Navigation performance in virtual reality–based cognitive assessment games as a candidate digital cognitive marker of hippocampal vulnerability: a scoping review

Abstract

Virtual reality–based cognitive assessment games (VR‐CAGs) are an emerging digital paradigm in dementia and Alzheimer's disease research. Although multiple studies report correlations between VR‐CAG performance and standard neuropsychological assessments, clinical adoption remains limited, indicating that behavioral evidence alone is insufficient and that consolidated neuroimaging evidence is required. Existing neuroimaging studies link VR‐CAG performance to regional brain activation, volumetric change, and brainwave dynamics, but this evidence remains scattered. We conducted a scoping review of 29 neuroimaging studies on VR‐CAGs. Three functional neural systems were associated with VR‐CAG performance: the spatial map system, the response system, and the executive control system. Two VR‐CAG archetypes – hippocampal‐based and adaptive navigation – were identified. A reporting and evaluation checklist is proposed to standardize VR‐CAG research. Review findings indicate that VR‐CAGs based on allocentric and egocentric tasks may be sensitive to hippocampal health, potentially acting as candidate digital markers of dementia‐relevant functional cognitive decline.