A Review on Serious Games for Dementia Care in Ageing Societies

Outcome measurement of cognitive impairment and dementia in serious digital games: a scoping review

PURPOSE

Dementia prevalence is increasing worldwide. With the emergence of digital rehabilitation, serious digital games are a potential tool to maintain and monitor function in people living with dementia. It is unclear however whether games can measure changes in cognition. We conducted a scoping review to identify the types of outcomes measured in studies of serious digital games for people with dementia and cognitive impairment.

METHODS

We included primary research of any design including adults with cognitive impairment arising from dementia or another health condition; reported data about use of serious digital games; and included any cognitive outcome. We searched Medline (via EBSCO), PsycInfo, CINAHL, Web of Science, from inception to 4th March 2024 and extracted study characteristics.

RESULTS

We reviewed 5899 titles, including 25 full text studies. We found heterogeneity in domains and measures used: global cognition (n = 15), specific cognitive processes (n = 13), motor function (n = 5), mood (n = 6), activities of daily living (n = 5), physiological processes (n = 4) and quality of life (n = 2). Use of outcome measurement tools was inconsistent; the most frequently used measures were the Montreal Cognitive Assessment (n = 8), the Mini-Mental State Examination (n = 7), and the Trail Making Test (n = 7). Nine studies used in-game measures, most of which were related to game performance.

CONCLUSION

We found very few studies with assessment of cognition within the game. Studies of serious games for people with dementia and cognitive impairment should develop digital outcome tools based on recommendations in Core Outcome Sets, to increase consistency between studies.

German version of the engagement of a person with dementia scale: translation and initial application experiences

BACKGROUND

Assessment tools for engagement in people with dementia often rely on self-reported measures which restricts their use in people with severe cognitive limitations. The Engagement of a Person with Dementia Scale (EPWDS) is a valid and reliable tool to assess behavioral and emotional expressions and responses of engagement in people with dementia through observation; however, the EPWDS is not yet available in the German language.

OBJECTIVES

1) Translation and cross-culturally adaptation of the original English version of the EPWDS into the German language (EPWDS-GER) and 2) to gain insights into assessing data with the newly developed instrument.

MATERIAL AND METHODS

International recommendations were followed to cross-culturally adapt the English original version of the EPWDS into the German language in 5 steps: translation by three independent translators, synthesis, back translation, expert committee review (N = 10) and test of the prefinal version in nursing practice (N = 22) on a 5-point Likert scale to assess comprehensibility, practicability and suitability of the EPWDS-GER.

RESULTS

The EPWDS-GER achieved high ratings for the five subscales on ease of understanding, ease of answering and importance of single items for assessing engagement. Average agreement for all items ranged from 3.86 to 4.43 (SD = 0.68-1.29). Overall rating of EPWDS-GER resulted in a mean agreement of 4.18 (SD = 0.73) for suitability and of 4.09 (SD = 0.81) for practicability.

CONCLUSION

The EPWDS-GER is an easy to use tool for measuring behavioral and emotional expressions and responses of engagement of a person with dementia and can now be utilized in clinical practice and research.

The limitations and challenges in the assessment of executive dysfunction associated with real-world functioning: The opportunity of serious games

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.

Effects of the Tovertafel® on apathy, social interaction and social activity of people with dementia in long-term inpatient care: results of a non-controlled within-subject-design study

Introduction

Tovertafel® is a VR-based serious game for dementia care (SGDC) that aims to stimulate residents affected by dementia in nursing homes, promote social and cognitive skills and reduce apathy. The aim of this study is to investigate the effects of using Tovertafel® on apathy, social interaction and social activity of people with dementia (PWD) in long-term inpatient care in Germany.

Methods

In this monocentric intervention study, 25 residents of an inpatient long-term care facility with moderate or severe dementia had two weekly applications of Tovertafel® over a period of 8 weeks. Effects on the residents' social interaction and activity were recorded before (T1), during (T2) and 1 h after (T3) each intervention using the Engagement of a Person with Dementia Scale (EPWDS). The degree of apathy was assessed using the Apathy Evaluation Scale (AES). Effects of Tovertafel® were examined using a simple repeated measures analysis of variance (ANOVA).

Results

Thirteen residents with moderate (52%) and 12 residents with severe dementia (48%) were included. Results showed that residents' apathy changed over the course of the trial and was partially reduced. ANOVA revealed significant changes in the positive expression of social participation in the overall group between individual observation times (p < 0.001; T1: MW = 2.67, SD = 1.352; T2: MW = 3.66, SD = 1.365; T3: MW = 3.10, SD = 1.300) and a significantly lower negative expression of social participation at T2 (MW = 1.09, SD = 0.358) than at T1 (MW = 1.19, SD = 0.579; p = 0.028). There was a significantly higher positive expression of behavioral involvement in the overall group at T3 (MW = 1.17, SD = 0.552) than at T1 (p = 0.003) or T2 (p = 0.045). Analyses did not find any significant interaction between observation times and degree of dementia.

Discussion

Results of the study show that the use of Tovertafel® over a period of 2 months had significant effects on apathy, social activity and social interaction in people with moderate or severe dementia. Symptoms of apathy could be reduced and social interaction and activity increased. However, due to limitations of the study design and special circumstances of the COVID-19 pandemic situation, findings might be overestimated and must be interpreted with care. Further research is necessary.

Validation and comparison of virtual reality and 3D mobile games for cognitive assessment against ACE-III in 82 young participants

Current medical and clinical ecosystem for dementia detection is inadequate for its early detection. Traditional cognitive assessments are introduced after cognitive impairment has begun to disrupt the real-world functioning of the person. Moreover, these tools are paper-pen based and fail to replicate the real-world situations wherein the person ultimately lives, acts and grows. The lack of tools for early detection of dementia, combined with absence of reliable pharmacological cure compound the problems associated with dementia diagnosis and care. Advancement of technology has facilitated early prediction of disease like cancer, diabetes, heart disease, but hardly any such translation has been observed for dementia or cognitive impairment. Given this background, we examine the potential of Virtual Reality (VR) and 3D Mobile-based goal-oriented games for cognitive assessment. We evaluate three games (2 in VR, one in mobile) among 82 young participants (aged 18-28 years) and compare and contrast the game-based results with their Addenbrooke Cognitive Examination (ACE-III) scores. Three main analysis methods are used: Correlative, Z-score and Regression analysis. Positive correlation was observed for ACE-III and game-based scores. Z-scores analysis revealed no difference between the two scores, and stronger statistical significance was found between game scores and cognitive health factors like age, smoking compared to ACE-III. Specific game performances also revealed about real-world traits of participants, like hand-use confusion and direction confusion. Results establish the plausibility of using goal-oriented games for more granular, time-based, and functional cognitive assessment.

Effects of Electronic Serious Games on Older Adults With Alzheimer's Disease and Mild Cognitive Impairment: Systematic Review With Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Serious games (SGs) are nonpharmacological interventions that are widely applied among older adults. To date, no evidence has been published regarding the effect of digital SGs on cognitive ability, daily behavioral capacity, or depression in older adults with Alzheimer's disease (AD) and mild cognitive impairment (MCI).

OBJECTIVE

This study aimed to assess the effect of SGs on older adults with AD and MCI by summarizing and pooling the results of previous studies.

METHODS

This meta-analysis examined the effectiveness of digital SGs in improving cognitive ability, enhancing daily behavioral capacity, and alleviating depression in older adults with AD and MCI. We searched the following databases up to December 31, 2023, to identify relevant high-quality randomized controlled trials (RCTs): PubMed, Embase, Web of Science, Scopus, and Cochrane Library. Stata 15.1 and Review Manager 5.3 were used to screen the 14 studies, extract data, code the data, and perform meta-analysis. Mean differences and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. Eligibility criteria were developed in accordance with the Population, Intervention, Comparison, Outcomes, and Study Design framework: (1) population (older adults with AD and MCI), (2) intervention (digital SG intervention), (3) comparison (digital SG intervention vs routine health care), (4) outcomes (cognitive ability, daily behavioral capacity, and depression), and (5) study or research design (RCT). Sensitivity analysis was performed, and a funnel plot was constructed.

RESULTS

From January 2017 to December 2023, we enrolled 714 individuals across 14 RCTs, with 374 (52.4%) in the severe game group using digital SGs and 340 (47.6%) in the control group using traditional methods. The results of our meta-analysis indicated that using digital SGs in older adults with AD and MCI is more effective than traditional training methods in several key areas. Specifically, digital SG therapy significantly increased cognitive ability, as found in the Mini-Mental State Examination (SMD 2.11, 95% CI 1.42-2.80; P<.001) and the Montreal Cognitive Assessment (SMD 2.75, 95% CI 1.98-3.51; P<.001), significantly increased daily behavioral capacity (SMD 0.53, 95% CI 0.06-0.99; P=.03), and significantly reduced depression (SMD -2.08, 95% CI -2.94 to -1.22; P<.001) in older adults with AD and MCI. No publication bias was detected based on the results of Begg and Egger tests.

CONCLUSIONS

Digital SGs offer a viable and effective nonpharmacological approach for older adults with AD and MCI, yielding better results compared to traditional formats. However, caution is warranted in interpreting these findings due to limited RCTs, small sample sizes, and low-quality meta-analyzed evidence.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews: CRDCRD42023486090; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=486090.

Efficacy of serious games for chronic pain management in older adults: A systematic review and meta-analysis

AIMS AND OBJECTIVES

To synthesise and appraise the evidence of the efficacy of serious games in reducing chronic pain among older adults.

BACKGROUND

Chronic pain in older adults generally results in a substantial handicap due to decreased mobility, exercise avoidance and various concerns that affect their overall quality of life. While serious games have been widely used as a pain management approach, no reviews have thoroughly examined their efficacy for chronic pain management in older adult populations.

DESIGN

A systematic review and meta-analysis.

METHODS

The CINAHL, the Cochrane Library, Embase, Medline, PubMed and Web of Science databases were comprehensively searched to find articles published from their inception until 17 April 2023. RoB-2 was used to assess the risk of bias in the included studies. The efficacy of serious games for pain management in older individuals was investigated using pooled standardised mean differences (SMDs) in pain reduction using a random effect model.

RESULTS

The meta-analysis comprised nine randomised controlled trials that included 350 older adult patients with pain. Serious games effectively alleviated pain in this group (pooled SMD = -0.62; 95% confidence interval: -1.15 to -0.10), although pain-related disability and fear require further investigation.

CONCLUSIONS

Serious games tended to effectively reduce pain in this older adult group; however, due to a lack of randomised controlled trials, the analysis found lower effectiveness in reducing pain-related disability and fear. Further studies are accordingly required to confirm these findings.

RELEVANCE TO CLINICAL PRACTICE

The findings of the study emphasise the importance of serious games to increase the motivation of older adults to exercise as one of the safe and extensively used pain management strategies. Serious games that effectively reduce chronic pain in older adults are characterised as consisting of diverse physical activities delivered through consoles, computer-based activities and other technologies.

PATIENT OR PUBLIC CONTRIBUTIONS

Serious games are recommended as being potentially useful and practical for reducing pain in older adults.

Virtual reality and cognitive rehabilitation for older adults with mild cognitive impairment: A systematic review

Virtual Reality (VR) has been gaining increasing attention as a potential ecological and effective intervention system for treating Mild Cognitive Impairment (MCI). However, it remains unclear the efficacy and effectiveness of VR-based cognitive rehabilitation therapy (VR-CRT) in comparison with cognitive rehabilitation therapy (CRT). Consequently, a systematic review on Pubmed, Scopus, PsycInfo, and Web Of Science was conducted to assess the state of the art of the literature published between 2003 and April 2023. Only articles that adopted CRT as control group and that included some measure of at least one domain among overall cognitive function, executive function and functional status were included. Participants needed to be older adults aged 65 or over with a diagnosis of MCI. The risk of bias and the quality of evidence were assessed using the Version 2 of the Cochrane risk-of-bias tool for randomized trials. Initially, 6503 records were considered and screened after removing duplicates (n = 1321). Subsequently, 81 full texts were assessed for eligibility. Four articles met the inclusion criteria but 2 of them were merged as they were describing different outcomes of the same research project. Consequently, 3 overall studies with a total of 130 participants were included in the final analysis. Due to the high heterogeneity in the methodology and outcome measures employed, it was not possible to conduct a meta-analysis. Included studies used semi-immersive (k = 2) and full-immersive (k = 1) VR systems in their research. Two articles evaluated overall cognitive function through the MoCA together with specific tests for executive functions (n = 69), while one study adopted a comprehensive neuropsychological battery to evaluate both cognitive function and executive function (n = 61). Finally, one study evaluated functional status through instrumental activities of daily living (n = 34). A However, the limited number of studies, the small sample size, and the potential issues with the quality and methodology of these studies that emerged from the risk of bias assessment may raise doubts about the reliability of their results. Nevertheless, although scarce, results of the present review suggest that VR-CRT may be paramount in treating MCI for its additional ecological and adaptive advantages, as all of the studies highlighted that it was at least as effective as conventional CRT for all the outcome measures. Therefore, more rigorous research that compares VR-CRT and CRT is needed to understand the degree to which VR-CRT is effective with older adults with MCI and the potential role of immersion to influence its efficacy. Indeed, these preliminary findings highlight the need for the development of standardized VR protocols, as the integration of such technology into clinical practice may help improve the quality of life and cognitive outcomes for this growing demographic.

"It's Another Feather in My Hat"-Exploring Factors Influencing the Adoption of Apps With People Living With Dementia

INTRODUCTION

With the growing interest and availability of mobile applications (apps) for people living with dementia, it is desirable to have a broader insight into how technology adoption may be further improved. This paper aims to explore the factors influencing adoption of mobile applications for people living with dementia.

METHODS

The recruitment of participants was facilitated through a dementia advocacy group of people living with dementia. A focus group design was applied to elicit discussion and to explore divergent views on the topic. The data was analysed using thematic analysis.

FINDINGS

The 15 individuals who participated in this study comprised of seven women and eight men within the age range of 60-90 years. This study reports key findings pertaining to the views and experiences of using mobile apps. Data analysis revealed the following four distinct themes; (Theme 1: Living with dementia)-"That's the difficulty there even with apps or anything else." (Theme 2: Motivation)- "It makes me feel good. I feel a little with it [laughs], that its not all gone in there" (Theme 3: Fears and Concerns)- "Can somebody else get into your personal memories?" (Theme 4- Support)- "So it's important that we have that support". Together these themes encapsulate the most influential aspects, as highlighted by the participants influencing the acceptance and adoption of apps.

CONCLUSION

This paper explores the barriers and facilitators to app acceptance and adoption. This includes the importance of "feel good moments" and positive experiences, challenges associated with living with dementia, the importance of ongoing support, and security of the user's information. This study adds to what is already known by capturing the views and experiences of people living with dementia in relation to the factors influencing the adoption of apps.

Age and sex effects on Super G performance are consistent across internet devices

There have been recent advances in the application of online games that assess motor skill acquisition/learning and its relationship to age and biological sex, both of which are associated with dementia risk. While this online motor learning assessment (called Super G), along with other computer-based cognitive tests, was originally developed to be completed on a computer, many people (including older adults) have been shown to access the internet through a mobile device. Thus, to improve the generalizability of our online motor skill learning game, it must not only be compatible with mobile devices but also yield replicable effects of various participant characteristics on performance relative to the computer-based version. It is unknown if age and sex differentially affect game performance as a function of device type (keyboard versus touchscreen control). Thus, the purpose of this study was to investigate if device type modifies the established effects of age and sex on performance. Although there was a main effect of device on performance, this effect did not alter the overall relationship between performance vs. age or sex. This establishes that Super G can now effectively be extended to both computer and mobile platforms to further test for dementia risk factors.

A review of the factors influencing adoption of digital health applications for people living with dementia

Objective

Researchers have used various theories and models to understand technology adoption, however, with the growing interest and availability of mobile applications (apps) for people living with dementia, it is desirable to have a broader insight into how technology adoption may be further improved. This paper aims to explore the factors influencing the adoption of digital health applications for people living with dementia and add to the current literature on this topic.

Methods

Searches were conducted in CINHAL, Web of Science, Psych Info, ProQuest Health and Medical, IEEE Xplore and Scopus. Citation searching and handsearching were used in the identification of other studies.

Results

Following an assessment of relevancy, nine studies remained and are included within this review. Methodological quality was assessed using The Mixed Methods Appraisal Tool (MMAT). A thematic analysis was used for the data synthesis of included studies. Each study reported on different types of apps.

Conclusion

From the synthesis of included studies, four analytic themes were identified; Theme 1: Personal and contextual factors; Theme 2: Perceived value and benefit; Theme 3: Design and content of app; and Theme 4: Digital Literacy and Confidence. People are diverse and so are their reasons for the adoption of apps. These findings provide an insight into the range of factors that impact the adoption of apps for people living with dementia. Understanding the factors that impact the adoption of mobile applications is critical to their success. These findings can be beneficial for app developers and for people living with dementia and their carers.

Effects of Home Based Serious Game Training (Brain Talk™) in the Elderly With Mild Cognitive Impairment: Randomized, a Single-Blind, Controlled Trial

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.

A systematic review and meta-analysis of randomized controlled trials on the effect of serious games on people with dementia

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.

PSTCNN: Explainable COVID-19 diagnosis using PSO-guided self-tuning CNN

Since 2019, the coronavirus disease-19 (COVID-19) has been spreading rapidly worldwide, posing an unignorable threat to the global economy and human health. It is a disease caused by severe acute respiratory syndrome coronavirus 2, a single-stranded RNA virus of the genus Betacoronavirus. This virus is highly infectious and relies on its angiotensin-converting enzyme 2-receptor to enter cells. With the increase in the number of confirmed COVID-19 diagnoses, the difficulty of diagnosis due to the lack of global healthcare resources becomes increasingly apparent. Deep learning-based computer-aided diagnosis models with high generalisability can effectively alleviate this pressure. Hyperparameter tuning is essential in training such models and significantly impacts their final performance and training speed. However, traditional hyperparameter tuning methods are usually time-consuming and unstable. To solve this issue, we introduce Particle Swarm Optimisation to build a PSO-guided Self-Tuning Convolution Neural Network (PSTCNN), allowing the model to tune hyperparameters automatically. Therefore, the proposed approach can reduce human involvement. Also, the optimisation algorithm can select the combination of hyperparameters in a targeted manner, thus stably achieving a solution closer to the global optimum. Experimentally, the PSTCNN can obtain quite excellent results, with a sensitivity of 93.65%±1.86%, a specificity of 94.32%±2.07%, a precision of 94.30%±2.04%, an accuracy of 93.99%±1.78%, an F1-score of 93.97%±1.78%, Matthews Correlation Coefficient of 87.99%±3.56%, and Fowlkes-Mallows Index of 93.97%±1.78%. Our experiments demonstrate that compared to traditional methods, hyperparameter tuning of the model using an optimisation algorithm is faster and more effective.

Bioactive Compounds and Their Derivatives: An Insight into Prospective Phytotherapeutic Approach against Alzheimer’s Disease

Alzheimer's disease (AD) is a common neurodegenerative brain disorder that causes cellular response alterations, such as impaired cholinergic mechanism, amyloid-beta (Aβ) AD aggregation, neuroinflammation, and several other pathways. AD is still the most prevalent form of dementia and affects many individuals across the globe. The exact cause of the disorder is obscure. There are yet no effective medications for halting, preventing, or curing AD's progress. Plenty of natural products are isolated from several sources and analyzed in preclinical and clinical settings for neuroprotective effects in preventing and treating AD. In addition, natural products and their derivatives have been promising in treating and preventing AD. Natural bioactive compounds play an active modulatory role in the pathological molecular mechanisms of AD development. This review focuses on natural products from plant sources and their derivatives that have demonstrated neuroprotective activities and maybe promising to treat and prevent AD. In addition, this article summarizes the literature pertaining to natural products as agents in the treatment of AD. Rapid metabolism, nonspecific targeting, low solubility, lack of BBB permeability, and limited bioavailability are shortcomings of most bioactive molecules in treating AD. We can use nanotechnology and nanocarriers based on different types of approaches.

Effect of exergaming on wellbeing of residents in a nursing home: a single blinded intervention study

Introduction

To improve the quality of life in nursing homes, meaningful activities and social contact are indispensable. Exergames can play a role addressing these needs.

Methods

In a randomized single blinded controlled intervention study, we investigated the effect of playing exergames on general wellbeing, fun and on social interaction.

Results

Thirty-five residents participated: 18 residents took part in the intervention group and 17 in the control group. The median mental wellbeing score of the intervention group increased from 42/50 to 45. The median sleep score of the intervention increased from 23/30 to 28. The median pain score of the intervention group improved from 18/20 to 20. The median score on subjective cognition increased from 24/30 to 26 while the mean scores on the objective assessment decreased from 1.8/2 to 1.7. Coaches gave an average fun score of 8.9/10 and an average intensity of exercise score of 11.6/20. Residents and coaches appreciated the social contact. Coaches reported a high feasibility (average of 4.1/5) but a low accessibility and a high intensity of supervision.

Conclusions

Exergaming is a feasible and pleasant complement to the usual activities with a positive impact on wellbeing, sleep, pain, and perceived cognition. Future research should focus on vulnerable groups and aim to develop a study in an implementation design.

Using Patient and Public Involvement to Elicit Opinion on Cognitive Training Games and Assessment Technologies for Dementia (Preprint)

Background

Cognitive training and assessment technologies offer the promise of dementia risk reduction and a more timely diagnosis of dementia, respectively. Cognitive training games may help reduce the lifetime risk of dementia by helping to build cognitive reserve, whereas cognitive assessment technologies offer the opportunity for a more convenient approach to early detection or screening.

Objective

This study aims to elicit perspectives of potential end users on factors related to the acceptability of cognitive training games and assessment technologies, including their opinions on the meaningfulness of measurement of cognition, barriers to and facilitators of adoption, motivations to use games, and interrelationships with existing health care infrastructure.

Methods

Four linked workshops were conducted with the same group, each focusing on a specific topic: meaningful improvement, learning and motivation, trust in digital diagnosis, and barriers to technology adoption. Participants in the workshops included local involvement team members acting as facilitators and those recruited via Join Dementia Research through a purposive selection and volunteer sampling method. Group activities were recorded, and transcripts were analyzed using thematic analysis with a combination of a priori and data-driven themes. Using a mixed methods approach, we investigated the relationships between the categories of the Capability, Opportunity, and Motivation–Behavior change model along with data-driven themes by measuring the φ coefficient between coded excerpts and ensuring the reliability of our coding scheme by using independent reviewers and assessing interrater reliability. Finally, we explored these themes and their relationships to address our research objectives.

Results

In addition to discussions around the capability, motivation, and opportunity categories, several important themes emerged during the workshops: family and friends, cognition and mood, work and hobbies, and technology. Group participants mentioned the importance of functional and objective measures of cognitive change, the social aspect of activities as a motivating factor, and the opportunities and potential shortcomings of digital health care provision. Our quantitative results indicated at least moderate agreement on all but one of the coding schemes and good independence of our coding categories. Positive and statistically significant φ coefficients were observed between several coding themes between categories, including a relatively strong positive φ coefficient between capability and cognition (0.468; P<.001).

Conclusions

The implications for researchers and technology developers include assessing how cognitive training and screening pathways would integrate into existing health care systems; however, further work needs to be undertaken to address barriers to adoption and the potential real-world impact of cognitive training and screening technologies.

International Registered Report Identifier (IRRID)

RR2-10.1007/978-3-030-49065-2_4

Telerehabilitation for Geriatrics

Advancements in medical science and technology, along with global increases in life expectancy, are changing the way health care services are delivered to the aging society. Telerehabilitation refers to rehabilitation services involving evaluation and treatment. It is an attractive option for older adults who may have multiple comorbidities. Limited access to in-person services and the concern about potential exposure to severe acute respiratory syndrome coronavirus-2 during this pandemic accelerated the implementation of telerehabilitation. This article review the scope, need, and implementation of telehealth and telerehabilitation in the aging population from the perspective of clinicians, patients, and caregivers.

Digital Gaming Interventions in Psychiatry: Evidence, Applications and Challenges

Human evolution has regularly intersected with technology. Digitalization of various services has brought a paradigm shift in consumerism. Treading this path, mental health practice has gradually moved to Digital Mental Health Interventions (DMHI), to improve service access and delivery. Applied games are one such innovation that has gained recent popularity in psychiatry. Based on the principles of gamification, they target psychosocial and cognitive domains, according to the deficits in various psychiatric disorders. They have been used to deliver cognitive behaviour therapy, cognitive training and rehabilitation, behavioural modification, social motivation, attention enhancement, and biofeedback. Research shows their utility in ADHD, autistic spectrum disorders, eating disorders, post-traumatic stress, impulse control disorders, depression, schizophrenia, dementia, and even healthy aging. Virtual reality and artificial intelligence have been used in conjunction with gaming interventions to improvise their scope. Even though these interventions hold promise in engagement, ease of use, reduction of stigma, and bridging the mental-health gap, there are pragmatic challenges, especially in developing countries. These include network quality, infrastructure, feasibility, socio-cultural adaptability, and potential for abuse. Keeping this in the background, this review summarizes the scope, promise, and evidence of digital gaming in psychiatric practice, and highlights the potential caveats in their implementation.