We would like to share our insights in designing, preparing, preforming, and analyzing usability tests for multiple connected augmented reality and virtual reality applications as well as traditional mobile applications developed for a multimodal screening tool. This screening tool is under development at the University of Applied Sciences FH JOANNEUM in Graz, Austria. Several researchers from the departments of health studies and applied computer sciences are working closely together to establish a tool for early diagnosis of cognitive impairments to contribute to the management of dementia. The usability of this screening tool was evaluated by ten therapists paired with ten clients as testing group 1 and two usability experts in a separate test (group 2). In this chapter, we would like to describe why we use observed summative evaluation using the co-discovery method followed by post-task questionnaires for the first testing group. We are going to discuss the reasons for performing the cognitive walkthrough method as co-discovery with usability experts of testing group two as well. Furthermore, we describe how we use camera recordings (traditional cameras, 360-degree cameras), screen recording, and special tailor-made software to experience the screening process through the user’s eyes.

Background The early diagnosis of cognitive impairments is an important step in the adequate management of dementia. The project “Smart Cognition & Behaviour Screening powered by Augmented Reality” (SCOBES-AR) aims to develop a multimodal screening tool (MST) for the early detection of cognitive impairments using augmented and virtual reality. The first project phase selected validated assessments for combination with the MST and tested it in 300 healthy older adults. Objective This study established a protocol for the implementation and usability of a mixed reality (MR)–enhanced multidisciplinary screening tool for the early detection of cognitive impairments in older adults. The developed MST will be partially enhanced by MR, which is a combination of augmented reality (AR) and virtual reality (VR). This MR-enhanced prototype of the screening tool (MR-MST) will be tested and compared to the previously developed MST. The usability of the prototype will also be examined. Methods This single-center observational crossover design study screens 100 healthy participants (aged 60-75 years) for cognitive decline using a specially developed MST (assessment of cognitive functions, olfactory sensitivity, nutritional preferences, gait parameters, reaction times, and activities of daily living) and an MR-enhanced MST in which the assessments of cognitive functions, reaction time, activities of daily living, and gait will be performed using tailor-made software and AR and VR hardware. The results of the MR-enhanced MST will be compared to those without MR. The usability of the developed MR-enhanced MST will be tested on 10 investigators and 10 test participants using observed summative evaluation and the codiscovery method, and on 2 usability experts using the codiscovery and cognitive walkthrough methods. Results This study was funded by the Austrian Research Promotion Agency (grant 866873) and received approval from the ethics committee of the Medical University of Graz. The MR-MST and the experimental protocol for this study were developed. All participants gave written informed consent. As of July 15, 2022, a total of 70 participants have been screened. Data analysis and dissemination are scheduled for completion by September 2023. Conclusions The development and testing of the MR-MST is an important step toward the establishment of the best practice procedure for the implementation of AR and VR in the screening of cognitive declines in older adults. It will help improve our knowledge of the usability and applicability of the developed prototype and promote further advancement in AR and VR technologies to be used in therapeutic settings. International Registered Report Identifier (IRRID) DERR1-10.2196/39513

BACKGROUND Early diagnosis of cognitive impairments is an important step in the adequate management of dementia. The project “Smart Cognition & Behavior Screening powered by Augmented Reality” (SCOBES AR) aims to develop a multimodal screening tool (MST) for early detection of cognitive impairments using augmented and virtual reality. In the first project phase validated assessments were selected, combined in MST and tested in 174 healthy elderly adults. In the present project phase, the developed MST will be partly enhanced by mixed reality (MR), a combination of augmented reality (AR) and virtual reality (VR). This MR-enhanced prototype of screening tool (MR-MST) will be tested and compared to the previously developed MST. In addition, the usability of this enhanced prototype will be examined. OBJECTIVE To establish a protocol for implementation and usability of MR-enhanced multidisciplinary screening tool for early detection of cognitive impairments in the elderly. METHODS In this cross-over design study protocol 100 healthy participants (aged 60-75 years) will be screened for cognitive declines using: i) specially developed MST (assessment of cognitive functions, olfactory sensitivity, nutritional preferences, gait parameters, reaction times, activities of daily living, and ii) MR-enhanced MST in which the assessments of cognitive functions, reaction time, activities of daily living and gait are performed using tailor made software and AR- and VR hardware. The results of the MR-enhanced MST will be compared with those without MR. The usability of the developed MR-enhanced MST will be tested on 10 investigators and 10 test participants using observed summative evaluation and the co-discovery method and on 2 usability experts using the co-discovery and the cognitive walkthrough method. RESULTS This study was funded by the Austrian Research Promotion Agency, grant number 866873 and received Ethic Vote from the Ethic committee of the Medical University of Graz. The MR-MST prototype and the study protocol for the present study were developed. As of May 09, 2022, 15 participants have been screened. To date, no results are available for this study protocol. CONCLUSIONS The development of the MR-MST prototype enables identifying best practise procedure for evaluating cognitive declines in the elderly using multimodal and AR/VR-enhanced screenings.