Assessment of cognitive function in patients with schizophrenia based on virtual reality serious games: a prospective nonrandomized clinical trial

Introduction Conventional neuropsychological tests for assessing cognitive function in schizophrenia face critical limitations in ecological validity and efficiency. We developed Fruit Pioneer , a virtual reality serious game simulating real-world cognitive demands, to address these challenges. This study aimed to validate its diagnostic validity in differentiating cognitive impairments between schizophrenia patients (SZs) and healthy controls (HCs), while evaluating user experience feasibility. Methods In this cross-sectional study, 107 participants (43 SZs, 64 HCs) underwent cognitive evaluation using the Brief Cognitive Assessment Tool for Schizophrenia (B-CATS) and Fruit Pioneer . Diagnostic validity was analyzed via receiver operating characteristic (ROC) curves and Spearman correlations. User experience was quantified using the Game Experience Questionnaire Core Module (GEQ-Core) and Simulator Sickness Questionnaire (SSQ). Results SZs exhibited significantly poorer performance on B-CATS compared to HCs (all subtests p < 0.05). Among 16 Fruit Pioneer performance indicators, 13 demonstrated strong discriminative power (AUC > 0.7). The Total Game Score (TGS) achieved high accuracy (AUC = 0.911, sensitivity = 83.72%, specificity = 89.06%). Directionally consistent correlations were observed between game indicators and B-CATS scores (e.g., TGS vs. Digit Symbol Substitution Test: r = 0.66, p < 0.01). Participants reported high immersion (GEQ-Core immersion: 2.45/4) and minimal simulator sickness (SSQ total: 5.12/48). Conclusion Fruit Pioneer provides a time-efficient (5-minute), ecologically valid tool for cognitive assessment in schizophrenia, demonstrating strong discriminative validity and user acceptability. Further validation should explore its clinical utility in broader populations and the association between its performance and functional outcomes.