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Pará T, Vidal de Carvalho LA, Mattos P, Dantas S, Gravier S, Johnston-Wilder S. Can the Clobber game become a classroom-based tool for screening students' executive functions? PROGRESS IN BRAIN RESEARCH 2023; 279:81-97. [PMID: 37661164 DOI: 10.1016/bs.pbr.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
The use of games for cognitive screening is not new and involves employing simple tasks as well as virtual reality. In this work, we introduce the use of the combinatorial game Clobber, created by the mathematicians Albert, Grossman, Nowakowski and Wolfe in 2001 in a classroom-based experiment and analyzed how it can assess cognitive functions. Specifically, this study tries to address how the use of the Clobber game can target executive functions (EFs) and why it may be a valuable game to assess EFs. Executive functions have an extremely complex nature and combine abilities which involve planning, decision-making, productive action, and self-regulation, among others. We performed a cross-sectional study with a sample of 111 participants aged 9-30 from three educational levels in which Clobber was applied in four different configurations varying in complexity. The findings identify two variables that can guide future experiments with Clobber: the game configuration and the time spent solving the game.
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Affiliation(s)
- Telma Pará
- Fundação de Apoio à Escola Técnica-FAETEC-RJ, Rio de Janeiro, Brazil.
| | | | - Paulo Mattos
- Fundação de Apoio à Escola Técnica-FAETEC-RJ, Rio de Janeiro, Brazil
| | - Simone Dantas
- Fundação de Apoio à Escola Técnica-FAETEC-RJ, Rio de Janeiro, Brazil
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Li Y, Pang J, Wang J, Wang W, Bo Q, Lei L, Wang X, Wang M. High-frequency rTMS over the left DLPFC improves the response inhibition control of young healthy participants: an ERP combined 1H-MRS study. Front Psychol 2023; 14:1144757. [PMID: 37275686 PMCID: PMC10233929 DOI: 10.3389/fpsyg.2023.1144757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/25/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Unlike the effect of repetitive transcranial magnetic stimulation (rTMS) in treating neuropsychiatric diseases, little is known about how personal factors might account for the disparity of results from studies of cognition and rTMS. In this study, we investigated the effects of high-frequency rTMS on response inhibition control and explored the time course changes in cognitive processing and brain metabolic mechanisms after rTMS using event-related potentials (ERPs) and magnetic resonance spectroscopy (1H-MRS). Methods Participants were all right-handed and were naive to rTMS and the Go/NoGo task. Twenty-five healthy young participants underwent one 10 Hz rTMS session per day in which stimulation was applied over the left dorsolateral prefrontal cortex (DLPFC), and a homogeneous participant group of 25 individuals received a sham rTMS treatment for 1 week. A Go/NoGo task was performed, an electroencephalogram (EEG) was recorded, and 1H-MRS was performed. Results The results revealed that there was a strong trend of decreasing commission errors of NoGo stimuli by high frequency rTMS over the left DLPFC, whereas there was no significant difference between before and after rTMS treatment with respect to these parameters in the sham rTMS group. High-frequency rTMS significantly increased the amplitude of NoGo-N2 but not Go-N2, Go-P3, or NoGo-P3. The myo-inositol /creatine complex (MI/Cr) ratio, indexing cerebral metabolism, in the left DLPFC was decreased in the rTMS treated group. Discussion This observation supports the view that high-frequency rTMS over the left DLPFC has the strong tendency of reducing commission errors behaviorally, increase the amplitude of NoGo-N2 and improve the response inhibition control of healthy young participants. The results are consistent with the excitatory properties of high frequency rTMS. We suggest that the increase in the NoGo-N2 amplitude may be related to the increased excitability of the DLPFC-anterior cingulate cortex (ACC) neural loop. Metabolic changes in the DLPFC may be a possible mechanism for the improvement of the response inhibition control of rTMS.
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Affiliation(s)
- Yanmin Li
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, Hebei, China
- Department of Neurology, Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang, Hebei, China
| | - Jianmin Pang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jing Wang
- Department of Respiratory Medicine, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Wei Wang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, Hebei, China
- Department of Neurology, Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang, Hebei, China
| | - Qianlan Bo
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, Hebei, China
- Department of Neurology, Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang, Hebei, China
| | - Licun Lei
- Department of Radiology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiayue Wang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, Hebei, China
- Department of Neurology, Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang, Hebei, China
| | - Mingwei Wang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, Hebei, China
- Department of Neurology, Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang, Hebei, China
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Hu YZ, Parimoo S, Chignell M, Lowe CJ, Morton JB. TAG-ME again: A serious game for measuring working memory. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-20. [PMID: 36881994 DOI: 10.1080/23279095.2023.2183361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BrainTagger (demo version: researcher-demo.braintagger.com) is a suite of Target Acquisition Games for Measurement and Evaluation (TAG-ME). Here we introduce TAG-ME Again, a serious game modeled after the well-established N-Back task, to assess working memory ability across three difficulty levels corresponding to 1-, 2-, and 3-back conditions. We also report on two experiments aimed at assessing convergent validity with the N-Back task. Experiment 1 examined correlations with N-Back task performance in a sample of adults (n = 31, 18-54 years old) across three measures: reaction time; accuracy; a combined RT/accuracy metric. Significant correlations between game and task were found, with the strongest relationship being for the most difficult version of the task (3-Back). In Experiment 2 (n = 66 university students, 18-22 years old), we minimized differences between the task and the game by equating stimulus-response mappings and spatial processing demands. Significant correlations were found between game and task for both the 2-Back and 3-Back levels. We conclude that TAG-ME Again is a gamified task that has convergent validity with the N-Back Task.
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Affiliation(s)
- You Zhi Hu
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Shireen Parimoo
- Department of Psychology, University of Toronto, Toronto, Canada
- Rotman Research Institute, Baycrest Centre, North York, Canada
| | - Mark Chignell
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Cassandra J Lowe
- Department of Psychology, University of Western Ontario, London, Canada
| | - J Bruce Morton
- Department of Psychology, University of Western Ontario, London, Canada
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Martínez-Pernía D, Olavarría L, Fernández-Manjón B, Cabello V, Henríquez F, Robert P, Alvarado L, Barría S, Antivilo A, Velasquez J, Cerda M, Farías G, Torralva T, Ibáñez A, Parra MA, Gilbert S, Slachevsky A. The limitations and challenges in the assessment of executive dysfunction associated with real-world functioning: The opportunity of serious games. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-17. [PMID: 36827177 PMCID: PMC11177293 DOI: 10.1080/23279095.2023.2174438] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Nowadays, there is a broad range of methods for detecting and evaluating executive dysfunction ranging from clinical interview to neuropsychological evaluation. Nevertheless, a critical issue of these assessments is the lack of correspondence of the neuropsychological test's results with real-world functioning. This paper proposes serious games as a new framework to improve the neuropsychological assessment of real-world functioning. We briefly discuss the contribution and limitations of current methods of evaluation of executive dysfunction (paper-and-pencil tests, naturalistic observation methods, and Information and Communications Technologies) to inform on daily life functioning. Then, we analyze what are the limitations of these methods to predict real-world performance: (1) A lack of appropriate instruments to investigate the complexity of real-world functioning, (2) the vast majority of neuropsychological tests assess well-structured tasks, and (3) measurement of behaviors are based on simplistic data collection and statistical analysis. This work shows how serious games offer an opportunity to develop more efficient tools to detect executive dysfunction in everyday life contexts. Serious games provide meaningful narrative stories and virtual or real environments that immerse the user in natural and social environments with social interactions. In those highly interactive game environments, the player needs to adapt his/her behavioral performance to novel and ill-structured tasks which are suited for collecting user interaction evidence. Serious games offer a novel opportunity to develop better tools to improve diagnosis of the executive dysfunction in everyday life contexts. However, more research is still needed to implement serious games in everyday clinical practice.
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Affiliation(s)
- David Martínez-Pernía
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Center (CMYN), Memory Unit - Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
| | - Loreto Olavarría
- Memory and Neuropsychiatric Center (CMYN), Memory Unit - Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - Victoria Cabello
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - Biomedical Science Institute, Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Fernando Henríquez
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Center (CMYN), Memory Unit - Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - Biomedical Science Institute, Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Laboratory for Cognitive and Evolutionary Neuroscience (LaNCE), Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Philippe Robert
- Cognition Behavior Technology (CoBTeK) Lab, FRIS-Université Côte d'Azur, Nice, France
| | - Luís Alvarado
- Departamento de Psiquiatría y Salud Mental Norte, Universidad de Chile, Santiago, Chile
| | - Silvia Barría
- Departamento de Ciencias Neurologicas Oriente, Facultad de Medicina, Universidad de Chile, and Servicio de Neurología, Hospital del Salvador, Santiago, Chile
| | - Andrés Antivilo
- Departamento de Ciencias Neurologicas Oriente, Facultad de Medicina, Universidad de Chile, and Servicio de Neurología, Hospital del Salvador, Santiago, Chile
| | - Juan Velasquez
- Facultad de Ciencias Físicas y Matemáticas, Web Intelligence Center, Universidad de Chile, Santiago, Chile
- Department of Industrial Engineering, Faculty of Physical and Mathematical Sciences, Instituto Sistemas Complejos de Ingeniería (ISCI), University of Chile, Santiago, Chile
| | - Mauricio Cerda
- Integrative Biology Program, Institute of Biomedical Sciences, and Center for Medical Informatics and Telemedicine, Faculty of Medicine, and Biomedical Neuroscience Institute, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Gonzalo Farías
- Department of Neurology North, Faculty of Medicine, University of Chile, Santiago, Chile
- Center for advanced clinical research (CICA), Hospital Clínico Universidad de Chile, Chile
| | - Teresa Torralva
- Institute of Cognitive and Translational Neuroscience (INCYT), Instituto de Neurología Cognitiva Foundation, Favaloro University, Buenos Aires, Argentina
| | - Agustín Ibáñez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
- Trinity College Dublin (TCD), Dublin, Ireland
| | - Mario A Parra
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Sam Gilbert
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Center (CMYN), Memory Unit - Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - Biomedical Science Institute, Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Neurology and Psychiatry, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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Wang P, Fang Y, Qi JY, Li HJ. FISHERMAN: A Serious Game for Executive Function Assessment of Older Adults. Assessment 2022:10731911221105648. [PMID: 35762827 DOI: 10.1177/10731911221105648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Executive functions (EFs) are essential for daily living activities but decline with age. Convenient assessment and timely intervention have particular significance for older adults. However, the traditional laboratory tasks of EFs are typically monotonous and inconvenient. The current study aimed to develop an interesting and convenient supplementary tool to assess EFs for older adults. According to the theory of EFs, we developed a serious game, FISHERMAN, to assess EFs. The game includes three subgames, Cautious Fisherman, Agile Fisherman, and Wise Fisherman, targeting core components of inhibition, shifting, and working memory, respectively. The current study aims to verify the reliability and validity of the game. One hundred and eight healthy older adults participated in this study and were tested through the FISHERMAN game and a battery of cognitive tests. The results show that the FISHERMAN game has high internal consistency reliability and good construct validity as well as criterion-related validity, suggesting that the game design is valid and can be used in EFs assessment for older adults. Future studies are warranted to establish the norm of the FISHERMAN game in older adults and investigate whether the FISHERMAN game can be generalized to other populations.
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Affiliation(s)
- Ping Wang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuan Fang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jing-Yi Qi
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Hui-Jie Li
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Wei HT, Hu YZ, Chignell M, Meltzer JA. Picture-Word Interference Effects Are Robust With Covert Retrieval, With and Without Gamification. Front Psychol 2022; 12:825020. [PMID: 35126268 PMCID: PMC8811038 DOI: 10.3389/fpsyg.2021.825020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
The picture-word interference (PWI) paradigm has been used to investigate the time course of processes involved in word retrieval, but is challenging to implement online due to dependence on measurements of vocal reaction time. We performed a series of four experiments to examine picture-word interference and facilitation effects in a form of covert picture naming, with and without gamification. A target picture was accompanied by an audio word distractor that was either unrelated, phonologically-related, associatively-related, or categorically-related to the picture. Participants were instructed to judge whether the name of the target picture ended in the phoneme assigned to the block by pressing corresponding keys as quickly and accurately as possible. Experiments 1 and 2 successfully replicated categorical interference and phonological facilitation effects at different optimal stimulus-onset-asynchronies (SOAs) between words and pictures. Experiment 3 demonstrated that a key gamification feature (collecting coins) motivated faster speed at the expense of accuracy in the gamified vs. experimental format of the task. Experiment 4 adopted the optimal SOAs and verified that the gamification reveals expected interference and facilitation effects despite the speed-accuracy tradeoff. These studies confirmed that categorical interference occurs earlier than phonological facilitation, while both processes are independent from articulation and inherent to word retrieval itself. The covert PWI paradigm and its gamification have methodological value for neuroimaging studies in which articulatory artifacts obscure word retrieval processes, and may be developed into potential online word-finding assessments that can reveal word retrieval difficulties with greater sensitivity.
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Affiliation(s)
- Hsi T. Wei
- Psychology Department, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Hospital, Toronto, ON, Canada
- *Correspondence: Hsi T. Wei
| | - You Zhi Hu
- Mechanical and Industrial Engineering Department, University of Toronto, Toronto, ON, Canada
| | - Mark Chignell
- Mechanical and Industrial Engineering Department, University of Toronto, Toronto, ON, Canada
| | - Jed A. Meltzer
- Psychology Department, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Hospital, Toronto, ON, Canada
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Wiley K, Robinson R, Mandryk RL. The Making and Evaluation of Digital Games Used for the Assessment of Attention: Systematic Review. JMIR Serious Games 2021; 9:e26449. [PMID: 34383674 PMCID: PMC8386381 DOI: 10.2196/26449] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/16/2021] [Accepted: 05/20/2021] [Indexed: 12/19/2022] Open
Abstract
Background Serious games are now widely used in many contexts, including psychological research and clinical use. One area of growing interest is that of cognitive assessment, which seeks to measure different cognitive functions such as memory, attention, and perception. Measuring these functions at both the population and individual levels can inform research and indicate health issues. Attention is an important function to assess, as an accurate measure of attention can help diagnose many common disorders, such as attention-deficit/hyperactivity disorder and dementia. However, using games to assess attention poses unique problems, as games inherently manipulate attention through elements such as sound effects, graphics, and rewards, and research on adding game elements to assessments (ie, gamification) has shown mixed results. The process for developing cognitive tasks is robust, with high psychometric standards that must be met before these tasks are used for assessment. Although games offer more diverse approaches for assessment, there is no standard for how they should be developed or evaluated. Objective To better understand the field and provide guidance to interdisciplinary researchers, we aim to answer the question: How are digital games used for the cognitive assessment of attention made and measured? Methods We searched several databases for papers that described a digital game used to assess attention that could be deployed remotely without specialized hardware. We used Rayyan, a systematic review software, to screen the records before conducting a systematic review. Results The initial database search returned 49,365 papers. Our screening process resulted in a total of 74 papers that used a digital game to measure cognitive functions related to attention. Across the studies in our review, we found three approaches to making assessment games: gamifying cognitive tasks, creating custom games based on theories of cognition, and exploring potential assessment properties of commercial games. With regard to measuring the assessment properties of these games (eg, how accurately they assess attention), we found three approaches: comparison to a traditional cognitive task, comparison to a clinical diagnosis, and comparison to knowledge of cognition; however, most studies in our review did not evaluate the game’s properties (eg, if participants enjoyed the game). Conclusions Our review provides an overview of how games used for the assessment of attention are developed and evaluated. We further identified three barriers to advancing the field: reliance on assumptions, lack of evaluation, and lack of integration and standardization. We then recommend the best practices to address these barriers. Our review can act as a resource to help guide the field toward more standardized approaches and rigorous evaluation required for the widespread adoption of assessment games.
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Affiliation(s)
- Katelyn Wiley
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Raquel Robinson
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Regan L Mandryk
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
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Evaluation of the Reaction Time and Accuracy Rate in Normal Subjects, MCI, and Dementia Using Serious Games. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11020628] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The main purpose of this research is to evaluate the differences in the reaction time and accuracy rate of three categories of subjects using our serious games. Thirty-seven subjects were divided into three groups: normal (n1 = 16), MCI (Mild Cognitive Impairment) (n2 = 10), and dementia—moderate-to-severe (n3 = 11) groups based on the MMSE (Mini Mental State Examination). Two serious games were designed: (1) whack-a-mole and (2) hit-the-ball. Two dependent variables, reaction time and accuracy rate, were statistically analyzed to compare elders’ performances in the games among the three groups for three levels of speed: slow, medium, and fast. There were significance differences between the normal group, the MCI group, and the moderate-to-severe dementia group in both the reaction-time and accuracy-rate analyses. We determined that the reaction times of the MCI and dementia groups were shorter compared to those of the normal group, with poorer results also observed in accuracy rate. Therefore, we conclude that our serious games have the feasibility to evaluate reaction performance and could be used in the daily lives of elders followed by clinical treatment in the future.
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Simoncini C, Spadoni G, Lai E, Santoni L, Angelini C, Ricci G, Siciliano G. Central Nervous System Involvement as Outcome Measure for Clinical Trials Efficacy in Myotonic Dystrophy Type 1. Front Neurol 2020; 11:624. [PMID: 33117249 PMCID: PMC7575726 DOI: 10.3389/fneur.2020.00624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/28/2020] [Indexed: 01/18/2023] Open
Abstract
Increasing evidences indicate that in Myotonic Dystrophy type 1 (DM1 or Steinert disease), an autosomal dominant multisystem disorder caused by a (CTG)n expansion in DMPK gene on chromosome 19q13. 3, is the most common form of inherited muscular dystrophy in adult patients with a global prevalence of 1/8000, and involvement of the central nervous system can be included within the core clinical manifestations of the disease. Variable in its severity and progression rate over time, likely due to the underlying causative molecular mechanisms; this component of the clinical picture presents with high heterogeneity involving cognitive and behavioral alterations, but also sensory-motor neural integration, and in any case, significantly contributing to the disease burden projected to either specific functional neuropsychological domains or quality of life as a whole. Principle manifestations include alterations of the frontal lobe function, which is more prominent in patients with an early onset, such as in congenital and childhood onset forms, here associated with severe intellectual disabilities, speech and language delay and reduced IQ-values, while in adult onset DM1 cognitive and neuropsychological findings are usually not so severe. Different methods to assess central nervous system involvement in DM1 have then recently been developed, these ranging from more classical psychometric and cognitive functional instruments to sophisticated psycophysic, neurophysiologic and especially computerized neuroimaging techniques, in order to better characterize this disease component, at the same time underlining the opportunity to consider it a suitable marker on which measuring putative effectiveness of therapeutic interventions. This is the reason why, as outlined in the conclusive section of this review, the Authors are lead to wonder, perhaps in a provocative and even paradoxical way to arise the question, whether or not the myologist, by now the popular figure in charge to care of a patient with the DM1, needs to remain himself a neurologist to better appreciate, evaluate and speculate on this important aspect of Steinert disease.
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Affiliation(s)
- Costanza Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Spadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Lai
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenza Santoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Giulia Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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