## 1 Introduction
### Limitations of Traditional Cognitive Assessment Tools  
Traditional neuropsychological assessments, such as the Stroop Test and Trail Making Test (TMT), are typically administered through paper-and-pencil or computer-based formats. The Trail Making Test (TMT), in particular, is a widely used neuropsychological tool that assesses cognitive functions like visual attention, task switching, and cognitive flexibility. It consists of two parts as follows: TMT-A, which requires connecting a series of numbered circles in ascending order, measuring sequencing and processing speed, and TMT-B, which requires alternating between numbers and letters, providing a measure of more complex cognitive processes such as mental flexibility and executive functioning [14]. However, these methods often fail to capture the complexity of real-world environments, lacking the distractions and stressors that individuals encounter in daily life. This limitation diminishes the ecological validity of these assessments, meaning they may not fully reflect an individual's cognitive abilities in everyday settings [15]. In contrast, VR tools excel at integrating dynamic perceptual stimuli with realistic scenarios within controlled laboratory settings, thereby significantly enhancing ecological validity [1; 2].  
Another significant drawback of traditional assessments is their reliance on the presence of a healthcare professional and their typical use only after cognitive impairments have been identified, potentially hindering early intervention [15]. Moreover, these kinds of assessments often cannot provide real-time feedback or continuous monitoring, making them ineffective in assessing cognitive changes over a period of time or in comparing the effectiveness of current interventions [16]. VR-based tools, however, can simulate real-world conditions while retaining the controlled aspects of traditional methods. This capability not only facilitates earlier and potentially remote or self-administered evaluations but also broadens access to neuropsychological assessments, thus promoting early intervention and more personalized care [2; 17].  
One of VR's most notable advantages in neuropsychological assessments is its ability to reduce human error in both test administration and result calculation. Traditional assessments, often perceived as monotonous and repetitive, can suffer from data quality issues due to participant disengagement. VR offers a more immersive and engaging alternative, which can enhance user participation and data accuracy [10; 15]. Furthermore, compared to traditional neuropsychological tools, VR assessments can better discriminate between different levels of cognitive impairment (such as mild cognitive impairment) due to improved sensitivity and specificity [18]. Moreover, VR tools allow for the collection of diverse data types during assessments, including eye and physical movements and facial expressions [11; 15; 19]. This multidimensional data collection enables a more holistic evaluation, potentially revealing cognitive aspects that traditional methods may overlook. Additionally, VR technology exhibits potential for real-time adaptation to the user's performance, providing a dynamic assessment environment [20], providing millisecond-level precision in performance recording, and enabling the calculation of detailed performance metrics, such as means and standard deviations, ensuring high precision and reliability in cognitive assessments [11; 21].