Evaluating the User Experience and Usability of Game-Based Cognitive Assessments for Older People: Systematic Review

Background: Game-based cognitive assessments (GBCAs) have the potential to transform the field of cognitive testing by enabling more effective screening of age-related cognitive decline. However, we lack a strong understanding of the usability and overall user experience of these games. This is a risk because the primary target users for GBCAs, older people, are seldom involved in game design research and development. Objective: This study aims to address this gap by investigating the usability, acceptability, and enjoyability of GBCAs for older people. Methods: This study followed established practices for undertaking evidence-based systematic reviews. Results: The initial database search returned 15,232 records. After a thorough screening process, 8 studies remained for extraction and analysis. A synthesis of the included papers identified 2 overlapping yet distinct areas of focus: system usability and subjective user experience. Usability scores were mostly positive across the studies included. However, in several of the game studies, older adults and those with cognitive impairment tended to find GBCAs less usable. This trend was observed even when the games were explicitly designed for these populations, and the tasks were simplistic and representative of basic daily activities. In our second focus area, user experience, we identified the importance of perceived challenge in mediating gameplay experience across groups. That is, generating the appropriate level of difficulty for each user is important for positive user experiences, specifically enjoyment. Conclusions:On the basis of these findings, we identified key learnings for researchers interested in designing and developing GBCAs. These include (1) recognizing that validity is essential but not sufficient on its own; (2) clearly defining the intended user; (3) designing games that align with the unique preferences and needs of older people; and (4), whenever possible, providing each user with their optimal level of challenge. Trial Registration: PROSPERO CRD42023433298; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023433298 (JMIRAging2025;8:e65252) doi: 10.2196/65252