VR Trail Making Test discriminates mild cognitive impairment

In a case–control preprint, 84 adults aged 60 to 89 years—42 with clinically diagnosed mild cognitive impairment and 42 healthy controls—completed paper and immersive virtual reality versions of the Trail Making Test alongside the Mini-Addenbrooke’s Cognitive Examination. The virtual reality test tracked head gaze to record completion times and errors automatically. All participants completed both virtual reality test parts, and cybersickness ratings decreased over the session. Participants with mild cognitive impairment were slower and committed more wrong-target selections on Part B of the virtual reality test than healthy controls. While the paper version held an advantage for Part A completion time, virtual reality Part B and error-based scores separated participants with impairment more effectively than the paper test. Still, the Mini-Addenbrooke’s Cognitive Examination discriminated impairment more accurately than any single trail-making score.