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Chien SY, Zaslavsky O, Berridge C. Technology Usability for People Living With Dementia: Concept Analysis. JMIR Aging 2024; 7:e51987. [PMID: 38959053 PMCID: PMC11255540 DOI: 10.2196/51987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/04/2024] [Accepted: 04/30/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Usability is a key indicator of the quality of technology products. In tandem with technological advancements, potential use by individuals with dementia is increasing. However, defining the usability of technology for individuals with dementia remains an ongoing challenge. The diverse and progressive nature of dementia adds complexity to the creation of universal usability criteria, highlighting the need for focused deliberations. Technological interventions offer potential benefits for people living with dementia and caregivers. Amid COVID-19, technology's role in health care access is growing, especially among older adults. Enabling the diverse population of people living with dementia to enjoy the benefits of technologies requires particular attention to their needs, desires, capabilities, and vulnerabilities to potential harm from technologies. Successful technological interventions for dementia require meticulous consideration of technology usability. OBJECTIVE This concept analysis aims to examine the usability of technology in the context of individuals living with dementia to establish a clear definition for usability within this specific demographic. METHODS The framework by Walker and Avant was used to guide this concept analysis. We conducted a literature review spanning 1984 to 2024, exploring technology usability for people with dementia through the PubMed, Web of Science, and Google Scholar databases using the keywords "technology usability" and "dementia." We also incorporated clinical definitions and integrated interview data from 29 dyads comprising individuals with mild Alzheimer dementia and their respective care partners, resulting in a total of 58 older adults. This approach aimed to offer a more comprehensive portrayal of the usability needs of individuals living with dementia, emphasizing practical application. RESULTS The evidence from the literature review unveiled that usability encompasses attributes such as acceptable learnability, efficiency, and satisfaction. The clinical perspective on dementia stages, subtypes, and symptoms underscores the importance of tailored technology usability assessment. Feedback from 29 dyads also emphasized the value of simplicity, clear navigation, age-sensitive design, personalized features, and audio support. Thus, design should prioritize personalized assistance for individuals living with dementia, moving away from standardized technological approaches. Synthesized from various sources, the defined usability attributes for individuals living with dementia not only encompass the general usability properties of effectiveness, efficiency, and satisfaction but also include other key factors: adaptability, personalization, intuitiveness, and simplicity, to ensure that technology is supportive and yields tangible benefits for this demographic. CONCLUSIONS Usability is crucial for people living with dementia when designing technological interventions. It necessitates an understanding of user characteristics, dementia stages, symptoms, needs, and tasks, as well as consideration of varied physical requirements, potential sensory loss, and age-related changes. Disease progression requires adapting to evolving symptoms. Recommendations include versatile, multifunctional technology designs; accommodating diverse needs; and adjusting software functionalities for personalization. Product feature classification can be flexible based on user conditions.
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Affiliation(s)
- Shao-Yun Chien
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Oleg Zaslavsky
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Clara Berridge
- School of Social Work, University of Washington, Seattle, WA, United States
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Crépeau-Hubert F, Baril AC, Di Caprio S, Haddad D, Picq C, Poncet F. Cross-cultural adaptation and validation of the cooking task to the French-Canadian context: assessing the impact of executive function disorders through cooking activities. Disabil Rehabil 2024; 46:1640-1651. [PMID: 37154574 DOI: 10.1080/09638288.2023.2204248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 04/14/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Acquired brain injury (ABI) often leads to deficits in executive functioning (EF) which is responsible for severe and longstanding disabilities in activities of daily living. The "Cooking Task" (CT), an ecological test of EF involving multi-tasking, was developed in France and exhibits excellent psychometric properties but has not yet been adapted and validated for the French-Canadian context. OBJECTIVES Conduct a cross-cultural adaptation and validation of the CT for the French-Canadian context. METHODS The CT was translated and adapted by a committee of experts and was validated. RESULTS Adaptation-changes were made to the language (e.g., cartable vs classeur), the materials (e.g., measuring cup vs scale), and the measuring units (e.g., ml/cups vs grams). Validation-Preliminary analyses were conducted on 24 participants with an ABI and 17 controls. Construct convergent validity: The French-Canadian-CT discriminates between ABI and control total score on the CT and on most error type categories. Construct known-group validity: French-Canadian-CT scores correlated with another measure of EF deficits (Dysexecutive Questionnaire and Six Elements Task). Inter-rater reliability score for the total error was high (ICC= .84) and results were similar to those obtained for the France-CT. CONTRIBUTIONS This study will provide a new ecologically valid tool for clinicians in Canada.
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Affiliation(s)
- Frédérik Crépeau-Hubert
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Audrey Changya Baril
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Sofia Di Caprio
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Dahlia Haddad
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Christine Picq
- Service de Médecine Physique et de Réadaptation, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
- Lethbridge-Layton-Mackay Rehabilitation Centre, CIUSSS Centre Ouest-de-l'Ile-de-Montréal, Montreal, Canada
| | - Frédérique Poncet
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Lethbridge-Layton-Mackay Rehabilitation Centre, CIUSSS Centre Ouest-de-l'Ile-de-Montréal, Montreal, Canada
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Chudzik A, Śledzianowski A, Przybyszewski AW. Machine Learning and Digital Biomarkers Can Detect Early Stages of Neurodegenerative Diseases. SENSORS (BASEL, SWITZERLAND) 2024; 24:1572. [PMID: 38475108 DOI: 10.3390/s24051572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/16/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
Neurodegenerative diseases (NDs) such as Alzheimer's Disease (AD) and Parkinson's Disease (PD) are devastating conditions that can develop without noticeable symptoms, causing irreversible damage to neurons before any signs become clinically evident. NDs are a major cause of disability and mortality worldwide. Currently, there are no cures or treatments to halt their progression. Therefore, the development of early detection methods is urgently needed to delay neuronal loss as soon as possible. Despite advancements in Medtech, the early diagnosis of NDs remains a challenge at the intersection of medical, IT, and regulatory fields. Thus, this review explores "digital biomarkers" (tools designed for remote neurocognitive data collection and AI analysis) as a potential solution. The review summarizes that recent studies combining AI with digital biomarkers suggest the possibility of identifying pre-symptomatic indicators of NDs. For instance, research utilizing convolutional neural networks for eye tracking has achieved significant diagnostic accuracies. ROC-AUC scores reached up to 0.88, indicating high model performance in differentiating between PD patients and healthy controls. Similarly, advancements in facial expression analysis through tools have demonstrated significant potential in detecting emotional changes in ND patients, with some models reaching an accuracy of 0.89 and a precision of 0.85. This review follows a structured approach to article selection, starting with a comprehensive database search and culminating in a rigorous quality assessment and meaning for NDs of the different methods. The process is visualized in 10 tables with 54 parameters describing different approaches and their consequences for understanding various mechanisms in ND changes. However, these methods also face challenges related to data accuracy and privacy concerns. To address these issues, this review proposes strategies that emphasize the need for rigorous validation and rapid integration into clinical practice. Such integration could transform ND diagnostics, making early detection tools more cost-effective and globally accessible. In conclusion, this review underscores the urgent need to incorporate validated digital health tools into mainstream medical practice. This integration could indicate a new era in the early diagnosis of neurodegenerative diseases, potentially altering the trajectory of these conditions for millions worldwide. Thus, by highlighting specific and statistically significant findings, this review demonstrates the current progress in this field and the potential impact of these advancements on the global management of NDs.
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Affiliation(s)
- Artur Chudzik
- Polish-Japanese Academy of Information Technology, Faculty of Computer Science, 86 Koszykowa Street, 02-008 Warsaw, Poland
| | - Albert Śledzianowski
- Polish-Japanese Academy of Information Technology, Faculty of Computer Science, 86 Koszykowa Street, 02-008 Warsaw, Poland
| | - Andrzej W Przybyszewski
- Polish-Japanese Academy of Information Technology, Faculty of Computer Science, 86 Koszykowa Street, 02-008 Warsaw, Poland
- UMass Chan Medical School, Department of Neurology, 65 Lake Avenue, Worcester, MA 01655, USA
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Kawabata N, Iida T, Kunishige M, Fukuda H, Miyaguchi H, Harada T. Evaluating the impact of a darts game intervention on cognitive function in older adults with and without mild cognitive impairment: a pilot study. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1327494. [PMID: 38375367 PMCID: PMC10875000 DOI: 10.3389/fresc.2024.1327494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
Introduction The current study investigated the relationship between the characteristics of a darts game, including the throwing motion toward a target, and mild cognitive impairment (MCI). To this end, we examined the associations between cognitive function and mental health, and the shift in center of gravity while throwing darts. In a preliminary investigation, a 1-month dart game intervention was conducted among older individuals living in the community. The participants were divided into the non-MCI and MCI groups, and the relationship between center of gravity movement during throwing and the presence of dementia was examined. Methods The intervention lasted for 1 month and was tested on healthy older individuals (aged ≥ 65 years) recruited from the community. The Japanese version of the Montreal Cognitive Assessment and the Trail Making Test was used to assess cognitive function. Mental health was evaluated using the Kessler Psychological Distress Scale and the Subjective Well-being Inventory. The center of pressure was analyzed to determine the center of gravity shift during dart throwing. Results The analysis of factors influencing the determination of the MCI score during the intervention revealed a tendency for the center of gravity shift to be associated as a protective factor in the non-MCI group, although this association did not reach statistical significance (odds ratio = 0.942, p = 0.084). In the MCI group, a significant effect of age was observed in the MCI score (odds ratio = 1.539, p = 0.007). Conclusion The current findings suggest that conducting center of gravity shift testing could potentially provide a helpful tool for predicting early decline in cognitive function.
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Affiliation(s)
- Nami Kawabata
- Program in Biological System Sciences, Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Hiroshima, Japan
- Department of Rehabilitation/Occupational Therapist, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Tadayuki Iida
- Program in Biological System Sciences, Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Hiroshima, Japan
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara, Japan
| | - Masafumi Kunishige
- Department of Occupational Therapy, Faculty of Health Science Technology, Bunkyo Gakuin University, Bunkyo, Japan
| | - Hiroshi Fukuda
- Graduate School of Information Sciences, Hiroshima City University, Hiroshima, Japan
| | - Hideki Miyaguchi
- Department of Human Behavior Science of Occupational Therapy, Health Sciences Major, Graduate School of Biomedical & Health Sciences, Hiroshima City University, Hiroshima, Japan
| | - Toshihide Harada
- Program in Biological System Sciences, Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Hiroshima, Japan
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara, Japan
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Wang L, Li J, Jia F, Lian L, Li L. The Development of Response and Interference Inhibition in Children: Evidence from Serious Game Training. CHILDREN (BASEL, SWITZERLAND) 2024; 11:138. [PMID: 38397250 PMCID: PMC10887659 DOI: 10.3390/children11020138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
A serious game titled "Crossing the Jungle" was developed in this study to train children's inhibition skills using the Stroop task. The effects of inhibitory control on children were tested by a pre-test, post-test, and one-month follow-up test. In the control groups, children were asked to play a commercial game instead. In experiment 1, 48 participants chose either the training or control game voluntarily, whereas, in experiment 2, 44 participants were randomly assigned to either group. In both experiments, children exposed to the serious game demonstrated training effects from the Stroop spatial task and near-transfer effects from the Flanker task. However, transferring effects were not produced by the Go/No-go task. As a result, although the serious game "Crossing the Jungle" does not improve response inhibition, children aged 9 to 12 who play it may benefit from improved interference inhibition abilities. This provides evidence for the mutual independence of interference inhibition and response inhibition in children at this stage.
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Affiliation(s)
- Lingyun Wang
- School of Psychology, Northeast Normal University, Changchun 130024, China; (L.W.); (J.L.); (L.L.)
- Jilin Provincial Key Laboratory of Cognitive Neuroscience and Brain Development, Northeast Normal University, Changchun 130024, China
| | - Jiajia Li
- School of Psychology, Northeast Normal University, Changchun 130024, China; (L.W.); (J.L.); (L.L.)
- Tianjin Vocational Institute, College of Electronical and Information Engineering, Tianjin 300410, China
| | - Fanli Jia
- Department of Psychology, Seton Hall University, South Orange, NJ 07079, USA;
| | - Lin Lian
- School of Psychology, Northeast Normal University, Changchun 130024, China; (L.W.); (J.L.); (L.L.)
| | - Lihong Li
- School of Psychology, Northeast Normal University, Changchun 130024, China; (L.W.); (J.L.); (L.L.)
- School of Social Welfare, Changchun Humanities and Sciences College, Changchun 130119, China
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Yang Z, Yang J, Yu DSF, Liu D, Ding F. Effects of Sport Stacking on Cognition in Patients With Mild Alzheimer's Disease and MCI: Preliminary Findings of Randomized Controlled Trial. J Geriatr Psychiatry Neurol 2024; 37:24-38. [PMID: 37669910 DOI: 10.1177/08919887231195227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
OBJECTIVE This mixed-method pilot study aims to investigate the feasibility and preliminary effects of sport stacking on cognitive function in individuals with mild Alzheimer's disease (AD) and those with mild cognitive impairment (MCI). METHODS Twenty-four community-dwelling subjects with confirmed mild AD or MCI were evenly randomly assigned to either the 12-week sport stacking intervention group (n = 12) or clinic routine management control group (n = 12). Outcome evaluation included the Auditory Verbal Learning Test (AVLT), Alzheimer's Disease Cooperative Study-Activities of Daily Living scale (ADCS-ADL), and plasma brain-derived neurotrophic factor (BDNF). A qualitative descriptive study was conducted to explore the overall perception and experience of the sport stacking from the subjects' perspective. RESULTS Twenty-two subjects completed the trial. At 12 weeks post-intervention, compared to the control group, the sport stacking group had significantly greater improvements in AVLT immediate recall (P < .001, Cohen d = .66) and an increase in plasma BDNF (P < .001, Cohen d = .64). Subgroup analysis indicated that subjects with MCI had significantly greater increases in AVLT immediate recall (P = .005, Cohen d = .72), ADCS-ADL (P = .130, Cohen d = .42) and plasma BDNF (P = .024, Cohen d = .83). Twelve subjects participating in the post-intervention interviews expressed the benefits (e.g., hand-eye coordination and faster reaction) from sport stacking and their enjoyment of it. CONCLUSION To the best of our knowledge, this is the first study indicating that sport stacking is feasible among individuals with MCI and mild AD. The preliminary effect on episodic memory is encouraging, possibly via upregulation of BDNF.
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Affiliation(s)
- Ziying Yang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jun Yang
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Doris S F Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Dunxiu Liu
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Fu Ding
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Catania V, Rundo F, Panerai S, Ferri R. Virtual Reality for the Rehabilitation of Acquired Cognitive Disorders: A Narrative Review. Bioengineering (Basel) 2023; 11:35. [PMID: 38247912 PMCID: PMC10813804 DOI: 10.3390/bioengineering11010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
This review article explores the use of Virtual Reality (VR) technology in cognitive rehabilitation for individuals with neurological conditions, such as stroke, traumatic brain injury, and neurodegenerative diseases. The introduction highlights the challenges posed by cognitive impairments and the limitations of traditional rehabilitation methods. VR is presented as a transformative tool that immerses individuals in interactive environments, offering promising opportunities for enhancing cognitive functions and improving quality of life. This article covers the foundational principles of VR, its applications across different clinical conditions and cognitive domains, and evaluates empirical evidence supporting its efficacy. It also discusses the advantages, limitations, challenges, and ethical considerations in the use of VR for cognitive rehabilitation. This review concludes by exploring future developments, including advancements in VR technology, the integration of Augmented Reality (AR) and artificial intelligence (AI), and the importance of standardized assessment tools for the objective evaluation of rehabilitation outcomes.
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Affiliation(s)
| | | | | | - Raffaele Ferri
- Units of Psychology I.C. and Unit of Bioinformatics and Statistics, Oasi Research Institute-IRCCS, 94018 Troina, Italy; (V.C.); (F.R.); (S.P.)
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Ye B, Chu CH, Bayat S, Babineau J, How TV, Mihailidis A. Researched Apps Used in Dementia Care for People Living With Dementia and Their Informal Caregivers: Systematic Review on App Features, Security, and Usability. J Med Internet Res 2023; 25:e46188. [PMID: 37824187 PMCID: PMC10603562 DOI: 10.2196/46188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/28/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Studies have shown that mobile apps have the potential to serve as nonpharmacological interventions for dementia care, improving the quality of life of people living with dementia and their informal caregivers. However, little is known about the needs for and privacy aspects of these mobile apps in dementia care. OBJECTIVE This review seeks to understand the landscape of existing mobile apps in dementia care for people living with dementia and their caregivers with respect to app features, usability testing, privacy, and security. METHODS ACM Digital Library, Cochrane Central Register of Controlled Trials, Compendex, Embase, Inspec, Ovid MEDLINE, PsycINFO, and Scopus were searched. Studies were included if they included people with dementia living in the community, their informal caregivers, or both; focused on apps in dementia care using smartphones or tablet computers; and covered usability evaluation of the app. Records were independently screened, and 2 reviewers extracted the data. The Centre for Evidence-Based Medicine critical appraisal tool and Mixed Methods Appraisal Tool were used to assess the risk of bias in the included studies. Thematic synthesis was used, and the findings were summarized and tabulated based on each research aim. RESULTS Overall, 44 studies were included in this review, with 39 (89%) published after 2015. In total, 50 apps were included in the study, with more apps developed for people living with dementia as end users compared with caregivers. Most studies (27/44, 61%) used tablet computers. The most common app feature was cognitive stimulation. This review presented 9 app usability themes: user interface, physical considerations, screen size, interaction challenges, meeting user needs, lack of self-awareness of app needs, stigma, technological inexperience, and technical support. In total, 5 methods (questionnaires, interviews, observations, logging, and focus groups) were used to evaluate usability. There was little focus on the privacy and security aspects, including data transfer and protection, of mobile apps for people living with dementia. CONCLUSIONS The limitations of this review include 1 reviewer conducting the full-text screening, its restriction to studies published in English, and the exclusion of apps that lacked empirical usability testing. As a result, there may be an incomplete representation of the available apps in the field of dementia care. However, this review highlights significant concerns related to the usability, privacy, and security of existing mobile apps for people living with dementia and their caregivers. The findings of this review provide a valuable framework to guide app developers and researchers in the areas of privacy policy development, app development strategies, and the importance of conducting thorough usability testing for their apps. By considering these factors, future work in this field can be advanced to enhance the quality and effectiveness of dementia care apps. TRIAL REGISTRATION PROSPERO CRD42020216141; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216141. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1159/000514838.
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Affiliation(s)
- Bing Ye
- Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Charlene H Chu
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Sayeh Bayat
- Department of Biomedical Engineering, University of Calgary, Calgary, AB, Canada
| | | | - Tuck-Voon How
- KITE, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Alex Mihailidis
- Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, Toronto, ON, Canada
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Hong C, Wang L. Virtual Reality Technology in Nursing Professional Skills Training: Bibliometric Analysis. JMIR Serious Games 2023; 11:e44766. [PMID: 37603389 PMCID: PMC10477921 DOI: 10.2196/44766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/16/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Nursing professional skills training has undergone significant transformation due to the exponential growth of computer and medical technology. The innovative use of virtual reality (VR) in nursing education has emerged as a cutting-edge technical support technique that has gained attention as a highly effective method for improving nurse training quality. OBJECTIVE This study aims to review the current status of VR technology in nursing professional skills training, research hotspots, and emerging trends in the last 15 years. METHODS The Web of Science Core Collection database was used to search for literature on VR technology in nursing professional skills training covering the period from 2006 to 2022. Biblioshiny (K-Synth Srl) was used to import and convert the records to Bibliometrix (K-Synth Srl) for analysis, and R (R Core Team) was used for descriptive bibliometric analysis. VOSviewer (Leiden University) was used to cluster co-occurring keywords, and Scimago Graphica (version 1.0.16; Scimago Lab) was used to generate a geographical visualization of published countries and regions. RESULTS A total of 1073 papers were analyzed, indicating a surge in research on the application of VR in nursing professional skills training in recent years, as evidenced by a positive trend in annual publication of relevant literature. The majority of studies were from the United States (n=340) and Canada (n=107), and Margaret Verkuyl was the most prolific author, leading the way with 9 publications. Furthermore, "Computerized Virtual Patients in Health Professions Education: a Systematic Review and Meta-Analysis" was the most frequently cited reference. Keywords such as education, simulation, skills, students, and care were most commonly used by researchers. CONCLUSIONS The bibliometric analysis provides a comprehensive overview of the use of VR in nursing professional skills training, indicating that VR-based training is an effective means of improving the skills and competencies of nursing students and professionals alike. The COVID-19 pandemic has reinforced the importance of developing VR-based distance education, despite challenges such as integrating virtual and real-world training and mitigating safety risks.
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Affiliation(s)
- Chengang Hong
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Liping Wang
- School of Nursing, Hangzhou Normal University, Hangzhou, China
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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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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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12
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Panerai S, Catania V, Rundo F, Tasca D, Musso S, Babiloni C, Prestianni G, Muratore S, Ferri R. Functional Living Skills in Patients with Major Neurocognitive Disorder Due to Degenerative or Non-Degenerative Conditions: Effectiveness of a Non-Immersive Virtual Reality Training. SENSORS (BASEL, SWITZERLAND) 2023; 23:1896. [PMID: 36850494 PMCID: PMC9966630 DOI: 10.3390/s23041896] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Virtual reality has gained attention as an effective tool for cognitive, motor, and daily activity rehabilitation in patients with major neurocognitive disorder (M-NCD). The first objective of this study was to check for differences between M-NCD caused by degenerative and non-degenerative conditions (DC and NDC, respectively) in terms of relearning four functional living skills (FLSs), by means of a non-immersive virtual reality training (VRT). The second purpose was to verify whether spontaneous transfer from the virtual environment to the real environment occurred. Four FLS apps were developed in our institute (Information, Suitcase, Medicine, and Supermarket). A nonrandomized interventional study was carried out, comparing experimental and control groups (EG and CG, respectively). The study included three phases: in vivo test at T1; VRT at T2 only for EG; in vivo test at T3. During the in vivo test, the four FLSs were assessed in their natural environments. Both EG-DC and EG-NDC significantly improved in all of the VRT variable scores (the EG-NDC group seemed to show better outcomes than the EG-DC group). Moderate-to-high satisfaction with the VRT was reported. EG-DC and EG-NDC also enhanced their performances in the in vivo test. No statistically significant differences between them were found. CG-DC and CG-NDC improved only in the execution time of Information in the in vivo test. These findings confirm the ecological validity of VRT for FLSs.
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Affiliation(s)
- Simonetta Panerai
- Unit of Psychology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | - Valentina Catania
- Unit of Psychology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | - Francesco Rundo
- Unit of Bioinformatics and Statistics, Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | - Domenica Tasca
- Unit of Psychology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | - Sabrina Musso
- Unit of Psychology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | - Claudio Babiloni
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Stefano Muratore
- Unit of Psychology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | - Raffaele Ferri
- Unit of Neurology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy
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13
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Manchanda N, Aggarwal A, Setya S, Talegaonkar S. Digital Intervention For The Management Of Alzheimer's Disease. Curr Alzheimer Res 2023; 19:CAR-EPUB-129308. [PMID: 36744687 DOI: 10.2174/1567205020666230206124155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 02/07/2023]
Abstract
Alzheimer's disease (AD) is a progressive, multifactorial, chronic, neurodegenerative disease with high prevalence and limited therapeutic options, making it a global health crisis. Being the most common cause of dementia, AD erodes the cognitive, functional, and social abilities of the individual and causes escalating medical and psychosocial needs. As yet, this disorder has no cure and current treatment options are palliative in nature. There is an urgent need for novel therapy to address this pressing challenge. Digital therapeutics (Dtx) is one such novel therapy that is gaining popularity globally. Dtx provides evidence based therapeutic interventions driven by internet and software, employing tools such as mobile devices, computers, videogames, apps, sensors, virtual reality aiding in the prevention, management, and treatment of ailments like neurological abnormalities and chronic diseases. Dtx acts as a supportive tool for the optimization of patient care, individualized treatment and improved health outcomes. Dtx uses visual, sound and other non-invasive approaches for instance-consistent therapy, reminiscence therapy, computerised cognitive training, semantic and phonological assistance devices, wearables and computer-assisted rehabilitation environment to find applications in Alzheimer's disease for improving memory, cognition, functional abilities and managing motor symptom. A few of the Dtx-based tools employed in AD include "Memory Matters", "AlzSense", "Alzheimer Assistant", "smart robotic dog", "Immersive virtual reality (iVR)" and the most current gamma stimulation. The purpose of this review is to summarize the current trends in digital health in AD and explore the benefits, challenges, and impediments of using Dtx as an adjunctive therapy for the management of AD.
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Affiliation(s)
- Namish Manchanda
- School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences & Research University, Govt. of NCT of Delhi, New Delhi-110017, India
| | - Akanksha Aggarwal
- Delhi Institute of Pharmaceutical Sciences And Research, Delhi Pharmaceutical Sciences & Research University, Govt. of NCT of Delhi, New Delhi-110017, India
| | - Sonal Setya
- Department of Pharmacy Practice, SGT College of Pharmacy, SGT University, Gurugram, Haryana-122505, India
| | - Sushama Talegaonkar
- School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences & Research University, Govt. of NCT of Delhi, New Delhi-110017, India
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14
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Lim EH, Kim DS, Won YH, Park SH, Seo JH, Ko MH, Kim GW. Effects of Home Based Serious Game Training (Brain Talk™) in the Elderly With Mild Cognitive Impairment: Randomized, a Single-Blind, Controlled Trial. BRAIN & NEUROREHABILITATION 2023; 16:e4. [PMID: 37033004 PMCID: PMC10079474 DOI: 10.12786/bn.2023.16.e4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 04/05/2023] Open
Abstract
Mild cognitive impairment (MCI) increases with aging society. Serious games may be effective in improving cognitive function in patients with MCI; however, research on their effects remains insufficient. This study aimed to confirm the efficacy and safety of cognitive rehabilitation training using a serious game (Brain Talk™) for the elderly with MCI. Twenty-four elderly individuals with MCI were randomized into study and control groups. The study group received 12 training sessions (30 min/session, 3 times/week), whereas the control group did not receive training. Blinded evaluations were conducted before and after the training and four weeks after the training. The primary outcome measures were the Korean Mini-Mental State Examination (K-MMSE) and K-MoCA (Korean Montreal Cognitive Assessment). Secondary outcome measures were the Semantic Verbal Fluency Task (SVFT), Trail-Making Test-B, and 2-back test. In the study group, the K-MMSE, K-MoCA, and SVFT scores after finishing the training and 4 weeks after training showed a significant increase; however, there was no significant change in the control group. No significant differences were observed between the two groups. Cognitive function significantly improved in the study group after training. Home-based serious games are considered helpful in improving cognitive function.
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Affiliation(s)
- Eun Hee Lim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Da-Sol Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Yu-Hui Won
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Sung-Hee Park
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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15
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Application of Immersive Virtual-Reality-Based Puzzle Games in Elderly Patients with Post-Stroke Cognitive Impairment: A Pilot Study. Brain Sci 2022; 13:brainsci13010079. [PMID: 36672060 PMCID: PMC9856594 DOI: 10.3390/brainsci13010079] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Background: The society is aging in China, and the cognitive level of elderly post-stroke patients gradually declines. Face-to-face cognitive functional training is no longer sufficient. Immersive virtual reality (IVR) is a promising rehabilitation training device. In this study, we developed an IVR-based puzzle game to explore its effectiveness, feasibility, and safety in elderly stroke patients with cognitive dysfunction. Methods: A total of 30 patients with mild post-stroke cognitive impairment after stroke were randomly assigned to a control or IVR group. Patients in both groups received routine rehabilitation therapy. Patients in the control group received traditional cognitive training, and those in the IVR group received IVR-based puzzle game therapy. Before and after treatment, Montreal cognitive assessment (MOCA), trail-making test-A (TMT-A), digit symbol substitution test (DSST), digital span test (DST), verbal fluency test (VFT), and modified Barthel index (MBI) were evaluated in both groups. In addition, the IVR group was administered a self-report questionnaire to obtain feedback on user experience. Results: There was no significant difference in the baseline data between the two groups. After six weeks of treatment, the cognitive assessment scores were improved in both groups. Moreover, the IVR group showed more improvements than the control group in the DSST (Z = 2.203, p = 0.028 < 0.05, η2 = 0.16); MOCA (T = 1.186, p = 0.246 > 0.05, d = 0.44), TMT-A (T = 1.791, p = 0.084 > 0.05, d = 0.65), MBI (T = 0.783, p = 0.44 > 0.05, d = 0.28), FDST (Z = 0.78, p = 0.435 > 0.05, η2 = 0.02), BDST (Z = 0.347, p = 0.728 > 0.05, η2 = 0.004), and VFT(Z = 1.087, p = 0.277 > 0.05, η2 = 0.039) did not significantly improve. The significant difference in DSST represents an improvement in executive function and visual−spatial cognitive characteristics. The other assessment scores did not show such features. Therefore, we did not observe significant differences through this measure. According to the results of the self-report questionnaire, most of the patients were satisfied with the equipment stability and training content. Several individuals reported mild adverse reactions. Conclusions: This pilot study suggests that IVR-based puzzle games are a promising approach to improve post-stroke cognitive function, especially executive cognitive function, and visual−spatial attention in older adults.
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16
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A systematic review and meta-analysis of randomized controlled trials on the effect of serious games on people with dementia. Ageing Res Rev 2022; 82:101740. [PMID: 36191740 DOI: 10.1016/j.arr.2022.101740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND An increase in dementia prevalence has been accompanied by increasing interest in new rehabilitation methods, such as serious games. Serious games hold the potential to postpone functional and cognitive declines in people with dementia by increasing their independence and engagement; however, the efficacy of serious games remains underexplored. This review was conducted to quantify the effects of serious games in people with dementia, including several newly published trials, with the hopes of contributing to evidence-based practice by offering support for clinical decision-making. METHODS Only randomized controlled trials (RCTs) assessing the impacts of game-based intervention programs compared with conventional therapy on cognitive function, instrumental and non-instrumental activities of daily living, or depression among people with dementia were included in this review. Meta-analyses were performed to determine the pooled standardized mean difference (SMD) of each outcome using a random-effects model. RESULTS The final search identified 12 studies that met our criteria. Overall, serious games were found to improve cognitive function (pooled SMD: 0.34; 95% CI: 0.07-0.61) and alleviated depression (pooled SMD: -0.131; 95% CI: -1.85 to -0.77) in people with dementia. CONCLUSIONS Serious games improve cognitive function and reduce depression in people with dementia. Future studies in this field should aim to evaluate and determine the long-term effect of these games.
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17
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Development and Evaluation of an Artificial Intelligence–Based Cognitive Exercise Game: A Pilot Study. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:4403976. [PMID: 36203500 PMCID: PMC9532122 DOI: 10.1155/2022/4403976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/06/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022]
Abstract
Recently, cognitive serious games have successfully been employed to train cognitive abilities in elderly people with mild cognitive impairment, Alzheimer’s disease, and related disorders. However, despite the continuous rehabilitation game design and its applications, the existing cognitive exercise games fall short of user interaction and personalized elements with regard to difficult levels, which leads to users leaving early and losing interests during the gameplay. In this regard, the purpose of the study was to design and develop the serious game inclusive of playful elements for user motivation, the web-based mobile application system for easy accessibility, and Artificial Intelligence– (AI–) based difficulty level adjustment system for prevention from earlier leaving out in the middle of the play so that the elderly users can feel entertaining and immersed into the cognitive game voluntarily. This study was designed as an eight-week pilot experiment with thirty-seven participants in their 60s to 80s for the game’s usability assessment purpose. Results of the study showed that the AI-based cognitive exercise game was acceptable, interesting, and motivating for the elderly people and the test results before and after the eight-week training suggest a relationship between longer the training on the game and lower cognitive assessment scores including geriatric quality of life scale, geriatric depression scale, and Korean version of mini-mental state examination (MMSE). These correlations demonstrate the potential value of serious games in clinical assessment of cognitive status for the elderly users with varying cognitive ability. Based on these results, the elderly-centered serious game with playful element can be potentially used in clinical settings, allowing the cognitive training to be more enjoyable and more medically effective. Given these promising results, a more focused study can extend to the game system or additional game tools or features to be explored that solely target the elderly by applying AI and advanced visualization devices.
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18
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Yang YH, Situmeang RFV, Ong PA, Liscic RM. Application of virtual reality for dementia management. BRAIN SCIENCE ADVANCES 2022. [DOI: 10.26599/bsa.2022.9050019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Age is recognized as the major factors of dementia, especially in for Alzheimer’s disease (AD). Given to the aged population, the increased number of demented population has been receiving a great impact in our society. Unfortunately, so far, no cured medicines have been demonstrated to provide effective treatment in AD. The combination of pharmacological and non-pharmacological interventions has been proposed to manage dementia with potential benefits especially in decreasing caregiver’s burden and behavior, as well as psychological problems of demented patients. Recently, giving to the glorious development in digital technologies, the virtual reality, one of the non-pharmacological interventions has been used extensively in dementia managements for its strengths which can be adapted in accordance with the heterogeneous needs from demented patients and their caregivers. However, various study designs and other reasons made these results difficult to be interpreted. In this review our goal is to provide a better understanding for these points.
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Affiliation(s)
- Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, China
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, China
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan, China
| | - Rocksy FV Situmeang
- Siloam Hospitals Lippo Village, Pelita Harapan University, Banten, Indonesia
| | - Paulus Anam Ong
- Department of Neurology, Hasan Sadikin Hospital, Bandung, Indonesia
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19
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Leung C, Wong KC, So WWY, Tse ZCK, Li D, Cao Y, Shum DHK. The application of technology to improve cognition in older adults: A review and suggestions for future directions. Psych J 2022; 11:583-599. [PMID: 35675967 PMCID: PMC9543085 DOI: 10.1002/pchj.565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 02/01/2023]
Abstract
The rapidly increasing worldwide population of older adults, along with the increasing prevalence of cognitive impairment and dementia in this population, is a growing health‐care problem. As such, advances in technology‐based cognitive interventions and games are playing an increasingly key role in preserving and improving older adults' cognitive function, especially during the COVID‐19 pandemic when opportunities for face‐to‐face activities or training are few. In this paper, we summarize from previous studies systematic reviews and meta‐analyses on the various types of technology used in cognitive interventions (namely, computerized cognitive training, virtual‐reality interventions and robot‐assisted interventions) and the empirical evidence on the effects of these technologies on global and specific cognitive functions in healthy and clinical populations of older adults (e.g., older adults with mild cognitive impairment or dementia). We also describe older adults' perceptions, experiences and acceptance of these technologies. Finally, we discuss the limitations, challenges and future avenues of research in this field.
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Affiliation(s)
- Carole Leung
- Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Kai Chun Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Winnie W Y So
- Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Zita C K Tse
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Duo Li
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Yuan Cao
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.,Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.,Mental Health Research Centre, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - David H K Shum
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.,Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.,Mental Health Research Centre, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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20
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Effectiveness of a Serious Game Design and Game Mechanic Factors for Attention and Executive Function Improvement in the Elderly: A Pretest-Posttest Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12146923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Attention allows us to focus and process information from our environment, and executive function enables us to plan, work, and manage our daily lives. As individuals become older, both of these cognitive abilities decline. It is essential for the elderly to perform more cognitive exercises. Previous studies have shown that arithmetic calculations require attention span and that playing video games requires executive function. Therefore, we developed a serious game involving mental arithmetic calculations specifically for improving attention span and executive functions. Our objective was to analyze the effectiveness of the game and the efficacy of the game’s mechanic factors affecting attention span and executive function in the elderly. Forty elderly volunteers who are over 60 years of age were invited to join an eight-week cognitive training program through an elderly social welfare center. Four assessment tests were used in pre-test and post-test before and after the training period. D-CAT and SAT are used for screening attention span; TMT-A and TMT-B are used for screening executive function. They were instructed to play the game for at least 15 min per day, 5 days per week, for a total of 8 weeks. There were three independent variables (difficulty, pressure, and competition) with two parameters that could be selected. A paired-sample t-test showed the effective results by comparing the pre-test scores and post-test scores of the cognitive training. There were significant improvements in attention span and executive functions. The mixed repeated-measure ANOVA and MANCOVA results showed that two game mechanic factors (difficulty and pressure) had a significant effect and an interaction effect, but the other factor (competition) had a non-significant effect. In conclusion, the game showed a significant enhancement in both attention span and executive functions after training, and the difficulty factor and the pressure factor were shown to have an effect, but the competition factor was shown to have no effect.
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21
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A Proposal of Cognitive Intervention in Patients with Alzheimer's Disease through an Assembling Game: A Pilot Study. J Clin Med 2022; 11:jcm11133907. [PMID: 35807192 PMCID: PMC9267896 DOI: 10.3390/jcm11133907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: Alzheimer’s disease is an irreversible brain disease, and current treatments are aimed at fighting cognitive decline. We have explored the feasibility of a game-based intervention for people with moderate Alzheimer’s disease; (2) Methods: Six participants, five women and one man, were recruited from a day center to participate in a five-week study, which included a re- and post-evaluation with the Montreal Cognitive Assessment (MoCA) and INECO Frontal Screening (IFS) tests. Three participants were assigned to the control group and three others to the experimental one. Both groups performed a play activity consisting of assembling a pie toy. Participants in the experimental group were asked to make a pie matching a sample after a time interval. Control group participants were asked to freely assemble a pie without the matching component; (3) Results: Patients were shown to be motivated during such an activity during the nine sessions. The experimental group showed a significant increase in IFS scores when comparing the post- and pre-intervention assessments. No significant differences were observed in MoCA scores; (4) The intervention created a social and emotional climate suitable to maintaining participants’ satisfaction and motivation, as well as to developing executive function while promoting positive emotions.
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22
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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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Contreras-Somoza LM, Toribio-Guzmán JM, Sánchez-Gómez MC, Irazoki E, Martín-Cilleros MV, Verdugo-Castro S, Parra-Vidales E, Perea-Bartolomé MV, Franco-Martín MÁ. Perceptions of Older People with Cognitive Impairment, Caregivers, and Professionals about ehcoBUTLER (Tablet Health Care Platform): A Qualitative Focus Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116761. [PMID: 35682344 PMCID: PMC9180242 DOI: 10.3390/ijerph19116761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 02/05/2023]
Abstract
EhcoBUTLER is a tablet platform mainly aimed at the elderly with mild cognitive impairment (MCI) to promote their well-being and health. The main objective of this study was to explore the perceptions and feedback level of the ehcoBUTLER potential users and stakeholders to improve its development. Through this exploration, the secondary objective was to contribute to the development of software/apps that promote their integral health. Focus groups were conducted (13 elderly with MCI, 13 with dementia, 12 caregivers, 11 professionals). The content and feedback level were analyzed. Participants liked the appearance of ehcoBUTLER, would like to use it, and were mainly interested in the emotional, healthy lifestyle, cognitive, and ergonomic tools. It is necessary to have prior training, more intuitive/customizable apps, low-price/free, offline/USB content, and add other activities/features. EhcoBUTLER is well-oriented to meet the needs and preferences of potential users. However, improvements in its usability, accessibility, and sustainability are needed. The participants’ perspectives provided a comprehensive view to improve ehcoBUTLER, so that in the future, it can benefit the elderly to be active agents in their health; support caregivers in their role and to have a respite; and professionals to have a multi-intervention platform. The present findings can contribute to the development of tablet software/apps that promote the integral well-being of this population.
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Affiliation(s)
- Leslie María Contreras-Somoza
- Faculty of Psychology, Campus Ciudad Jardín, University of Salamanca, Avenida de la Merced, 109, 37005 Salamanca, Spain; (E.I.); (M.V.P.-B.); (M.Á.F.-M.)
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Carretera de la Hiniesta 137, 49024 Zamora, Spain; (J.M.T.-G.); (E.P.-V.)
- Correspondence:
| | - José Miguel Toribio-Guzmán
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Carretera de la Hiniesta 137, 49024 Zamora, Spain; (J.M.T.-G.); (E.P.-V.)
| | - María Cruz Sánchez-Gómez
- Department of Didactic, Organization and Research Methods, University of Salamanca, Paseo de Canalejas, 169, 37008 Salamanca, Spain; (M.C.S.-G.); (M.V.M.-C.); (S.V.-C.)
| | - Eider Irazoki
- Faculty of Psychology, Campus Ciudad Jardín, University of Salamanca, Avenida de la Merced, 109, 37005 Salamanca, Spain; (E.I.); (M.V.P.-B.); (M.Á.F.-M.)
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Carretera de la Hiniesta 137, 49024 Zamora, Spain; (J.M.T.-G.); (E.P.-V.)
| | - María Victoria Martín-Cilleros
- Department of Didactic, Organization and Research Methods, University of Salamanca, Paseo de Canalejas, 169, 37008 Salamanca, Spain; (M.C.S.-G.); (M.V.M.-C.); (S.V.-C.)
| | - Sonia Verdugo-Castro
- Department of Didactic, Organization and Research Methods, University of Salamanca, Paseo de Canalejas, 169, 37008 Salamanca, Spain; (M.C.S.-G.); (M.V.M.-C.); (S.V.-C.)
| | - Esther Parra-Vidales
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Carretera de la Hiniesta 137, 49024 Zamora, Spain; (J.M.T.-G.); (E.P.-V.)
| | - María Victoria Perea-Bartolomé
- Faculty of Psychology, Campus Ciudad Jardín, University of Salamanca, Avenida de la Merced, 109, 37005 Salamanca, Spain; (E.I.); (M.V.P.-B.); (M.Á.F.-M.)
| | - Manuel Ángel Franco-Martín
- Faculty of Psychology, Campus Ciudad Jardín, University of Salamanca, Avenida de la Merced, 109, 37005 Salamanca, Spain; (E.I.); (M.V.P.-B.); (M.Á.F.-M.)
- Department of Psychiatry and Mental Health, Río Hortega University Hospital, Calle Dulzaina, 2, 47012 Valladolid, Spain
- Department of Psychiatry, Zamora Provincial Hospital, Calle Hernán Cortés, 40, 49071 Zamora, Spain
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Borgnis F, Baglio F, Pedroli E, Rossetto F, Uccellatore L, Oliveira JAG, Riva G, Cipresso P. Available Virtual Reality-Based Tools for Executive Functions: A Systematic Review. Front Psychol 2022; 13:833136. [PMID: 35478738 PMCID: PMC9036486 DOI: 10.3389/fpsyg.2022.833136] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/17/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Executive dysfunctions constitute a significant public health problem: their high impact on everyday life makes it a priority to identify early strategies for evaluating and rehabilitating these disorders in a real-life context. The ecological limitation of traditional neuropsychological tests and several difficulties in administering tests or training in real-life scenarios have paved the way to use Virtual Reality-based tools to evaluate and rehabilitate Executive Functions (EFs) in real-life. Objective This work aims to conduct a systematic review to provide a detailed description of the VR-based tools currently developed for the evaluation and rehabilitation of EFs. Methods We systematically searched for original manuscripts regarding VR tools and EFs by looking for titles and abstracts in the PubMed, Scopus, PsycInfo, and Web of Science databases up to November 2021 that contained the following keywords “Virtual Reality” AND “Executive function*.” Results and Conclusion We analyzed 301 articles, of which 100 were included. Our work shows that available VR-based tools appear promising solutions for an ecological assessment and treatment of EFs in healthy subjects and several clinical populations.
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Affiliation(s)
- Francesca Borgnis
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Faculty of Psychology, eCampus University, Milan, Italy
| | | | - Lidia Uccellatore
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Giuseppe Riva
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
- *Correspondence: Pietro Cipresso
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25
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Carbone E, Piras F, Pastore M, Borella E. The Role of Individual Characteristics in Predicting Short- and Long-Term Cognitive and Psychological Benefits of Cognitive Stimulation Therapy for Mild-to-Moderate Dementia. Front Aging Neurosci 2022; 13:811127. [PMID: 35087398 PMCID: PMC8787290 DOI: 10.3389/fnagi.2021.811127] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: This study examined the role of individual characteristics in predicting short- and long-term benefits of the Italian version of Cognitive Stimulation Therapy (CST-IT), an evidence-based intervention for people with mild-to-moderate dementia. Materials and Methods: Data were drawn from a sample (N = 123) of people with dementia (PwD) who took part in a multicenter controlled clinical trial of CST-IT. Assessments at pre-test, immediately after completing the treatment, and 3 months later investigated the following outcomes: general cognitive functioning and language, mood and behavior, everyday functioning, and quality of life. Age, education and baseline (pre-test) cognitive functioning, mood (depression) and behavioral and neuropsychiatric symptoms were considered as predictors of any short- and long-term benefits. Results: Linear mixed-effects models showed that different individual characteristics -particularly education and age- influenced the benefits of CST-IT, depending on the outcome measures considered. Higher education predicted larger gains in general cognitive functioning and, along with less severe depressive symptoms, in language (magnification effects). Older age was associated with positive changes in mood (compensation effects). Albeit very modestly, older age was also associated with larger gains in everyday functioning (compensation effects). Gains in quality of life were predicted by older age and lower education (compensation effects). Baseline cognitive functioning, mood and/or behavioral symptoms broadly influenced performance too, but their role again depended on the outcomes considered. Discussion: These findings underscore the importance of considering and further exploring how psychosocial interventions like CST are affected by individual characteristics in order to maximize their efficacy for PwD.
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Affiliation(s)
- Elena Carbone
- Department of General Psychology, University of Padova, Padua, Italy
- *Correspondence: Elena Carbone,
| | - Federica Piras
- Neuropsychiatry Laboratory, Clinical and Behavioral Neurology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Massimiliano Pastore
- Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy
| | - Erika Borella
- Department of General Psychology, University of Padova, Padua, Italy
- Erika Borella,
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26
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Steinert L, Putze F, Küster D, Schultz T. Predicting Activation Liking of People With Dementia. FRONTIERS IN COMPUTER SCIENCE 2022. [DOI: 10.3389/fcomp.2021.770492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Physical, social and cognitive activation is an important cornerstone in non-pharmacological therapy for People with Dementia (PwD). To support long-term motivation and well-being, activation contents first need to be perceived positively. Prompting for explicit feedback, however, is intrusive and interrupts the activation flow. Automated analyses of verbal and non-verbal signals could provide an unobtrusive means of recommending suitable contents based on implicit feedback. In this study, we investigate the correlation between engagement responses and self-reported activation ratings. Subsequently, we predict ratings of PwD based on verbal and non-verbal signals in an unconstrained care setting. Applying Long-Short-Term-Memory (LSTM) networks, we can show that our classifier outperforms chance level. We further investigate which features are the most promising indicators for the prediction of activation ratings of PwD.
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27
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Jang S, Choi SW, Son SJ, Oh J, Ha J, Kim WJ, Roh HW, Kim KY, Lee S, Jung E, Cha W, Chae H, Kang S, Kwon JH, Kim IY, Lee JY, Shin HK, Ryu JS, Ahn R, Hong CH, Seok JH. Virtual reality-based monitoring test for MCI: A multicenter feasibility study. Front Psychiatry 2022; 13:1057513. [PMID: 36741575 PMCID: PMC9891464 DOI: 10.3389/fpsyt.2022.1057513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES As the significance of the early diagnosis of mild cognitive impairment (MCI) has emerged, it is necessary to develop corresponding screening tools with high ecological validity and feasible biomarkers. Virtual reality (VR)-based cognitive assessment program, which is close to the daily life of the older adults, can be suitable screening tools for MCI with ecological validity and accessibility. Meanwhile, dehydroepiandrosterone (DHEA) has been observed at a low concentration in the older adults with dementia or cognitive decline, indicating its potential as a biomarker of MCI. This study aimed to determine the efficacy and usability of a VR cognitive assessment program and salivary DHEA for screening MCI. METHODS The VR cognitive assessment program and the traditional Montreal Cognitive Assessment (MOCA) test were performed on 12 patients with MCI and 108 healthy older adults. The VR program operates in a situation of caring for a grandchild, and evaluates the memory, attention, visuospatial, and executive functions. An analysis of covariance (ANCOVA), a partial correlation analysis, and receiving operating characteristic (ROC) curve analysis were conducted for statistical analysis. RESULTS According to the ANCOVA, no significant difference in MOCA scores was found between the normal and MCI groups (F = 2.36, p = 0.127). However, the VR total score of the MCI group was significantly lower than that of the normal group (F = 8.674, p = 0.004). There was a significant correlation between the MOCA and VR scores in the total and matched subdomain scores. The ROC curve analysis also showed a larger area under the curve (AUC) for the VR test (0.765) than for the MOCA test (0.598), and the sensitivity and specificity of the VR program were 0.833 and 0.722, respectively. Salivary DHEA was correlated with VR total (R 2 = 0.082, p = 0.01) and attention scores (R 2 = 0.086, p = 0.009). CONCLUSION The VR cognitive test was as effective as the traditional MOCA test in the MCI classification and safe enough for older adults to perform, indicating its potential as a diagnostic tool. It has also been shown that salivary DHEA can be used as a biomarker for MCI.
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Affiliation(s)
- Sooah Jang
- Research Institute of Minds.AI, Co., Ltd., Seoul, Republic of Korea
| | - Sun-Woo Choi
- Research Institute of Minds.AI, Co., Ltd., Seoul, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University, Suwon, Gyeonggi-do, Republic of Korea
| | - Jooyoung Oh
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junghee Ha
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jung Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea
| | - Hyun Woong Roh
- Department of Psychiatry, Ajou University, Suwon, Gyeonggi-do, Republic of Korea
| | - Keun You Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - San Lee
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea
| | - Eunjin Jung
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woojin Cha
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heonjoo Chae
- FNIKorea Co., Ltd., Gwacheon, Gyeonggi-do, Republic of Korea
| | - Suzi Kang
- FNIKorea Co., Ltd., Gwacheon, Gyeonggi-do, Republic of Korea
| | - Ji Hye Kwon
- Research Institute of Minds.AI, Co., Ltd., Seoul, Republic of Korea
| | - In-Young Kim
- Research Institute of Minds.AI, Co., Ltd., Seoul, Republic of Korea
| | - Ju-Yeal Lee
- Research Institute of Minds.AI, Co., Ltd., Seoul, Republic of Korea
| | - Hyun Kyung Shin
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Sun Ryu
- Research Institute of Minds.AI, Co., Ltd., Seoul, Republic of Korea.,Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ryunsup Ahn
- Research Institute of Minds.AI, Co., Ltd., Seoul, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University, Suwon, Gyeonggi-do, Republic of Korea
| | - Jeong-Ho Seok
- Research Institute of Minds.AI, Co., Ltd., Seoul, Republic of Korea.,Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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28
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Zhu K, Lin R, Li H. Study of virtual reality for mild cognitive impairment: A bibliometric analysis using CiteSpace. Int J Nurs Sci 2022; 9:129-136. [PMID: 35079614 PMCID: PMC8766785 DOI: 10.1016/j.ijnss.2021.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/04/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives Non-invasive and low-cost virtual reality (VR) technology is important for early evaluation and intervention in mild cognitive impairment (MCI). This study aimed to demonstrate the current status of overseas and domestic research as well as the focus and frontier of VR technology among individuals with MCI through a bibliometric analysis. Methods Studies from the core collection of Web of Science™ between 1995 and 2020 were used; furthermore, CiteSpace 5.7 R3 was utilized to analyse information on authors/cited authors, keywords, burst words, and cited references. Results In total, 230 publications were identified. Most studies were published in the USA (45 publications) and Italy (41 publications), where Guiseppe Riva ranks first (14 publications), and Tarnanas I is the author with the highest centrality (0.44). The hot topics in VR applications in the MCI population are ‘physical activity,’ ‘people,’ ‘single-blind,’ ‘disease,’ ‘walking,’ ‘technology,’ ‘working memory,’ and ‘risk’ in recent years. The keyword ‘mild cognitive impairment’ has attracted extensive attention since 2012, showing the strongest citation outbreak (8.28). The clustering results of the literature show the research types and emerging trends, including ‘exergame,’ ‘serious games,’ ‘spatial navigation,’ ‘activities of daily living,’ ‘exercise,’ ‘enriched environment’ and ‘wayfinding.‘ Conclusions Cognitive assessment and nonpharmacological intervention research on patients with MCI have become the focus of dementia prevention in recent years. Virtual technology, combined with traditional methods such as exercise therapy, provides new ideas for innovative cognitive evaluation and cognitive intervention.
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Affiliation(s)
- Kaiyan Zhu
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Rong Lin
- The School of Nursing, Fujian Medical University, Fuzhou, China
- Research Center for Nursing Theory and Practice, Fujian Provincial Hospital, Fuzhou, China
| | - Hong Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
- Research Center for Nursing Theory and Practice, Fujian Provincial Hospital, Fuzhou, China
- Corresponding author.
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29
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Xue B, Xiao A, Luo X, Li R. The effect of a game training intervention on cognitive functioning and depression symptoms in the elderly with mild cognitive impairment: A randomized controlled trial. Int J Methods Psychiatr Res 2021; 30:e1887. [PMID: 34291527 PMCID: PMC8633942 DOI: 10.1002/mpr.1887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/10/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to explore whether game training could improve cognitive functioning and depression symptoms in the elderly affected by mild cognitive impairment (MCI). METHODS A non-blinded randomized controlled trial was conducted. Participants were 72 patients with MCI and depression from a nursing home in Wuhan. Participants were randomized to either the intervention group or the control group (n = 36 each). The intervention group received regular nursing care plus game training for 50 min, three times per week for 8 weeks, whereas the control group received only regular nursing care during the same research period. Cognitive functioning and depression symptoms were tested in both groups at baseline and at the end of the 8-week intervention. We used the Montreal Cognitive Assessment and the 15-item Geriatric Depression Scale to assess cognitive functioning and depression symptoms, respectively. RESULTS The 8-week game training intervention significantly improved the cognitive and depression scores when compared with the control group and baseline scores (p < 0.05). No significant difference was observed in the control group (p > 0.05). CONCLUSIONS Our results suggest that the implementation of game training can improve the cognitive functioning and depression symptoms of the elderly with MCI, indicated that can be widely used.
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Affiliation(s)
- Bing Xue
- Department of Nursing, School of Health Sciences, Wuhan University, Wuhan, China
| | - Ao Xiao
- Department of Nursing, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xianwu Luo
- Department of Nursing, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, China
| | - Rui Li
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, China
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30
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Lin CW, Mao TY, Huang CF. A Novel Game-Based Intelligent Test for Detecting Elderly Cognitive Function Impairment. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:1698406. [PMID: 34880929 PMCID: PMC8648469 DOI: 10.1155/2021/1698406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022]
Abstract
PURPOSES This research explores the game-based intelligent test (GBIT), predicts the possibilities of Mini-Mental State Examination (MMSE) scores and the risk of cognitive impairment, and then verifies GBIT as one of the reliable and valid cognitive assessment tools. METHODS This study recruited 117 elderly subjects in Taiwan (average age is 79.92 ± 8.68, average height is 156.91 ± 8.01, average weight is 59.14 ± 9.67, and average MMSE score is 23.33 ± 6.16). A multiple regression model was used to analyze the GBIT parameters of the elderly's reaction, attention, coordination, and memory to predict their MMSE performance. The binary logistic regression was then utilized to predict their risk of cognitive impairment. The statistical significance level was set as α = 0.05. RESULTS Multiple regression analysis showed that gender, the correct number of reactions, and the correct number of memory have a significantly positive predictive power on MMSE of the elderly (F = 37.60, R 2 = 0.69, and p < 0.05). Binary logistic regression analysis noted that the correct average number of reactions falls by one question, and the ratio of cognitive dysfunction risk increases 1.09 times (p < 0.05); the correct average number of memory drops by one question, the ratio of cognitive dysfunction risk increases 3.76 times (p < 0.05), and the overall model predictive power is 88.20% (sensitivity: 84.00%; specificity: 92.30%). CONCLUSIONS This study verifies that GBIT is reliable and can effectively predict the cognitive function and risk of cognitive impairment in the elderly. Therefore, GBIT can be used as one of the feasible tools for evaluating older people's cognitive function.
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Affiliation(s)
- Chih-Wei Lin
- Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan
| | - Tso-Yen Mao
- Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan
| | - Chun-Feng Huang
- Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan
- Department of Family Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
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31
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Liu N, Yin J, Tan SSL, Ngiam KY, Teo HH. Mobile health applications for older adults: a systematic review of interface and persuasive feature design. J Am Med Inform Assoc 2021; 28:2483-2501. [PMID: 34472601 PMCID: PMC8510293 DOI: 10.1093/jamia/ocab151] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/01/2021] [Accepted: 07/05/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Mobile-based interventions have the potential to promote healthy aging among older adults. However, the adoption and use of mobile health applications are often low due to inappropriate designs. The aim of this systematic review is to identify, synthesize, and report interface and persuasive feature design recommendations of mobile health applications for elderly users to facilitate adoption and improve health-related outcomes. MATERIALS AND METHODS We searched PubMed, Embase, PsycINFO, CINAHL, and Scopus databases to identify studies that discussed and evaluated elderly-friendly interface and persuasive feature designs of mobile health applications using an elderly cohort. RESULTS We included 74 studies in our analysis. Our analysis revealed a total of 9 elderly-friendly interface design recommendations: 3 recommendations were targeted at perceptual capabilities of elderly users, 2 at motor coordination problems, and 4 at cognitive and memory deterioration. We also compiled and reported 5 categories of persuasive features: reminders, social features, game elements, personalized interventions, and health education. DISCUSSION Only 5 studies included design elements that were based on theories. Moreover, the majority of the included studies evaluated the application as a whole without examining end-user perceptions and the effectiveness of each single design feature. Finally, most studies had methodological limitations, and better research designs are needed to quantify the effectiveness of the application designs rigorously. CONCLUSIONS This review synthesizes elderly-friendly interface and persuasive feature design recommendations for mobile health applications from the existing literature and provides recommendations for future research in this area and guidelines for designers.
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Affiliation(s)
- Na Liu
- Discipline of Business Information Systems, The University of Sydney Business School, Sydney, Australia
| | - Jiamin Yin
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
| | - Sharon Swee-Lin Tan
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
| | - Kee Yuan Ngiam
- Department of Surgery, National University Hospital, Singapore, Singapore
| | - Hock Hai Teo
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
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32
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Panerai S, Gelardi D, Catania V, Rundo F, Tasca D, Musso S, Prestianni G, Muratore S, Babiloni C, Ferri R. Functional Living Skills: A Non-Immersive Virtual Reality Training for Individuals with Major Neurocognitive Disorders. SENSORS 2021; 21:s21175751. [PMID: 34502642 PMCID: PMC8433763 DOI: 10.3390/s21175751] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/15/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
The loss of functional living skills (FLS) is an essential feature of major neurocognitive disorders (M-NCD); virtual reality training (VRT) offers many possibilities for improving FLS in people with M-NCD. The aim of our study was to verify the effectiveness of a non-immersive VRT on FLS for patients with M-NCD. VRT was carried out for 10 to 20 sessions, by means of four 3D apps developed in our institute and installed on a large touch screen. The experimental group (EG) and the control group (CG) included 24 and 18 patients with M-NCD, respectively. They were administered the in vivo test (in specific hospital places reproducing the natural environments) at T1 (pre-training) and T3 (post-training); at T2, only EG was administered VRT. Statistically significant differences between EG and CG in all the in vivo tests were found in the number of correct responses; during VRT, the number of correct responses increased, while the execution times and the number of clues decreased. The improvement in the in vivo tests appeared to be related to the specific VRT applied. The satisfaction of participants with the VRT was moderate to high.
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Affiliation(s)
- Simonetta Panerai
- Unit of Psychology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy; (S.P.); (D.G.); (V.C.); (D.T.); (S.M.); (G.P.); (S.M.)
| | - Donatella Gelardi
- Unit of Psychology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy; (S.P.); (D.G.); (V.C.); (D.T.); (S.M.); (G.P.); (S.M.)
| | - Valentina Catania
- Unit of Psychology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy; (S.P.); (D.G.); (V.C.); (D.T.); (S.M.); (G.P.); (S.M.)
| | - Francesco Rundo
- Unit of Bioinformatics and Statistics, Oasi Research Institute-IRCCS, 94018 Troina, Italy;
| | - Domenica Tasca
- Unit of Psychology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy; (S.P.); (D.G.); (V.C.); (D.T.); (S.M.); (G.P.); (S.M.)
| | - Sabrina Musso
- Unit of Psychology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy; (S.P.); (D.G.); (V.C.); (D.T.); (S.M.); (G.P.); (S.M.)
| | - Giuseppina Prestianni
- Unit of Psychology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy; (S.P.); (D.G.); (V.C.); (D.T.); (S.M.); (G.P.); (S.M.)
| | - Stefano Muratore
- Unit of Psychology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy; (S.P.); (D.G.); (V.C.); (D.T.); (S.M.); (G.P.); (S.M.)
| | - Claudio Babiloni
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, 00185 Rome, Italy;
| | - Raffaele Ferri
- Unit of Neurology I.C., Oasi Research Institute-IRCCS, 94018 Troina, Italy
- Correspondence:
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Physical Training In-Game Metrics for Cognitive Assessment: Evidence from Extended Trials with the Fitforall Exergaming Platform. SENSORS 2021; 21:s21175756. [PMID: 34502647 PMCID: PMC8434168 DOI: 10.3390/s21175756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022]
Abstract
Conventional clinical cognitive assessment has its limitations, as evidenced by the environmental shortcomings of various neuropsychological tests conducted away from an older person’s everyday environment. Recent research activities have focused on transferring screening tests to computerized forms, as well as on developing short screening tests for screening large populations for cognitive impairment. The purpose of this study was to present an exergaming platform, which was widely trialed (116 participants) to collect in-game metrics (built-in game performance measures). The potential correlation between in-game metrics and cognition was investigated in-depth by scrutinizing different in-game metrics. The predictive value of high-resolution monitoring games was assessed by correlating it with classical neuropsychological tests; the area under the curve (AUC) in the receiver operating characteristic (ROC) analysis was calculated to determine the sensitivity and specificity of the method for detecting mild cognitive impairment (MCI). Classification accuracy was calculated to be 73.53% when distinguishing between MCI and normal subjects, and 70.69% when subjects with mild dementia were also involved. The results revealed evidence that careful design of serious games, with respect to in-game metrics, could potentially contribute to the early and unobtrusive detection of cognitive decline.
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Abbadessa G, Brigo F, Clerico M, De Mercanti S, Trojsi F, Tedeschi G, Bonavita S, Lavorgna L. Digital therapeutics in neurology. J Neurol 2021; 269:1209-1224. [PMID: 34018047 PMCID: PMC8136262 DOI: 10.1007/s00415-021-10608-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 12/14/2022]
Abstract
Digital therapeutics (DTx) is a section of digital health defined by the DTx Alliance as “delivering evidence-based therapeutic interventions to patients that are driven by software to prevent, manage, or treat a medical disorder or disease. They are used independently or in concert with medications, devices, or other therapies to optimize patient care and health outcomes”. Chronic disabling diseases could greatly benefit from DTx. In this narrative review, we provide an overview of DTx in the care of patients with neurological dysfunctions.
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Affiliation(s)
- G Abbadessa
- Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - F Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), 39012, Naples, Italy
| | - M Clerico
- Clinical and Biological Sciences Department, University of Torino, 10124, Turin, Italy
| | - S De Mercanti
- Clinical and Biological Sciences Department, University of Torino, 10124, Turin, Italy
| | - F Trojsi
- Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - G Tedeschi
- Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - S Bonavita
- Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - L Lavorgna
- Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy.
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Khaleghi A, Aghaei Z, Mahdavi MA. A Gamification Framework for Cognitive Assessment and Cognitive Training: Qualitative Study. JMIR Serious Games 2021; 9:e21900. [PMID: 33819164 PMCID: PMC8170558 DOI: 10.2196/21900] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/05/2020] [Accepted: 02/08/2021] [Indexed: 12/19/2022] Open
Abstract
Background Cognitive tasks designed to measure or train cognition are often repetitive and presented in a monotonous manner, features that lead to participant boredom and disengagement. In this situation, participants do not put forth their best effort to do these tasks well. As a result, neuropsychologists cannot draw accurate conclusions about the data collected, and intervention effects are reduced. It is assumed that greater engagement and motivation will manifest as improved data quality. Gamification, the use of game elements in nongame settings, has been heralded as a potential mechanism for increasing participant engagement in cognitive tasks. Some studies have reported a positive effect of gamification on participant performance, although most studies have shown mixed results. One reason for these contrasting findings is that most studies have applied poor and heterogeneous design techniques to gamify cognitive tasks. Therefore, an appropriate gamification design framework is needed in these tasks. Objective This study aimed to propose a framework to guide the design of gamification in cognitive tasks. Methods We employed a design science research (DSR) approach to provide a framework for gamifying cognitive assessments and training by synthesizing current gamification design frameworks and gamification works in cognitive assessment and training, as well as incorporating field experiences. The prototypes of the framework were iteratively evaluated with 17 relevant experts. Results We proposed a framework consisting of 7 phases: (1) preparation; (2) knowing users; (3) exploring existing tools for assessing or training a targeted cognitive context and determining the suitability of game-up and mapping techniques; (4) ideation; (5) prototyping using the Objects, Mechanics, Dynamics, Emotions (OMDE) design guideline; (6) development; and (7) disseminating and monitoring. Conclusions We found that (1) an intermediate design framework is needed to gamify cognitive tasks, which means that game elements should be selected by considering current cognitive assessment or training context characteristics since game elements may impose an irrelevant cognitive load that, in turn, can jeopardize data quality; (2) in addition to developing a new gamified cognitive task from scratch, 2 gamification techniques are widely used (first, adding game elements to an existing cognitive task and second, mapping an existing game to a cognitive function or impairment to assess or train it); and (3) further research is required to investigate the interplay of cognitive processes and game mechanics.
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Affiliation(s)
- Ali Khaleghi
- Department of Computer Engineering, Imam Khomeini International University, Qazvin, Iran
| | - Zahra Aghaei
- Department of Computer Engineering, Imam Khomeini International University, Qazvin, Iran
| | - Mohammad Amin Mahdavi
- Department of Computer Engineering, Imam Khomeini International University, Qazvin, Iran
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Robert P, Albrengues C, Fabre R, Derreumaux A, Pancrazi MP, Luporsi I, Dubois B, Epelbaum S, Mercier G, Foulon P, Bremond F, Manera V. Efficacy of serious exergames in improving neuropsychiatric symptoms in neurocognitive disorders: Results of the X-TORP cluster randomized trial. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12149. [PMID: 34013018 PMCID: PMC8112479 DOI: 10.1002/trc2.12149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/24/2020] [Accepted: 01/06/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the efficacy of a serious exergame in improving the neuropsychiatric symptoms of patients with neurocognitive disorders. METHODS X-Torp is a serious exergame combining motor and cognitive activities. Ninety-one subjects (mean age = 81.7 years, mean Mini-Mental State Examination = 18.3) were recruited in 16 centers. Centers were randomized into intervention and control centers. Subjects underwent assessment for cognitive and behavioral symptoms at baseline (BL), the end of the intervention (W12), and 12 weeks after the end of the intervention (W24). RESULTS The comparison of neuropsychiatric symptoms between BL and W12 and W24 showed that subjects of the intervention group improved in apathy between BL and W12. Mixed analysis (time BL, W12, W24 x group) indicated a significant increase in apathy and neuropsychiatric symptoms in the control subjects. DISCUSSION The use of X-Torp improved neuropsychiatric symptoms, particularly apathy. Future studies should more consistently use behavioral and neuropsychiatric symptoms as outcome measures.
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Affiliation(s)
- Philippe Robert
- CoBTeK LabUniversité Côte d'AzurNiceFrance
- Centre mémoire CMRRCentre Hospitalier Universitaire de NiceNiceFrance
- Association Innovation AlzheimerNiceFrance
| | - Claire Albrengues
- Centre mémoire CMRRCentre Hospitalier Universitaire de NiceNiceFrance
| | - Roxane Fabre
- Département de Santé PubliqueCentre Hospitalier Universitaire de NiceNiceFrance
| | - Alexandre Derreumaux
- CoBTeK LabUniversité Côte d'AzurNiceFrance
- Centre mémoire CMRRCentre Hospitalier Universitaire de NiceNiceFrance
| | | | | | - Bruno Dubois
- Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) SalpetrièreParisFrance
| | - Stéphane Epelbaum
- Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) SalpetrièreParisFrance
| | - Grégoire Mercier
- UMR CEPELUniversité de MontpellierMontpellierFrance
- DIM, CHU de MontpellierHôpital La ColombiereMontpellierFrance
| | - Pierre Foulon
- Company GENIOUS Healthcare—Mindmaze GroupLausanneSwitzerland
| | | | - Valeria Manera
- CoBTeK LabUniversité Côte d'AzurNiceFrance
- Association Innovation AlzheimerNiceFrance
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Contreras-Somoza LM, Irazoki E, Toribio-Guzmán JM, de la Torre-Díez I, Diaz-Baquero AA, Parra-Vidales E, Perea-Bartolomé MV, Franco-Martín MÁ. Usability and User Experience of Cognitive Intervention Technologies for Elderly People With MCI or Dementia: A Systematic Review. Front Psychol 2021; 12:636116. [PMID: 33967901 PMCID: PMC8100576 DOI: 10.3389/fpsyg.2021.636116] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/31/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction Incorporating technology in cognitive interventions represents an innovation, making them more accessible, flexible, and cost-effective. This will not be feasible without adequate user-technology fit. Bearing in mind the importance of developing cognitive interventions whose technology is appropriate for elderly people with cognitive impairment, the objective of this systematic review was to find evidence about usability and user experience (UX) measurements and features of stimulation, training, and cognitive rehabilitation technologies for older adults with mild cognitive impairment (MCI) or dementia. Method The Medline, PubMed, Scopus, ScienceDirect, and PsycINFO databases were searched for literature published in the last 10 years (2009–2019), and three researchers independently reviewed potentially eligible studies, following specific inclusion criteria. A systematic review of the studies was conducted, presenting a qualitative synthesis of usability and UX measures with their outcomes, study characteristics and features of the cognitive intervention technologies. Results Ten studies were selected: five were cognitive stimulation and five were cognitive training. Most of them (60%) were computer-based programs with a serious game format. Efficiency and effectiveness were the most frequent measurements used for collecting objective usability data, showing that elderly people with cognitive impairment require more time (45%) and help (40%) but can complete tasks (60%). Regarding UX or subjective usability data, questionnaires and scales were the most used methods, reporting positive experience despite certain difficulties with the interface in five studies. Conclusion Measuring usability and UX in cognitive intervention technologies for older adults with MCI or dementia provides an integrated view that can contribute to their development according to the needs and characteristics of the target population. More research is required to include this population group in usability and UX studies, as well as standardized tools and consensus on the relationship of these terms to guarantee the future effectiveness of cognitive intervention technologies. Review registration This review was registered in the PROSPERO (CRD42020158147) International Register of Systematic Review Protocols.
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Affiliation(s)
- Leslie María Contreras-Somoza
- Faculty of Psychology, University of Salamanca, Salamanca, Spain.,Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | - Eider Irazoki
- Faculty of Psychology, University of Salamanca, Salamanca, Spain.,Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | - José Miguel Toribio-Guzmán
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | | | - Angie Alejandra Diaz-Baquero
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain.,Biomedical Research Institute of Salamanca, University of Salamanca, Salamanca, Spain
| | - Esther Parra-Vidales
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | | | - Manuel Ángel Franco-Martín
- Faculty of Psychology, University of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca, University of Salamanca, Salamanca, Spain.,Río Hortega Hospital's Psychiatry and Mental Health Service, Valladolid, Spain.,Zamora Public Welfare Complex, Zamora, Spain
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Bottiroli S, Bernini S, Cavallini E, Sinforiani E, Zucchella C, Pazzi S, Cristiani P, Vecchi T, Tost D, Sandrini G, Tassorelli C. The Smart Aging Platform for Assessing Early Phases of Cognitive Impairment in Patients With Neurodegenerative Diseases. Front Psychol 2021; 12:635410. [PMID: 33790839 PMCID: PMC8005545 DOI: 10.3389/fpsyg.2021.635410] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Smart Aging is a serious game (SG) platform that generates a 3D virtual reality environment in which users perform a set of screening tasks designed to allow evaluation of global cognition. Each task replicates activities of daily living performed in a familiar environment. The main goal of the present study was to ascertain whether Smart Aging could differentiate between different types and levels of cognitive impairment in patients with neurodegenerative disease. Methods: Ninety-one subjects (mean age = 70.29 ± 7.70 years)—healthy older adults (HCs, n = 23), patients with single-domain amnesic mild cognitive impairment (aMCI, n = 23), patients with single-domain executive Parkinson's disease MCI (PD-MCI, n = 20), and patients with mild Alzheimer's disease (mild AD, n = 25)—were enrolled in the study. All participants underwent cognitive evaluations performed using both traditional neuropsychological assessment tools, including the Mini-Mental State Examination (MMSE), Montreal Overall Cognitive Assessment (MoCA), and the Smart Aging platform. We analyzed global scores on Smart Aging indices (i.e., accuracy, time, distance) as well as the Smart Aging total score, looking for differences between the four groups. Results: The findings revealed significant between-group differences in all the Smart Aging indices: accuracy (p < 0.001), time (p < 0.001), distance (p < 0.001), and total Smart Aging score (p < 0.001). The HCs outperformed the mild AD, aMCI, and PD-MCI patients in terms of accuracy, time, distance, and Smart Aging total score. In addition, the mild AD group was outperformed both by the HCs and by the aMCI and PD-MCI patients on accuracy and distance. No significant differences were found between aMCI and PD-MCI patients. Finally, the Smart Aging scores significantly correlated with the results of the neuropsychological assessments used. Conclusion: These findings, although preliminary due to the small sample size, suggest the validity of Smart Aging as a screening tool for the detection of cognitive impairment in patients with neurodegenerative diseases.
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Affiliation(s)
- Sara Bottiroli
- Faculty of Law, Giustino Fortunato University, Benevento, Italy.,National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Sara Bernini
- National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Elena Cavallini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elena Sinforiani
- National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Chiara Zucchella
- Neurology Unit, Department of Neurosciences, Verona University Hospital, Verona, Italy
| | - Stefania Pazzi
- Consorzio di Bioingegneria Medica e Informatica CBIM, Pavia, Italy
| | - Paolo Cristiani
- Consorzio di Bioingegneria Medica e Informatica CBIM, Pavia, Italy
| | - Tomaso Vecchi
- National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Daniela Tost
- Computer Graphics Division Research Centre for Biomedical Engineering (CREB), Universitat Politecnica de Catalunya, Barcelona, Spain
| | - Giorgio Sandrini
- National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Kimura K, Moussavi Z. Do Older and Young Adults Learn to Integrate Geometry While Navigating in an Environment of a Serious Game? Neurosci Insights 2021; 16:2633105520988861. [PMID: 33709080 PMCID: PMC7841238 DOI: 10.1177/2633105520988861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/31/2020] [Indexed: 11/24/2022] Open
Abstract
We evaluated the outcomes of an intervention using a serious game designed to be
played on iPads for improving spatial reorientation by training users to
integrate geometry of the environment, instead of relying solely on featural
cues. Using data logged online through a clinical study of using this game, the
effect of training among 16 older adults (69.3 ± 6.4 years, 4 males), who played
the game repeatedly (self-administered) over a period of 8 weeks, was
investigated. The game contains a hexagonal room with 3 objects, textured walls,
and grids on the floor, which are removed one by one as the participant played
the game. In each level, the room also rotates such that the viewpoint of the
user is different from that of the previous level. Participants cannot play a
higher level unless they make no mistake during the trials of the lower test
level. In addition to data of older adults available from that clinical trial,
we recruited 16 young adults (27.3 ± 5.6 years, 4 males) to play the game for 5
sessions and compared their results with those of the older adults. We evaluated
the error type made in each test level and the scores for each session among
older adults. Further, we compared the frequency of each error type between
young and older adults during the test levels that a landmark adjacent to the
target was removed over the first 5 sessions. The results of older adults’
performance suggest they learned to make fewer mistakes over the sessions. Also,
both young and older adults learned to integrate the geometrical cues rather
than relying on the landmark cue adjacent to the target to find the target.
Overall, the results indicate the designed hexagonal room game can enhance
spatial cognition among all age groups of adults.
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Affiliation(s)
- Kazushige Kimura
- Graduate Program in Biomedical Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Zahra Moussavi
- Graduate Program in Biomedical Engineering, University of Manitoba, Winnipeg, MB, Canada
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Kim JH, Park S, Lim H. Developing a virtual reality for people with dementia in nursing homes based on their psychological needs: a feasibility study. BMC Geriatr 2021; 21:167. [PMID: 33678160 PMCID: PMC7938563 DOI: 10.1186/s12877-021-02125-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 03/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background The purpose of this study was (1) to develop a virtual reality (VR) intervention program based on the psychological needs of patients residing in nursing facilities in South Korea to alleviate their behavioral and psychological symptoms and (2) to confirm the possibility of utilizing VR in patients with dementia. Methods In the first phase, patients with dementia residing in nursing homes and experiencing behavioral and psychological symptoms were recruited. Surveys and questionnaires were used to identify activities that alleviated the behavioral and psychological symptoms of dementia (BPSD) among the patients. These activities were classified into five types of psychological needs. In the second phase, a fully immersive, interactive, easy-to-use VR platform was developed that reflected these psychological needs. Patients with dementia experienced the VR content. The researchers assessed the level of the participants’ immersion, preference, and interaction with the VR using a 5-point Likert scale. Results In the feasibility test, 10 nursing home residents were recruited. The mean immersion score was 4.93 ± 0.16 points, the mean preference score was 4.35 ± 0.41 points, and the mean interaction score was 3.84 ± 0.43 points using a 5-point Likert scale. Higher mean scores indicated a more positive outcome. Six of the 10 participants required assistance while using the VR. The mean VR experience duration was 10.00 ± 3.46 min. Conclusions The VR-based intervention program that was developed to reduce BPSD was feasible for the participants and provided them with a high degree of satisfaction and immersion. Furthermore, this study also confirmed the convenience and safety of the program. These findings support the potential use of VR-based BPSD intervention programs to treat patients with dementia. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02125-w.
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Affiliation(s)
- Jung-Hee Kim
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Korea.
| | - Seonmin Park
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Korea
| | - Hyeongji Lim
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Korea
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Monardo G, Pavese C, Giorgi I, Godi M, Colombo R. Evaluation of Patient Motivation and Satisfaction During Technology-Assisted Rehabilitation: An Experiential Review. Games Health J 2021; 10:13-27. [DOI: 10.1089/g4h.2020.0024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Giulia Monardo
- Service of Psychology and Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Chiara Pavese
- Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Ines Giorgi
- Service of Psychology and Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Marco Godi
- Division of Physical Medicine and Rehabilitation and Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Roberto Colombo
- Service of Bioengineering, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
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Ferreira-Brito F, Alves S, Santos O, Guerreiro T, Caneiras C, Carriço L, Verdelho A. Photo-Realistic Interactive Virtual Environments for Neurorehabilitation in Mild Cognitive Impairment (NeuroVRehab.PT): A Participatory Design and Proof-of-Concept Study. J Clin Med 2020; 9:jcm9123821. [PMID: 33255869 PMCID: PMC7760013 DOI: 10.3390/jcm9123821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
Mild cognitive impairment (MCI) is characterized by cognitive, psychological, and functional impairments. Digital interventions typically focus on cognitive deficits, neglecting the difficulties that patients experience in instrumental activities of daily living (IADL). The global conjecture created by COVID-19 has highlighted the seminal importance of digital interventions for the provision of healthcare services. Here, we investigated the feasibility and rehabilitation potential of a new design approach for creating highly realistic interactive virtual environments for MCI patients’ neurorehabilitation. Through a participatory design protocol, a neurorehabilitation digital platform was developed using images captured from a Portuguese supermarket (NeuroVRehab.PT). NeuroVRehab.PT’s main features (e.g., medium-sized supermarket, the use of shopping lists) were established according to a shopping behavior questionnaire filled in by 110 older adults. Seven health professionals used the platform and assessed its rehabilitation potential, clinical applicability, and user experience. Interviews were conducted using the think-aloud method and semi-structured scripts, and four main themes were derived from an inductive semantic thematic analysis. Our findings support NeuroVRehab.PT as an ecologically valid instrument with clinical applicability in MCI neurorehabilitation. Our design approach, together with a comprehensive analysis of the patients’ past experiences with IADL, is a promising technique to develop effective digital interventions to promote real-world functioning.
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Affiliation(s)
- Filipa Ferreira-Brito
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (O.S.); (A.V.)
- Correspondence:
| | - Sérgio Alves
- LASIGE, Faculdade de Ciências Universidade de Lisboa, 1749-016 Lisboa, Portugal; (S.A.); (T.G.); (L.C.)
| | - Osvaldo Santos
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (O.S.); (A.V.)
- Unbreakable Idea Research, Lda, 2550-426 Painho, Portugal
| | - Tiago Guerreiro
- LASIGE, Faculdade de Ciências Universidade de Lisboa, 1749-016 Lisboa, Portugal; (S.A.); (T.G.); (L.C.)
| | - Cátia Caneiras
- Laboratório de Investigação em Microbiologia na Saúde Ambiental (EnviHealthMicro Lab), Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal;
- Healthcare Department, Nippon Gases Portugal, 2600-242 Vila Franca de Xira, Portugal
| | - Luís Carriço
- LASIGE, Faculdade de Ciências Universidade de Lisboa, 1749-016 Lisboa, Portugal; (S.A.); (T.G.); (L.C.)
| | - Ana Verdelho
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (O.S.); (A.V.)
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
- Neurology Service, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal
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Jin R, Pilozzi A, Huang X. Current Cognition Tests, Potential Virtual Reality Applications, and Serious Games in Cognitive Assessment and Non-Pharmacological Therapy for Neurocognitive Disorders. J Clin Med 2020; 9:E3287. [PMID: 33066242 PMCID: PMC7602094 DOI: 10.3390/jcm9103287] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 12/13/2022] Open
Abstract
As the global population ages, the incidence of major neurocognitive disorders (major NCDs), such as the most common geriatric major NCD, Alzheimer's disease (AD), has grown. Thus, the need for more definitive cognitive assessment or even effective non-pharmacological intervention for age-related NCDs is becoming more and more pressing given that no definitive diagnostics or efficacious therapeutics are currently unavailable for them. We evaluate the current state of the art of cognitive assessment for major NCDs, and then briefly glance ahead at potential application of virtual reality (VR) technologies in major NCD assessment and in cognition training of visuospatial reasoning in a 3D environment, as well as in the alleviation of depression and other symptoms of cognitive disorders. We believe that VR-based technologies have tremendous potentials in cognitive assessment and non-pharmacological therapy for major NCDs.
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Affiliation(s)
| | | | - Xudong Huang
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA; (R.J.); (A.P.)
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Frost E, Porat T, Malhotra P, Picinali L. A Novel Auditory-Cognitive Training App for Delaying or Preventing the Onset of Dementia: Participatory Design With Stakeholders. JMIR Hum Factors 2020; 7:e19880. [PMID: 32996884 PMCID: PMC7557448 DOI: 10.2196/19880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/20/2020] [Accepted: 08/12/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Multiple gaming apps exist under the dementia umbrella for skills such as navigation; however, an app to specifically investigate the role of hearing loss in the process of cognitive decline is yet to be designed. There is a demonstrable gap in the utilization of games to further the knowledge of the potential relationship between hearing loss and dementia. OBJECTIVE This study aims to identify the needs, facilitators, and barriers in designing a novel auditory-cognitive training gaming app. METHODS A participatory design approach was used to engage key stakeholders across audiology and cognitive disorder specialties. Two rounds, including paired semistructured interviews and focus groups, were completed and thematically analyzed. RESULTS A total of 18 stakeholders participated, and 6 themes were identified to inform the next stage of app development. These included congruence with hobbies, life getting in the way, motivational challenge, accessibility, addictive competition, and realism. CONCLUSIONS The findings can now be implemented in the development of the app. The app will be evaluated against outcome measures of speech listening in noise, cognitive and attentional tasks, quality of life, and usability.
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Affiliation(s)
- Emily Frost
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Talya Porat
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Paresh Malhotra
- Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - Lorenzo Picinali
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
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45
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Mantovani E, Zucchella C, Bottiroli S, Federico A, Giugno R, Sandrini G, Chiamulera C, Tamburin S. Telemedicine and Virtual Reality for Cognitive Rehabilitation: A Roadmap for the COVID-19 Pandemic. Front Neurol 2020; 11:926. [PMID: 33041963 PMCID: PMC7522345 DOI: 10.3389/fneur.2020.00926] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/17/2020] [Indexed: 12/26/2022] Open
Abstract
The current COVID-19 pandemic presents unprecedented new challenges to public health and medical care delivery. To control viral transmission, social distancing measures have been implemented all over the world, interrupting the access to routine medical care for many individuals with neurological diseases. Cognitive disorders are common in many neurological conditions, e.g., stroke, traumatic brain injury, Alzheimer's disease, and other types of dementia, Parkinson's disease and parkinsonian syndromes, and multiple sclerosis, and should be addressed by cognitive rehabilitation interventions. To be effective, cognitive rehabilitation programs must be intensive and prolonged over time; however, the current virus containment measures are hampering their implementation. Moreover, the reduced access to cognitive rehabilitation might worsen the relationship between the patient and the healthcare professional. Urgent measures to address issues connected to COVID-19 pandemic are, therefore, needed. Remote communication technologies are increasingly regarded as potential effective options to support health care interventions, including neurorehabilitation and cognitive rehabilitation. Among them, telemedicine, virtual reality, augmented reality, and serious games could be in the forefront of these efforts. We will briefly review current evidence-based recommendations on the efficacy of cognitive rehabilitation and offer a perspective on the role of tele- and virtual rehabilitation to achieve adequate cognitive stimulation in the era of social distancing related to COVID-19 pandemic. In particular, we will discuss issues related to their diffusion and propose a roadmap to address them. Methodological and technological improvements might lead to a paradigm shift to promote the delivery of cognitive rehabilitation to people with reduced mobility and in remote regions.
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Affiliation(s)
- Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Zucchella
- Section of Neurology, Department of Neurosciences, Verona University Hospital, Verona, Italy
| | - Sara Bottiroli
- Giustino Fortunato University, Benevento, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Rosalba Giugno
- Department of Computer Science, University of Verona, Verona, Italy
| | - Giorgio Sandrini
- IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristiano Chiamulera
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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46
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Ning H, Li R, Ye X, Zhang Y, Liu L. A Review on Serious Games for Dementia Care in Ageing Societies. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2020; 8:1400411. [PMID: 32537264 PMCID: PMC7279699 DOI: 10.1109/jtehm.2020.2998055] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/02/2020] [Accepted: 05/23/2020] [Indexed: 11/25/2022]
Abstract
Dementia is a severe disease threatening ageing societies, which not only causes great harm to patients both physically and psychologically but also places a heavy burden on patients’ families. Medications have been used for the treatment of dementia but with little success. However, serious games, as a new form of dementia therapy, stand out from various therapeutic methods and pave the way for dementia treatment. In the field of serious games for dementia care (SGDC) in ageing societies, there exists abundant research related to this topic. While, a detailed review of the development route and a category framework for characteristics of dementia are still needed. Besides, due to the large number of games, it is difficult to select out effective ones. Yet, there is no unified and comprehensive assessment methods for SGDC. So a reliable assessment model is worth studying. In this paper, we review these existing research work on SGDC from two perspectives: (1) the development of SGDC; (2) the different symptoms in different dementia stages. We also propose a comprehensive and professional assessment model of the therapeutic effectiveness of SGDC to compensate for the simplicity of existing assessment methods. Finally, a discussion related to SGDC is presented.
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Affiliation(s)
- Huansheng Ning
- School of Computer and Communication EngineeringUniversity of Science and Technology BeijingBeijing100083China.,Beijing Engineering Research Center for Cyberspace Data Analysis and ApplicationsBeijing100083China
| | - Rongyang Li
- School of Computer and Communication EngineeringUniversity of Science and Technology BeijingBeijing100083China
| | - Xiaozhen Ye
- School of Computer and Communication EngineeringUniversity of Science and Technology BeijingBeijing100083China
| | - Yudong Zhang
- School of InformaticsUniversity of LeicesterLeicesterLE1 7RHU.K
| | - Lu Liu
- School of InformaticsUniversity of LeicesterLeicesterLE1 7RHU.K
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47
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The Use of a Virtual Reality Platform for the Assessment of the Memory Decline and the Hippocampal Neural Injury in Subjects with Mild Cognitive Impairment: The Validity of Smart Aging Serious Game (SASG). J Clin Med 2020; 9:jcm9051355. [PMID: 32384591 PMCID: PMC7290592 DOI: 10.3390/jcm9051355] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022] Open
Abstract
Due to the lack of pharmacological treatment for dementia, timely detection of subjects at risk can be of seminal importance for preemptive rehabilitation interventions. The aim of the study was to determine the usability of the smart aging serious game (SASG), a virtual reality platform, in assessing the cognitive profile of an amnestic mild cognitive impairment (aMCI) population, its validity in discriminating aMCI from healthy controls (HC), and in detecting hippocampal degeneration, a biomarker of clinical progression towards dementia. Thirty-six aMCI and 107 HC subjects were recruited and administered the SASG together with a neuropsychological evaluation. All aMCI and 30 HC subjects performed also an MRI for hippocampal volume measurement. Results showed good usability of the SASG despite the low familiarity with technology in both groups. ROC curve analyses showed similar discriminating abilities for SASG and gold standard tests, and a greater discrimination ability compared to non-specific neuropsychological tests. Finally, linear regression analysis revealed that the SASG outperformed the Montreal cognitive assessment test (MoCA) in the ability to detect neuronal degeneration in the hippocampus on the right side. These data show that SASG is an ecological task, that can be considered a digital biomarker providing objective and clinically meaningful data about the cognitive profile of aMCI subjects.
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Manera V, Abrahams S, Agüera-Ortiz L, Bremond F, David R, Fairchild K, Gros A, Hanon C, Husain M, König A, Lockwood PL, Pino M, Radakovic R, Robert G, Slachevsky A, Stella F, Tribouillard A, Trimarchi PD, Verhey F, Yesavage J, Zeghari R, Robert P. Recommendations for the Nonpharmacological Treatment of Apathy in Brain Disorders. Am J Geriatr Psychiatry 2020; 28:410-420. [PMID: 31495772 DOI: 10.1016/j.jagp.2019.07.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 11/18/2022]
Abstract
Apathy is a common neuropsychiatric syndrome observed across many neurocognitive and psychiatric disorders. Although there are currently no definitive standard therapies for the treatment of apathy, nonpharmacological treatment (NPT) is often considered to be at the forefront of clinical management. However, guidelines on how to select, prescribe, and administer NPT in clinical practice are lacking. Furthermore, although new Information and Communication Technologies (ICT) are beginning to be employed in NPT, their role is still unclear. The objective of the present work is to provide recommendations for the use of NPT for apathy, and to discuss the role of ICT in this domain, based on opinions gathered from experts in the field. The expert panel included 20 researchers and healthcare professionals working on brain disorders and apathy. Following a standard Delphi methodology, experts answered questions via several rounds of web-surveys, and then discussed the results in a plenary meeting. The experts suggested that NPT are useful to consider as therapy for people presenting with different neurocognitive and psychiatric diseases at all stages, with evidence of apathy across domains. The presence of a therapist and/or a caregiver is important in delivering NPT effectively, but parts of the treatment may be performed by the patient alone. NPT can be delivered both in clinical settings and at home. However, while remote treatment delivery may be cost and time-effective, it should be considered with caution, and tailored based on the patient's cognitive and physical profile and living conditions.
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Affiliation(s)
- Valeria Manera
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France; Association Innovation Alzheimer (VM, PR), Nice, France.
| | - Sharon Abrahams
- School of Philosophy, Psychology and Language Sciences (SA), University of Edinburgh, Edinburgh, United Kingdom; Euan MacDonald Centre for Motor Neurone Disease Research (SA, RR), University of Edinburgh, Edinburgh, United Kingdom
| | - Luis Agüera-Ortiz
- Department of Psychiatry (LA-O), Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre & CIBERSAM, Madrid, Spain
| | - François Bremond
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France; INRIA (FB, AK), STARS Team, Sophia Antipolis, France
| | - Renaud David
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France; Centre Hospitalier Universitaire (CHU) de Nice (RD, PR), CMRR, Nice, France
| | - Kaci Fairchild
- Department of Veterans Affairs (KF, JY), VA Palo Alto Health Care System, CA; Department of Psychiatry and Behavioral Sciences (KF, JY), Stanford University School of Medicine, CA
| | - Auriane Gros
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France
| | - Cécile Hanon
- Psychiatric Department, Regional Resource Center of Old Age Psychiatry Corentin-Celton Hospital (CH), Academic Hospital West Paris, AP-HP, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences (MH, PL), John Radcliffe Hospital Oxford OX3 9DU, United Kingdom; Department of Experimental Psychology (MH, PL), University of Oxford, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging (MH, PL), University of Oxford, Oxford, United Kingdom
| | - Alexandra König
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France; INRIA (FB, AK), STARS Team, Sophia Antipolis, France
| | - Patricia L Lockwood
- Nuffield Department of Clinical Neurosciences (MH, PL), John Radcliffe Hospital Oxford OX3 9DU, United Kingdom; Department of Experimental Psychology (MH, PL), University of Oxford, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging (MH, PL), University of Oxford, Oxford, United Kingdom
| | - Maribel Pino
- Broca Living Lab (MP), AP-HP, Paris Descartes University, Sorbonne Paris Cite, Paris, France
| | - Ratko Radakovic
- Euan MacDonald Centre for Motor Neurone Disease Research (SA, RR), University of Edinburgh, Edinburgh, United Kingdom; Faculty of Medicine and Health Sciences (RR), University of East Anglia, Norwich, United Kingdom; Alzheimer Scotland Dementia Research Centre (RR), University of Edinburgh, Edinburgh, United Kingdom
| | - Gabriel Robert
- EA4712 "Comportement et Noyaux Gris Centraux" (GR), Université de Rennes1, France
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO) (AS), Faculty of Medicine, University of Chile, Santiago, Chile; Neuropsychology and Clinical Neuroscience Laboratory (LANNEC) (AS), Physiopathology Department - ICBM, Chile; Neuroscience and East Neuroscience Departments (AS), Faculty of Medicine, University of Chile, Chile; Memory and Neuropsychiatric Clinic (CMYN) Neurology Department (AS), Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile; Servicio de Neurología (AS), Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Florindo Stella
- Laboratório de Neurociências LIM27 (FS), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil; UNESP - Universidade Estadual Paulista (FS), Biosciences Institute, Campus of Rio Claro, Rio Claro, SP, Brazil
| | - Anaïs Tribouillard
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France; ISTR (AT), Institute of Rehabilitation Sciences and Techniques, University of Lyon 1, Lyon, France; Specialised Alzheimer Team (AT), SSIAD Quimper, France
| | | | - Frans Verhey
- Department of Psychiatry and Neuropsychology (FV), Maastricht University, School for Mental Health and Neuroscience (MHeNs), Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Jerome Yesavage
- Department of Veterans Affairs (KF, JY), VA Palo Alto Health Care System, CA; Department of Psychiatry and Behavioral Sciences (KF, JY), Stanford University School of Medicine, CA
| | - Radia Zeghari
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France
| | - Philippe Robert
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France; Association Innovation Alzheimer (VM, PR), Nice, France; Centre Hospitalier Universitaire (CHU) de Nice (RD, PR), CMRR, Nice, France
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49
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Wang S, Yin H, Li G, Jia Y, Leng M, Meng Q, Wang C, Chen L. Detection of Mild Cognitive Impairment Based on Virtual Reality: A Scoping Review. Curr Alzheimer Res 2020; 17:126-140. [PMID: 32183674 DOI: 10.2174/1567205017666200317100421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 12/09/2019] [Accepted: 02/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND To delay the decline in cognition and reduce the incidence of dementia, the precise detection of Mild Cognitive Impairment (MCI) is necessary. The application of Virtual Reality (VR) technology in this detection can overcome the shortage of traditional paper-and-pencil tests. OBJECTIVE This review aimed to summarize the research progress of the detection of MCI using VR. METHODS Eight databases from their inception to November 19, 2019, were systematically searched for studies applying VR in the detection of MCI. A thematic analysis was conducted according to the specific detection purpose and the main corresponding cognitive domains assessed were summarized; characteristics of the VR applications were also summarized. RESULTS Twenty-eight studies were finally included. The detection purposes included discrimination between healthy controls and those with MCI, discrimination between aMCI subtypes, detection of MCI patients at risk of Alzheimer's Disease (AD), and discrimination between MCI and AD. VR tasks assessing spatial memory were applicable for all detection purposes, and the assessment of combinations of memory and executive function seemed more sensitive. Executive function and intentional episodic memory could be assessed to discriminate among healthy controls, individuals with MCI and those with AD. Incidental episodic memory was effective in detecting MCI with hippocampal atrophy. The most common characteristics of the VR applications were the use of semi-immersion, joysticks or gamepad interactions and simple, one-time behavioral assessments. CONCLUSION VR applications are promising in the detection of MCI, but further research is needed for clinical use.
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Affiliation(s)
- Shuo Wang
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130000, China
| | - Huiru Yin
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130000, China
| | - Guichen Li
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130000, China
| | - Yong Jia
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130000, China
| | - Minmin Leng
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130000, China
| | - Qiuyan Meng
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130000, China
| | - Chunyan Wang
- Senior Officials Inpatient Ward, First Hospital of Jilin University, Changchun, 130000, China
| | - Li Chen
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130000, China
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50
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Robert P, Manera V, Derreumaux A, Ferrandez Y Montesino M, Leone E, Fabre R, Bourgeois J. Efficacy of a Web App for Cognitive Training (MeMo) Regarding Cognitive and Behavioral Performance in People With Neurocognitive Disorders: Randomized Controlled Trial. J Med Internet Res 2020; 22:e17167. [PMID: 32159519 PMCID: PMC7097721 DOI: 10.2196/17167] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/16/2020] [Accepted: 02/04/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cognitive and behavioral symptoms are the clinical hallmarks of neurocognitive disorders. Cognitive training may be offered to reduce the risks of cognitive decline and dementia and to reduce behavioral symptoms, such as apathy. Information and communication technology approaches, including serious games, can be useful in improving the playful aspect of computerized cognitive training and providing motivating solutions in elderly patients. OBJECTIVE The objective of this study was to assess the effectiveness of employing the MeMo (Memory Motivation) Web app with regard to cognitive and behavioral symptoms in patients with neurocognitive disorders. METHODS MeMo is a Web app that can be used on any Web browser (computer or tablet). The training activities proposed in MeMo are divided into the following two parts: memory and mental flexibility/attention. The study included 46 individuals (mean age 79.4 years) with a diagnosis of neurocognitive disorders at the Institut Claude Pompidou Memory Center in Nice. This randomized controlled study compared the evolution of cognition and behavior between patients not using MeMo (control group) and patients using MeMo (MeMo group) for 12 weeks (four sessions per week). Patients underwent memory and attention tests, as well as an apathy assessment at baseline, week 12 (end of the training period), and week 24 (12 weeks after the end of the training sessions). In addition, to assess the impact of high and low game uses, the MeMo group was divided into patients who used MeMo according to the instructions (about once every 2 days; active MeMo group) and those who used it less (nonactive MeMo group). RESULTS When comparing cognitive and behavioral scores among baseline, week 12, and week 24, mixed model analysis for each cognitive and behavioral score indicated no significant interaction between testing time and group. On comparing the active MeMo group (n=9) and nonactive MeMo group (n=13), there were significant differences in two attention tests (Trial Making Test A [P=.045] and correct Digit Symbol Substitution Test items [P=.045]) and in the Apathy Inventory (AI) (P=.02). Mixed analysis (time: baseline, week 12, and week 24 × number of active days) indicated only one significant interaction for the AI score (P=.01), with a significant increase in apathy in the nonactive MeMo group. CONCLUSIONS This study indicates that the cognitive and behavioral efficacies of MeMo, a Web-based training app, can be observed only with regular use of the app. Improvements were observed in attention and motivation. TRIAL REGISTRATION ClinicalTrials.gov NCT04142801; https://clinicaltrials.gov/ct2/show/NCT04142801.
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Affiliation(s)
- Philippe Robert
- Cognition Behaviour Technology Lab, Université Côte d'Azur, Nice, France.,Association Innovation Alzheimer, Nice, France.,Centre Memoire, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Valeria Manera
- Cognition Behaviour Technology Lab, Université Côte d'Azur, Nice, France.,Association Innovation Alzheimer, Nice, France
| | - Alexandre Derreumaux
- Association Innovation Alzheimer, Nice, France.,Centre Memoire, Centre Hospitalier Universitaire de Nice, Nice, France
| | | | - Elsa Leone
- Centre Memoire, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Roxane Fabre
- Departement de Santé Publique, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Jeremy Bourgeois
- Centre Memoire, Centre Hospitalier Universitaire de Nice, Nice, France
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