Exploring Older Adults' Video Game Use in the PRISM Computer System

Effects of player-video game interaction on the mental effort of older adults with the use of electroencephalography and NASA-TLX

While player-video game interaction appears to affect older adults in gaming, there is limited knowledge regarding the cognitive demands associated with the anticipation of performing a button press, specifically focusing on the input and game elements relation (I/E relation) in game environments. The study aims to investigate the effects of lateral and rotational displacement amplitudes of game elements, triggered by a single button-press, on the cognitive effort of older adults. Both subjective and objective measurement methods were employed to assess these effects. A total of 48 older adults participated in three casual video game tasks encompassing lateral and rotational displacements at varying I/E relations (low, medium, and high). Results obtained from the NASA Task Load Index and electroencephalography (EEG) measurements revealed significant differences between the I/E relations. Specifically, the subjective rating of cognitive demand among older players was significantly impacted by a small rotation angle associated with a button press, leading to increased mental, physical, and temporal demands, along with decreased performance. Surprisingly, the analysis of EEG data, particularly the theta-alpha ratio, revealed significant interaction effects of I/E relations, button press type, and game type on the cognitive demand required during gameplay. These findings offer practical implications and point towards future avenues for developing player-video game interactions that are more cognitively friendly for older players in gaming environments.

Associations between Sedentary Duration and Cognitive Function in Older Adults: A Longitudinal Study with 2-Year Follow-Up

OBJECTIVES

This study aimed to investigate the association between different forms of sedentary behavior and cognitive function in Chinese community-dwelling older adults.

DESIGN

A longitudinal study with a 2-year follow-up.

SETTING AND PARTICIPANTS

Data from 5356 participants at baseline and 956 participants at the follow-up of the Anhui Healthy Longevity Survey (AHLS) were analysed.

MEASUREMENTS

Cognitive function was evaluated by the Mini-Mental State Examination (MMSE), and mild cognitive impairment (MCI) was classified according to education-specific criteria. Self-report questionnaires were used to assess the sedentary behavior of the participants.

RESULTS

The participants who reported longer screen-watching sedentary duration had higher MMSE scores (1-2 hours: β=0.758, 95% CI: 0.450, 1.066; > 2 hours: β=1.240, 95% CI: 0.917, 1.562) and lower likelihoods of MCI (1-2 hours: OR= 0.787, 95% CI: 0.677, 0.914; >2 hours: OR=0.617, 95% CI: 0.524, 0.726). The participants who had played cards (or mahjong) sedentary had higher MMSE scores (β= 1.132, 95% CI: 0.788, 1.476) and lower likelihoods of MCI (OR=0.572, 95% CI: 0.476, 0.687). However, the participants who reported longer other forms of sedentary duration had lower MMSE scores (1-2 hours: β=-0.409, 95% CI: -0.735, -0.082; > 2 hours: β=-1.391, 95% CI: -1.696, -1.087) and higher likelihoods of MCI (1-2 hours: OR=1.271, 95% CI: 1.081, 1.496; > 2 hours: OR=1.632, 95% CI: 1.409, 1.889). No significant association was detected between sedentary duration and MCI incidence.

CONCLUSION

Variations in the impact of diverse sedentary behaviors on the cognitive function were detected in Chinese older adults. However, such associations were cross-sectional and longitudinal associations were not found in the current study.

Does Computer Use Improve Older Adults' Cognitive Functioning? Evidence From the Personal Reminder Information and Social Management Trial

BACKGROUND AND OBJECTIVES

Numerous longitudinal studies suggest that technology use in late adulthood is associated with cognitive benefits. Using data from a randomized controlled trial, the current study examined whether computer use improves cognition in older adults with little to no previous computer experience.

RESEARCH DESIGN AND METHODS

This study used data from the Personal Reminder Information and Social Management (PRISM) trial. Community-dwelling older adults with little previous computer experience (MAge = 76.15) were randomly assigned to learn and use a computer (the PRISM system, n = 150) or interact with parallel content delivered in a nondigital format (paper binder, n = 150) for 12 months. Objective and subjective cognitive outcomes were measured before (pretest) and after the intervention (posttest). Latent change score models and Bayesian analysis of variances were used to examine cognitive change at the ability and individual measure level.

RESULTS

Computer training and use for 12 months did not lead to cognitive improvements at the ability level. Strong evidence against cognitive benefits at the individual measure level was also observed.

DISCUSSION AND IMPLICATIONS

Casual computer use does not provide enough cognitive stimulation to improve cognition in late adulthood. Cognitive benefits observed in longitudinal studies may be mediated by other factors or influenced by confounding variables.

Dissecting Digital Card Games to Yield Digital Biomarkers for the Assessment of Mild Cognitive Impairment: Methodological Approach and Exploratory Study

Background

Mild cognitive impairment (MCI), the intermediate cognitive status between normal cognitive decline and pathological decline, is an important clinical construct for signaling possible prodromes of dementia. However, this condition is underdiagnosed. To assist monitoring and screening, digital biomarkers derived from commercial off-the-shelf video games may be of interest. These games maintain player engagement over a longer period of time and support longitudinal measurements of cognitive performance.

Objective

This paper aims to explore how the player actions of Klondike Solitaire relate to cognitive functions and to what extent the digital biomarkers derived from these player actions are indicative of MCI.

Methods

First, 11 experts in the domain of cognitive impairments were asked to correlate 21 player actions to 11 cognitive functions. Expert agreement was verified through intraclass correlation, based on a 2-way, fully crossed design with type consistency. On the basis of these player actions, 23 potential digital biomarkers of performance for Klondike Solitaire were defined. Next, 23 healthy participants and 23 participants living with MCI were asked to play 3 rounds of Klondike Solitaire, which took 17 minutes on average to complete. A generalized linear mixed model analysis was conducted to explore the differences in digital biomarkers between the healthy participants and those living with MCI, while controlling for age, tablet experience, and Klondike Solitaire experience.

Results

All intraclass correlations for player actions and cognitive functions scored higher than 0.75, indicating good to excellent reliability. Furthermore, all player actions had, according to the experts, at least one cognitive function that was on average moderately to strongly correlated to a cognitive function. Of the 23 potential digital biomarkers, 12 (52%) were revealed by the generalized linear mixed model analysis to have sizeable effects and significance levels. The analysis indicates sensitivity of the derived digital biomarkers to MCI.

Conclusions

Commercial off-the-shelf games such as digital card games show potential as a complementary tool for screening and monitoring cognition.

Trial Registration

ClinicalTrials.gov NCT02971124; https://clinicaltrials.gov/ct2/show/NCT02971124

Detecting Mild Cognitive Impairment via Digital Biomarkers of Cognitive Performance Found in Klondike Solitaire: A Machine-Learning Study

Background

Mild cognitive impairment (MCI) is a condition that entails a slight yet noticeable decline in cognition that exceeds normal age-related changes. Older adults living with MCI have a higher chance of progressing to dementia, which warrants regular cognitive follow-up at memory clinics. However, due to time and resource constraints, this follow-up is conducted at separate moments in time with large intervals in between. Casual games, embedded into the daily life of older adults, may prove to be a less resource-intensive medium that yields continuous and rich data on a patient's cognition.

Objective

To explore whether digital biomarkers of cognitive performance, found in the casual card game Klondike Solitaire, can be used to train machine-learning models to discern games played by older adults living with MCI from their healthy counterparts.

Methods

Digital biomarkers of cognitive performance were captured from 23 healthy older adults and 23 older adults living with MCI, each playing 3 games of Solitaire with 3 different deck shuffles. These 3 deck shuffles were identical for each participant. Using a supervised stratified, 5-fold, cross-validated, machine-learning procedure, 19 different models were trained and optimized for F1 score.

Results

The 3 best performing models, an Extra Trees model, a Gradient Boosting model, and a Nu-Support Vector Model, had a cross-validated F1 training score on the validation set of ≥0.792. The F1 score and AUC of the test set were, respectively, >0.811 and >0.877 for each of these models. These results indicate psychometric properties comparative to common cognitive screening tests.

Conclusion

The results suggest that commercial card games, not developed to address specific mental processes, may be used for measuring cognition. The digital biomarkers derived from Klondike Solitaire show promise and may prove useful to fill the current blind spot between consultations.

Prediction of the use of mobile device interfaces in the progressive aging process with the model of Fitts' law

PURPOSE

As the population ages, so do the potential users of technology, and older adults' behaviors when using mobile device interfaces are becoming increasingly important. A representative model for detecting older adults' behaviors and performance on the use of mobile device interfaces is needed to provide individualized designs. This research aimed to investigate the applicability of the broadly used model of Fitts' law to detect the progressive changes in the use of mobile device interfaces in older adults. The effect of experience with using technology on performance on a Fitts task was also examined.

METHOD

A sample of 135 older adults was recruited to test the application of Fitts' model to the use of technology by older adult users. Each participant was asked to finish tasks at 9 levels of difficulty, from easy to difficult, in a multidirectional tapping task. Analysis of variance was employed to examine the effect of age on performance on the Fitts task, movement time, and the standard deviation of movement time. Stepwise regression was used to investigate how well age and technology use could predict performance on the Fitts task.

RESULT

Performance on the Fitts task was sensitive to the gradual changes in abilities with aging. Rather than the amount of experience in using technology, age was the stronger predictor of older adults' performance on the Fitts task. Additionally, compared with the younger groups, the users above 80 years old demonstrated significantly higher behavioral variation during the use of mobile device interfaces.

CONCLUSION

This research confirmed that Fitts' law is applicable to the evaluation of the effects of aging on the use of mobile device interfaces. Adults above the age of 80 years should be a major focus for special individualized interface design. This finding can inform future designers and researchers in the development of individualized interface designs for older adult users to enhance their user experiences of mobile device technology.

RELEVANCE TO INDUSTRY

Future designers and researchers can apply the finding on Fitts' law in this research to develop user-friendly interface designs for mobile technology for older adults and thereby improve their user experiences to enhance their independence and quality of life through the use of technology.

Contrary to Myth, Older Adults Multitask With Media and Technologies, But Studying Their Multitasking Behaviors Can Be Challenging

Background and Objectives

The study's objective was to explore older adults' (aged 65 or older) descriptions of behavior related to multitasking with traditional and newer media/information and communication technologies (ICTs) and perceived benefits of such behavior, along with older adults' preference for research methods used to study their multitasking behaviors. Employing common media-use measures that heavily rely on self-reporting in populations of older adults is challenging, especially given that patterns of media/ICT use are becoming increasingly complex. Cumulatively, people spend more time using media than they are aware of because of the tendency to use some forms of media simultaneously. As cognitive ability deteriorates with age, self-reported recollection of complex patterns of media/ICT use, such as multitasking, among older adults increases the threat to data accuracy.Research Design and Methods:  Twenty-eight community-dwelling older adults in a Midwestern U.S. state participated in in-depth interviews (average length was 40 minutes) to discuss their use of traditional and newer media/technologies in combination with other activities and outline methods researchers should use to study such behaviors.

Results

Participants reported they engaged in multitasking behaviors similar to those of younger generations, with the difference in the higher extent of using traditional media and ICTs. They talked about multitasking with radio and television for "background noise" as being a rewarding experience. They perceived the effects of multitasking to be detrimental to attention and performance and attributed this media-use habit to individual psychological and demographic differences. They preferred ethnographic observation and keeping a paper-and-pencil diary as research methods to study multitasking among their peers. Data-logging methods were less popular because they raised privacy concerns among interviewees.

Discussion and Implications

Different types of traditional and newer media and technologies could be used differently in situations that require older adults to focus, relax, or be efficient. The findings suggest that future researchers strive for a compromise between data access and data accuracy when they select a research method to study media use among older adults.