## 4 Discussion  
According to the results presented in this study, the evaluation of usability revealed notable results among patients, particularly in the home study. Patient responses indicated favorable outcomes in terms of user satisfaction and learning simplicity. With respect to usability, while higher values were observed, no statistically significant differences were found in the overall SUS scores between 6 weeks and baseline. However, in the home setting, these differences were statistically significant, indicating a better SUS score at 6 weeks than at baseline. Additionally, professionals reported high SUS scores. High adherence was observed overall, with participants exceeding the mandatory number of weeks, especially among those in the home setting compared with those in the clinical setting. In addition, some participants, all from the home study group, surpassed the prescribed frequency of sessions. However, it is noteworthy that the percentage of completed weeks was lower in the home setting than in the clinical setting. One potential explanation could be the lack of immediate professional assistance when issues arose or differences in motivation levels. Nonetheless, the total number of training hours was greater among the participants in the home study. Observational grid assessments demonstrated a high success rate for tasks, although an increase in errors was noted during the home study. In the case of the professionals, they provided positive feedback on the use of the device, while patients also reported heightened satisfaction levels and a positive inclination toward adopting COGNIVITRA. With respect to effectiveness, a noninferiority significant change toward improving patient quality of life, ambulation, and cognitive improvement was reported. In fact, the values obtained at the 6-week time point indicate that patients perceived themselves to be in general good health (according to EQ-5D-5L values) [20], to have good mobility with some difficulties but still relatively functional (according to the T25-FW scores) [21], and as having mild cognitive impairment (according to the MoCA scores) [22]. The slight improvement in most values or the maintenance of the patient's situation for some scores remains a strength of the obtained results. Although there was a nonsignificant increase in satisfaction after 6 and 12 weeks of training, satisfaction seemed to be more pronounced in the home setting than in the clinical setting. Importantly, most participants reported a positive experience with COGNIVITRA, with many noting an overall improvement in their subjective perception of general health, as evidenced by the EQ-VAS scores. This satisfaction with the device was translated as 75.0% of patients and caregivers being willing to pay either a monthly/per use fee or purchase the product. Figure 9: Time spent performing the cognitive and physical exercises (**A**) and patient/professional ratios (**B**) among the total sample and patients from both the home study and the clinical setting study. The improvement or maintenance of patients' cognitive status and user engagement with these types of devices among patients with MCI has already been described in similar studies. A pilot study comprising 49 participants, 20 with MCI and 29 healthy participants, investigated SmartWalk [23], a novel tool that combines aerobic exercise and cognitive protocols to stimulate cognitive function through the use of foot inertial sensing and a test for the auditory sustained attention domain to detect the user's gait and performance on cognitive tasks that are synchronized with the user's walking pace. The results showed that the tool was effective in improving cognitive function in both groups, particularly in the areas of sustained attention and vigilance. In our study, longer training periods were needed to assess the effectiveness of COGNIVITRA thoroughly.