{
  "abstract": "Background: Immersive virtual reality (VR) adaptations of neuropsychological tests change how participants respond and must be validated in each clinical population. We evaluated the Trail Making Test in Virtual Reality (TMT-VR), a head-gaze version of the paper-and-pencil Trail Making Test (hereafter, TMT) that records completion times and wrong-target selections automatically, in older adults with and without mild cognitive impairment (MCI). Methods: In this case–control evaluation, 84 adults aged 60–89 years (42 with clinically diagnosed MCI, 42 healthy comparison participants) completed the TMT-VR, the TMT and the Mini-Addenbrooke’s Cognitive Examination (M-ACE), with pre- and post-exposure cybersickness ratings. Planned analyses examined feasibility, convergence, group differences and diagnostic accuracy for all 26 TMT-VR scores against their TMT counterparts and the M-ACE, with demographic adjustment, multiplicity correction, bootstrap validation and education-matched sensitivity analysis. Results: All participants completed both TMT-VR parts, and cybersickness ratings decreased over the session. Part B completion times correlated positively across formats within both groups. Participants with MCI were slower and made more wrong-target selections on TMT-VR Part B but not Part A. Score for score, the TMT-VR matched the TMT on Part B completion time and discriminated MCI more effectively on the Part B, total and B−A error scores and every Part B-specific derived score; these effects persisted after demographic adjustment and widened in the education-matched subsample. The TMT's advantage lay in Part A completion time, and its error scores carried little discriminatory information. With education equalised, the TMT-VR B−A scores gave balanced operating characteristics and approached the M-ACE, which every TMT score remained below. The M-ACE discriminated more accurately than any single trail-making score of either format. Conclusions: The TMT-VR is a feasible, well-tolerated adaptation with convergent validity against the TMT and known-groups validity for MCI. Because it discriminated MCI more effectively on the Part B-specific and error-based scores that carry the test's executive demand, it emerges as the preferable Trail Making Test format within neuropsychological batteries for MCI; whether it adds diagnostic information beyond global screens such as the M-ACE must be established in consecutive clinical referrals, together with age- and education-stratified normative cut-offs.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "name": "Panagiotis Kourtesis"
    },
    {
      "name": "Antonia Ioakeimidou"
    },
    {
      "name": "Myrto Dimakopoulou"
    },
    {
      "name": "Christina Anastasopoulou"
    },
    {
      "name": "Maria Roussou"
    },
    {
      "name": "Petros Roussos"
    },
    {
      "name": "Chrysanthi Nega"
    },
    {
      "name": "Ion Beratis"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8vt132wfxxfnv.bib",
  "cited_by": 0,
  "doi": "10.31234/osf.io/wqx32_v1",
  "fulltext_url": null,
  "id": "8vt132wfxxfnv",
  "issns": [],
  "landing_url": "https://osf.io/preprints/psyarxiv/wqx32_v1/",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "bepress",
      "Aging"
    ],
    [
      "bepress",
      "Assessment"
    ],
    [
      "bepress",
      "Attention"
    ],
    [
      "bepress",
      "Clinical Decision Making"
    ],
    [
      "bepress",
      "Clinical Neuroscience"
    ],
    [
      "bepress",
      "Clinical Psychology"
    ],
    [
      "bepress",
      "Cognitive Neuroscience"
    ],
    [
      "bepress",
      "Cognitive Psychology"
    ],
    [
      "bepress",
      "Developmental Psychology"
    ],
    [
      "bepress",
      "Diagnosis"
    ],
    [
      "bepress",
      "Engineering Psychology"
    ],
    [
      "bepress",
      "Memory"
    ],
    [
      "bepress",
      "Neurocognitive Disorders"
    ],
    [
      "bepress",
      "Neuroscience"
    ],
    [
      "bepress",
      "Old Age"
    ],
    [
      "bepress",
      "Social and Behavioral Sciences"
    ],
    [
      "openalex",
      "2738|Dementia and Cognitive Impairment Research"
    ]
  ],
  "openalex": "W7214536317",
  "pdf_url": "https://osf.io/wqx32/download",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-27",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/8vt132wfxxfnv.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:23:17Z",
      "native_id": "wqx32",
      "source": "osf",
      "url": "https://osf.io/preprints/psyarxiv/wqx32_v1/"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "bepress:Cognitive Neuroscience",
      "subfield": "neuroscience"
    },
    {
      "field": "medicine",
      "origin": "bepress:Clinical Psychology",
      "subfield": "psychiatry"
    }
  ],
  "title": "Validity, Diagnostic Accuracy, and Feasibility of Trail Making Test in Virtual Reality for Mild Cognitive Impairment",
  "title_text": "Validity, Diagnostic Accuracy, and Feasibility of Trail Making Test in Virtual Reality for Mild Cognitive Impairment",
  "type": "preprint",
  "updated_at": "2026-10-30T12:23:17Z",
  "url": "https://research.draconitic.com/paper/8vt132wfxxfnv",
  "venue": "PsyArXiv",
  "versions": []
}