermarket program for the screening of mild cognitive impairment in older adults: Diagnostic accuracy study. JMIR Serious Games, 9(4):e30919. DOI: 10.2196/30919.
Zhang, Z., Gao, L., Jin, G., Guo, L., Yao, Y., Dong, L., e Han, J. (2021). THAN: Task-driven hierarchical attention network for the diagnosis of mild cognitive impairment and Alzheimer’s disease. Quantitative Imaging in Medicine and Surgery, 11(7):3338–3354. DOI: 10.21037/qims-21-91.
Zygouris, S., Giakoumis, D., Votis, K., Doumpoulakis, S., Ntovas, K., Segkouli, S., Karagiannidis, C., Tzovaras, D., e Tsolaki, M. (2015). Can a virtual reality cognitive training application fulfill a dual role? using the virtual supermarket cognitive training application as a screening tool for mild cognitive impairment. Journal of Alzheimer’s Disease, 44(4):1333–1347. DOI: 10.3233/JAD-141260.
Publicado
29/09/2026
Como Citar
MENDES, Yunguer Dvorak; CLUA, Esteban W.; COSTA, Raquel Quimas Molina; POMPEU, José Eduardo; CAMPOS, Lucas Mannarino Santos de; MAGALHÃES, Juliana; PORCINO, Thiago; SILVA, Elizabeth Mendes da.
A Virtual Reality Serious Game for Cognitive Assessment in Mild Cognitive Impairment and Early Alzheimer’s Disease. In: SIMPÓSIO BRASILEIRO DE JOGOS E ENTRETENIMENTO DIGITAL (SBGAMES), 25. , 2026, Goiânia/GO.
Anais [...].
Porto Alegre: Sociedade Brasileira de Computação,
2026
.
p. 833-845.
DOI: https://doi.org/10.5753/sbgames.2026.25653.
