Feasibility and Usability of Mixed Reality Cognitive Training in Older Adults with and without Mild Cognitive Impairment

Background Mild Cognitive Impairment (MCI) represents an intermediate stage between normal aging and dementia. Although traditional cognitive training is widely used, it frequently suffers from low engagement and heterogeneous protocols. Mixed Reality (MR) offers a compelling alternative for neuro-rehabilitation by integrating virtual objects into the physical environment to maintain the user’s sense of presence and safety while improving engagement and intervention efficacy. However, the feasibility of MR exergames for individuals with cognitive decline remains underexplored. Objective This study aimed to compare the feasibility of using MR exergames between older adults with MCI and healthy older adults. Methods Forty-two participants (comprising 21 in the MCI group and 21 in the healthy group) were recruited and engaged in MR exergaming using the HoloLens 2® headset. The System Usability Scale (SUS), Intrinsic Motivation Inventory (IMI), and Cybersickness Questionnaire (CSQ) were used to assess usability, motivation, and adverse effects of technology adoption, respectively. Data were analyzed using the Mann-Whitney U Test to compare differences between groups. Results There were no significant differences between the MCI and healthy groups in SUS ( p  = 1.000), enjoyment ( p  = 0.939), perceived competence ( p  = 0.791), perceived choice ( p  = 0.422), tension ( p  = 0.657), and CSQ scores ( p  = 0.717). Conclusion The results support the feasibility of MR exergames for older adults with MCI. The similar user experience between groups suggests that MR technology may be an accessible and engaging tool for cognitive-motor training in this population. Further research should explore the long-term benefits of MR-based interventions in this demographic. Trial registration: The protocol was approved by the Mahidol University Central Institutional Review Board on May 3, 2024 (MU-CIRB 2024/114.0305) and was registered at ClinicalTrials.gov on February 19, 2025 (NCT 06843733).