Scenario-Based Serious Game for Screening Mild Cognitive Impairment in Older Adults: Cross-Sectional Preliminary Validation Study.

Background: 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. Objective: This study aimed to develop and preliminarily evaluate a tablet-based, scenario-based serious game for community-based MCI screening among Korean older adults. Methods: 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. Results: The group with MCI was older (77.3 vs 74.5 y; Conclusions: 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.