Touchscreen games to detect cognitive impairment in senior adults. A user-interaction pilot study.

INTRODUCTION: Alzheimer's disease is a degenerative brain disease and the most common cause of dementia. Today, 47 million people live with dementia worldwide. This number is projected to increase to more than 131 million by 2050, as populations age. Therefore, the World Health Organization considers serious cognitive deterioration a public health priority. OBJECTIVES: Advanced cognitive evaluation mechanisms are needed to help make an early diagnosis. These new mechanisms should overcome the limitations of current neuropsychological tests, including delayed detection; being perceived as intrusive; being non-ecological; being dependent on confounding factors; or their administration being expensive, among others. A promising novel approach consists of the introduction of serious games based on virtual reality and machine learning able to assess cognitive traits relevant to the diagnosis of mild cognitive impairment and Alzheimer's disease. METHODS: As a result of a preliminary pilot experiment, promising evidence was obtained about the predictive power of this solution. However, for these new serious games to be effective, evidence has to be gathered on the player experience by senior adults, avoiding the limitations of traditional tests at the same time. This study addresses these aspects with the participation of 74 senior users and 15 test administrators. RESULTS: Main findings confirm the usability and playability of Panoramix, a game battery designed according to the principles discussed above, its technological acceptability and its accessibility. For example, in relation to acceptability, the game battery was scored 4.39 in a 5-point scale, while its average usability score was 4.45 regardless of socio-cultural level or previous experience with digital technologies. In addition, health professionals confirm both, usability and playability, levels with an average score of 6.5 in a 7-point scale. Participants' willingness of using this kind of systems for cognitive evaluation was also confirmed. CONCLUSION: Promising results obtained pave the way for additional work to confirm the diagnostic validity according to clinical standards of these new cognitive assessment tools.

Learning to Detect Cognitive Impairment through Digital Games and Machine Learning Techniques.

OBJECTIVE: Alzheimer's disease (AD) is one of the most prevalent diseases among the adult population. The early detection of Mild Cognitive Impairment (MCI), which may trigger AD, is essential to slow down the cognitive decline process. METHODS: This paper presents a suit of serious games that aims at detecting AD and MCI overcoming the limitations of traditional tests, as they are time-consuming, affected by confounding factors that distort the result and usually administered when symptoms are evident and it is too late for preventive measures. The battery, named Panoramix, assesses the main early cognitive markers (i.e., memory, executive functions, attention and gnosias). Regarding its validation, it has been tested with a cohort study of 16 seniors, including AD, MCI and healthy individuals. RESULTS: This first pilot study offered initial evidence about psychometric validity, and more specifically about construct, criterion and external validity. After an analysis using machine learning techniques, findings show a promising 100% rate of success in classification abilities using a subset of three games in the battery. Thus, results are encouraging as all healthy subjects were correctly discriminated from those already suffering AD or MCI. CONCLUSIONS: The solid potential of digital serious games and machine learning for the early detection of dementia processes is demonstrated. Such a promising performance encourages further research to eventually introduce this technique for the clinical diagnosis of cognitive impairment.

The acceptability of TV-based game platforms as an instrument to support the cognitive evaluation of senior adults at home.

INTRODUCTION: The computing capabilities of state-of-the-art television sets and media centres may facilitate the introduction of computer-assisted evaluation at home. This approach would help to overcome the drawbacks of traditional pen-and-paper evaluations administered in clinical facilities, as they could be performed in a more comfortable environment, the subject's home, and they would be more flexible for designing complex environments for the evaluation of neuropsychological constructs that are difficult to assess through traditional testing. The objective of this work was to obtain some initial evidence about the technical acceptance by senior adults of serious games played at home on the TV set and therefore about the convenience of further investigating such an approach to cognitive assesment. MATERIALS AND METHODS: We developed a collection of games to be deployed on a TV environment. These games were tried by a group of senior adults at their homes. The Technology Acceptance Model (TAM) was used to validate this approach. Surveys were performed to study the perceived usefulness and perceived ease of use of such technical setting as an instrument for their cognitive evaluation; that is, its technical acceptance. Subjective information collected from participants was correlated with actual interaction data captured. An additional survey was performed 36 months after pilot testing to have an indication about the long-term perceptions about usefulness and ease of use. RESULTS: More than 90% of participating subjects perceived cognitive games on TV as useful or very useful. The majority of participants selected the TV set as their preferred option to interact with serious games at home, when compared to other devices such as smartphones, tablets or PCs. This result correlates with the number of participants perceiving them as easily usable or very easy to use, and also with automatically captured interaction data. Three out of four seniors expressed their interest in keeping the system at home after the pilot. Besides, these perceptions are fairly stable in time as shown by the survey performed 36 months after pilot testing. LIMITATIONS: Although participating users are a representative sample of the Galician population, which in turn is comparable to the population of most rural areas in Europe, a larger and more diverse user sample would be needed to obtain significant results for a wider population profile. CONCLUSION: The study confirmed the technical acceptance, that is, the perceived usefulness and perceived ease of use, of the TV-based home technical setting introduced as a means of cognitive evaluation. This study provides initial evidence on the viability of a TV-based serious games approach for cognitive longitudinal screening at home with little intervention of clinical professionals, thus contributing to the early detection of cognitive impairments in the senior population.