Design and Implementation of Game-Based Cognitive Screening Instruments for Older Adults

Abstract

Dementia is a neuropsychological disorder that has physical, psychological, social, and economic impact on the individual, their families and society in general. Still, it is underdiagnosed worldwide. With nearly 10 million new cases every year, according to the WHO, there is an urgent need to develop assistive technologies to the dementia care context. Dementia is characterized by a decline in one or more cognitive domains and the early detection of cognitive changes and possible underlying dementia is possible with the use of Cognitive Screening Instruments. Traditionally, these instruments are pen‐and‐paper‐based, but recent studies have investigated the use of video games as an alternative to the traditional method. Most previous studies have followed an exploratory approach and used existing games, bespoke games, or activities‐of‐daily‐living games to investigate the correlation between performance on validated tests and performance on the game. While those studies have proven that data collected during gameplay correlate with cognitive performance, there still exists plenty of opportunities to explore new designs that improve the experience of the older adult undertaking the cognitive assessment, but most importantly, incorporate the same criteria of traditional Cognitive Screening Instruments. This research work focused on the design and implementation of CogWorldTravel, a serious game for the cognitive screening of older adults that features six mini‐games targeting at least one element of each major cognitive domain. A literature review on the use of games for such purpose is performed and the design, implementation, and evaluation processes of CogWorldTravel are described. A pilot study was conducted with older adults to verify that they would be able to play the game. In addition, semi‐structured interviews with experts in assessing dementia were performed, who confirmed that CogWorldTravel is paving the way towards an alternative cognitive screening instrument. The lessons learnt from both studies are integrated and a series of design recommendations is captured for improvement in future iterations. New mini‐games can be added to test additional cognitive elements not included in this first version. It is expected that the use of game‐based Cognitive Screening Instruments will contribute to the global dementia underdiagnoses issue. By being a self‐administrated instrument, it reduces the time required from the healthcare professional. It also offers the opportunity to include several cognitive elements, which is helpful for clinicians in differentiating diagnosis. Finally, the introduction of game elements may improve the experience of people being tested and hopefully alleviate the anxiety experienced during cognitive screening.