Jigsaw Puzzling Taps Multiple Cognitive Abilities and Is a Potential Protective Factor for Cognitive Aging

Functional perspectives in mental jigsaw puzzles: Insights from eye-tracking, questionnaire, and behavioral data

This study investigated cognitive strategies in mental jigsaw puzzles, integrating mental rotation and translation with a focus on directionality and detour arguments. Unlike object mental rotation tasks, these puzzles introduced physical constraints, revealing systematic directional tendencies in both eye movements and subjective reports. Specifically, smaller protruding objects were consistently directed toward larger indented objects. This was accompanied by longer completion times and reduced linearity, paralleling strategies used in physical puzzle-solving. Behavioral asymmetries observed in the puzzles unexpectedly mirrored those found in object mental rotation tasks. While controlling for mental motion directions showed comparable completion times at 300° between tasks, the study did not fully clarify the role of detours, indicating the need for further research.

Evaluating the Effectiveness of Jigsaw-Based Learning in Medical Education: Students' Perceptions and Feedback

Background The medical education system periodically revises the teaching-learning strategies. Medical students find it difficult to cope with pre-clinical subjects due to limited patient exposure and traditional didactic lectures. This study introduced a jigsaw method for revising biochemistry topics and assessed first-year medical students' perceptions and feedback on its effectiveness and implementation in medical education. Materials and methods This cross-sectional study enrolled 80 students for a jigsaw exercise on the topic "carbohydrate chemistry." Students were divided into four groups guided by a moderator. Further subgroups were created in each group, and each student was assigned a subtopic in "carbohydrate chemistry." Students with common subtopics were regrouped to self-study the provided study material. Students then reassembled in their original subgroups to teach their respective subtopics to their peers. Thus, it enables all students of a subgroup to learn all subtopics of the main topic in a short time as an interactive team. In the end, students filled out a feedback form providing their opinion about the effectiveness of the exercise. Results Out of 80 students, 71 responded to the survey, yielding an 88.75% response rate. Most students opined that the jigsaw exercise enhanced their understanding (N = 59, 83.1%), clarified concepts (N = 54, 76.1%), improved retention (N = 55, 77.5%), and communication skills (N = 59, 83.1%) and that it is a good method to revise topics (N = 58, 81.7%). Most supported its inclusion in the medical curriculum (N = 56, 78.9%) and recommended frequent use (N = 49, 69%). Conclusion The jigsaw exercise seems promising for improving students' understanding, clearing doubts, enhancing retention and communication skills, and fast revision. The authors recommend its inclusion in the curriculum to facilitate self-directed active learning.

Effectiveness of jigsaw puzzle assisted visual reinforcement technique on toothbrushing knowledge, practices and clinical parameters of hearing and speech-impaired adolescents: A single-blind randomized controlled trial

BACKGROUND

Oral health education (OHE) for hearing and speech-impaired (HSI) adolescents relies heavily on sign language. However, it is not effective in conveying oral health concepts due to communication barriers, resulting in suboptimal oral health outcomes. This study aims to evaluate the impact of the jigsaw puzzle assisted visual reinforcement (JPVR) technique on toothbrushing knowledge, practices, and clinical parameters among HSI adolescents.

METHODS

The study was carried out as a single-blind randomized controlled trial in a public school in Belagavi, India for a period of three months. The study included 95 participants who were randomly allocated into two groups. One group received sign language with JPVR technique, and the other group received only sign language. A self-designed 15-item closed-ended questionnaire (Cronbach's alpha value of 0.88; content validity ratio = 0.85) was developed to assess the knowledge, and practices at baseline and 3 months. Plaque and gingival indices were also recorded.

RESULTS

At the end of 3 months, the knowledge gained and practices improved in JPVR group were significantly higher compared to sign language group (p = .001). The mean plaque score was significantly lower in JPVR group than that in the sign language group (p = .001); however, gingival index did not show any statistically significant difference at 3 months.

CONCLUSION

The current study demonstrated that OHE utilizing JPVR technique led to significant improvements in toothbrushing knowledge, practices, and plaque scores compared to that of conventional sign language. This promising strategy has the potential to be cost-effective and does not incorporate specialized sign language training for health professionals.

Jigsaw as a Revision Module for Enhancing Learning in Biochemistry Among First-Year Medical Students

Aim Biochemistry includes the elaborate study of various biomolecules and intricate mechanisms that first-year medical students find difficult to understand and retain when taught through didactic lectures. Therefore, this study aims to test the effectiveness of jigsaw as a revision module in increasing the knowledge and retention capacity of students in Biochemistry. Materials and methods Eighty students were enrolled in the study. An MCQ-based pre-test was administered to students after a biochemistry topic was taught through a didactic lecture. Students were then divided into four groups led by a moderator. Each moderator divided their group of 20 students into four subgroups. Five subtopics from the lecture were assigned to each subgroup (one topic per student). The students receiving the same subtopic from all subgroups were teamed together to collectively study the subtopic within 30 minutes. Students then dispersed and joined their original subgroups to teach their subtopics to their peers (time allowed: 50 minutes). Thus, each student eventually learned five subtopics in a short period through self-directed learning. Post-tests and delayed post-tests were conducted after the jigsaw activity. Responses were analyzed through student t-tests and correlations. Results The post-test and delayed post-test scores were significantly higher than the pre-test scores, indicating an increase in knowledge and retention of information, respectively. The gain in scores was significantly higher in the "non-high achiever" vs. "high-achiever" group indicating that the jigsaw benefitted average and below-average students. The pre-test, post-test, and delayed post-test scores showed significant correlations. Conclusions Jigsaw was found to be an effective revision exercise in biochemistry in improving the quality of medical education.

A multimodal non-pharmacological intervention for persons with dementia in nursing homes: a multicentre randomised controlled trial

BACKGROUND

Persons with dementia in nursing homes often experience cognitive decline (e.g., memory and visuospatial/construction problems), behavioural and psychological symptoms of dementia (BPSD), and impaired activities of daily living. Therefore, comprehensive interventions for this population are needed. We assessed whether a multimodal non-pharmacological intervention improved cognitive functions, BPSD, and activities of daily living in persons with dementia in nursing homes.

METHODS

This was a multicentre randomised controlled trial. Participants were 40 persons with dementia (38 women) living in four nursing homes (intervention group = 21; control group = 19). The intervention was conducted for 8 weeks, followed by an 8-week follow-up. Outcome measures were scores on the Japanese version of the Neurobehavioral Cognitive Status Examination Five and the ABC Dementia Scale. In the analysis, parameters were estimated using Bayesian statistics and a mixed-effects linear regression model for the change in each outcome measure.

RESULTS

There were significant between-group differences in changes in ABC Dementia Scale BPSD scores (8-week: posteriori median = 1.66, 95% Bayesian confidence interval 0.36-3.01; 16-week: median = 2.37, 95% Bayesian confidence interval 0.05-4.65). There was also a significant between-group difference in changes in Neurobehavioral Cognitive Status Examination Five constructional ability scores (16-week: median = 0.93, 95% Bayesian confidence interval 0.35-1.50).

CONCLUSION

This intervention may have a maintenance and improvement effect on BPSD in persons with dementia in nursing homes, and a sustained effect on constructional ability post-intervention. The intervention may be useful and easy to apply in practice.

Self-reported and physiological stress indicators and the moderating role of the Dark Tetrad in violent and non-violent gaming

Playing non-violent video games has been shown to reduce perceived levels of stress (Pallavicini et al., 2021). Does this effect also apply to violent game content? As findings suggest a particular preference for such games among people with certain personality traits, such as the Dark Tetrad (i.e., Machiavellianism, everyday sadism, subclinical psychopathy, and narcissism; e.g., Bonfá-Araujo et al., 2022; Greitemeyer, 2015; Greitemeyer & Sagioglou, 2017) do these traits influence the stress they feel? In the present lab experiment, potential stress-reducing effects of violent and non-violent video games were compared to a control condition (solving a jigsaw puzzle). Cortisol levels, heart rate variability (HRV), and self-reported stress levels were assessed before, during, and after gameplay. Irrespective of game condition, playing video game passages decreased cortisol levels, a typical indicator of stress. In addition, playing violent games led to a significant decrease in certain HRV indicators (i.e., ratio of low frequency power to high-frequency power), thus providing additional support for stress relief. In contrast, trying to solve a jigsaw puzzle did not result in stress reduction. Most results involving the Dark Tetrad traits showed null findings. However, participants with greater Dark Tetrad expressions experienced more relaxation after violent gameplay while showing greater stress reaction after trying to solve a jigsaw puzzle. The present results indicate that playing violent or non-violent video games can lead to physiological relaxation-an important finding for future research on the potential of video games for stress relief interventions.

Sex differences in visuospatial cognition- a female advantage in jigsaw puzzle solving

Mentally visualizing objects, understanding relationships between two- or three- dimensional objects, and manipulating objects in space are some examples of visuospatial abilities. Numerous studies have shown that male participants outperform female participants in visuospatial tasks, particularly in mental rotation. One exception is solving jigsaw puzzles. Performance by seven- to eight-year-old girls was found to be superior to that of boys of the same age (Kocijan et al. 2017). No study, however, has confirmed this finding in an adult population, where sex differences are often detectable. Seventy-nine young adult participants were given four different jigsaw puzzles and the Shepard and Metzler mental rotation test (MRT) with two main goals: First, to investigate possible sex differences in jigsaw puzzle solving, and second, to explore a potential relationship between mental rotation and jigsaw puzzle solving. We hypothesized that female participants would outperform males in the jigsaw puzzles but males would outperform females in the MRT. The findings confirmed this hypothesis. Notably, the male performance in jigsaw puzzle solving was attributed to their sex and mediated by their higher MRT scores. These results yielded two key insights. First, they indicate a dissociation between these two visuospatial abilities, jigsaw puzzle solving and mental rotation; and second, female and male participants capitalize on their distinct cognitive strengths when solving visuospatial tasks.

Transmogrifying Anatomy Learning by Kaizen Strategies and Game-Based Education

INTRODUCTION

The study explores the significance of continuous improvement through Kaizen in the evolving landscape of anatomy education. In this study, our objectives were twofold: 1) to assess the effectiveness of incorporating games in the first-year medical curriculum for reinforcing anatomy knowledge, and 2) to explore whether game-based sessions elicit improved student responses in the learning of anatomy.

METHODOLOGY

A total of 100 first-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students at All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India, were exposed to game-based learning which involved six rounds: acronym mnemonics (Redolent), jigsaw puzzle solving (Dumbfound), Filling gaps in concept maps (Blogging), Connecting images (Kinship), case scenario creation (Penman), and rapid-fire round (Rattling).

RESULTS

At the end of the intervention, a test was taken and feedback was obtained from all the participants using a prevalidated questionnaire prepared based on a 5-point Likert scale. Questionnaire responses were subjected to descriptive analysis, and reliability analysis (Cronbach's α) was performed to evaluate the internal consistencies of items. A paired t-test indicated that there was a significantly large difference between before (mean (M) = 17.2, standard deviation (SD) = 9.1) and after (M = 25.9, SD = 8), t(99) = 18.4, p < .001, signifying that the performance of the students was far better with game-based learning approaches than conventional learning.

CONCLUSION

Combining game-based education with Kaizen principles in anatomy education not only prepares students for success in their academic pursuits but also empowers them to navigate the complexities of the ever-evolving healthcare landscape with confidence and proficiency.

Eye Movements as Proxy for Visual Working Memory Usage: Increased Reliance on the External World in Korsakoff Syndrome

In the assessment of visual working memory, estimating the maximum capacity is currently the gold standard. However, traditional tasks disregard that information generally remains available in the external world. Only when to-be-used information is not readily accessible, memory is taxed. Otherwise, people sample information from the environment as a form of cognitive offloading. To investigate how memory deficits impact the trade-off between sampling externally or storing internally, we compared gaze behaviour of individuals with Korsakoff amnesia (n = 24, age range 47-74 years) and healthy controls (n = 27, age range 40-81 years) on a copy task that provoked different strategies by having information freely accessible (facilitating sampling) or introducing a gaze-contingent waiting time (provoking storing). Indeed, patients sampled more often and longer, compared to controls. When sampling became time-consuming, controls reduced sampling and memorised more. Patients also showed reduced and longer sampling in this condition, suggesting an attempt at memorisation. Importantly, however, patients sampled disproportionately more often than controls, whilst accuracy dropped. This finding suggests that amnesia patients sample frequently and do not fully compensate for increased sampling costs by memorising more at once. In other words, Korsakoff amnesia resulted in a heavy reliance on the world as 'external memory'.

A Novel Neurorehabilitation Approach for Neural Plasticity Overstimulation and Reorganization in Patients with Neurological Disorders

Neurological disorders are those that are associated with impairments in the nervous system. These impairments affect the patient’s activities of daily living. Recently, many advanced modalities have been used in the rehabilitation field to treat various neurological impairments. However, many of these modalities are available only in clinics, and some are expensive. Most patients with neurological disorders have difficulty reaching clinics. This review was designed to establish a new neurorehabilitation approach based on the scientific way to improve patients’ functional recovery following neurological disorders in clinics or at home. The human brain is a network, an intricate, integrated system that coordinates operations among billions of units. In fact, grey matter contains most of the neuronal cell bodies. It includes the brain and the spinal cord areas involved in muscle control, sensory perception, memory, emotions, decision-making, and self-control. Consequently, patients’ functional ability results from complex interactions among various brain and spinal cord areas and neuromuscular systems. While white matter fibers connect numerous brain areas, stimulating or improving non-motor symptoms, such as motivation, cognitive, and sensory symptoms besides motor symptoms may enhance functional recovery in patients with neurological disorders. The basic principles of the current treatment approach are established based on brain connectivity. Using motor, sensory, motivation, and cognitive (MSMC) interventions during rehabilitation may promote neural plasticity and maximize functional recovery in patients with neurological disorders. Experimental studies are strongly needed to verify our theories and hypothesis.

Successful Aging for Community-Dwelling Older Adults: An Experimental Study with a Tablet App

Mobile health (mHealth) technologies offer an opportunity to enable the care and support of community-dwelling older adults, however, research examining the use of mHealth in delivering quality of life (QoL) improvements in the older population is limited. We developed a tablet application (eSeniorCare) based on the Successful Aging framework and investigated its feasibility among older adults with low socioeconomic status. Twenty five participants (females = 14, mean age = 65 years) used the app to set and track medication intake reminders and health goals, and to play selected casual mobile games for 24 weeks. The Older person QoL and Short Health (SF12v2) surveys were administered before and after the study. The Wilcoxon rank tests were used to determine differences from baseline, and thematic analysis was used to analyze post-study interview data. The improvements in health-related QoL (HRQoL) scores were statistically significant (V=41.5, p=0.005856) across all participants. The frequent eSeniorCare users experienced statistically significant improvements in their physical health (V=13, p=0.04546) and HRQoL (V=7.5, p=0.0050307) scores. Participants reported that the eSeniorCare app motivated timely medication intake and health goals achievement, whereas tablet games promoted mental stimulation. Participants were willing to use mobile apps to self-manage their medications (70%) and adopt healthy activities (72%), while 92% wanted to recommend eSeniorCare to a friend. This study shows the feasibility and possible impact of an mHealth tool on the health-related QoL in older adults with a low socioeconomic status. mHealth support tools and future research to determine their effects are warranted for this population.

Randomized double-masked controlled trial of cognitive training in breast cancer survivors: a preliminary study

PURPOSE

To evaluate the acceptability, satisfaction, and preliminary efficacy of cognitive training for improving cognitive function and health outcomes in breast cancer survivors (BCS).

PATIENTS AND METHODS

BCS enrolled in this 2-group randomized, double-masked controlled trial of cognitive training. Primary outcomes included the acceptability and satisfaction of the interventions. Secondary outcomes included examining the effect size and reliable improvement of perceived cognitive function and health outcomes, including work ability, health perception (status and change), and quality of life. Exploratory outcomes were performance on neuropsychological tests and plasma levels of brain-derived neurotropic factor (BDNF). Data were collected at baseline and immediately post-intervention. Using ANCOVA models, the intervention was compared to attention control while adjusting for covariates and baseline values. The effect sizes for differences in means and the reliable improvement percentage were reported.

RESULTS

Thirty-six BCS completed the study and were on average 57.6 (SD = 8.0) years old, 59.4% Caucasian, and had some college education (74.5%). Both programs were reported to be satisfactory and acceptable. Non-significant small effect sizes were noted for the intervention on cognitive abilities (d = 0.26) and cognitive concerns (d =  - 0.32), with reliable improvement noted in 32% and 28% of BCS, respectively. Small to medium effect sizes were noted in improvement in work ability (d = 0.37) and health perception status (d = 0.30) and change (d = 0.60, p < 0.05).

CONCLUSIONS

Cognitive training was acceptable to BCS and resulted in improvement in perceived cognitive function and perceptions of "real-world" health benefits. A larger randomized controlled trial is warranted to determine its effectiveness for objective cognitive performance.

Alzheimer's Association Project VITAL: A Florida Statewide Initiative Using Technology to Impact Social Isolation and Well-Being

Lack of social engagement and the resulting social isolation can have negative impacts on health and well-being, especially in senior care communities and for those living with dementia. Project VITAL leverages technology and community resources to create a network for connection, engagement, education, and support of individuals with dementia and their caregivers, and explores the impact of these interventions in reducing feelings of social isolation and increasing mood among residents during the COVID-19 pandemic. Through two phases, 600 personalized Wi-Fi-enabled iN2L tablets were distributed to 300 senior care communities (55% assisted living communities, 37% skilled nursing communities, 6% memory care communities, and 2% adult family-care homes) to connect and engage residents and their families. Different phases also included Project ECHO, a video-based learning platform, Alzheimer's Association virtual and online education and support for family caregivers, evidence-based online professional dementia care staff training and certification, and Virtual Forums designed to explore ways to build sustainable, scalable models to ensure access to support and decrease social isolation in the future. Tablet usage was collected over an 11-month period and an interim survey was designed to assess the effectiveness of the tablets, in preventing social isolation and increasing mood among residents during the COVID-19 pandemic. A total of 105 care community staff (whose community used the tablets) completed the survey and overall, these staff showed a high level of agreement to statements indicating that residents struggled with loneliness and mood, and that the tablet was useful in improving loneliness and mood in residents and allowing them to stay in touch with family and friends. Additional positive results were seen through a variety of other responses around the tablets and Project ECHO. Overall, the tablets were shown to be an effective way to engage residents and connect them with friends and family, as well as being a useful tool for staff members. A third phase is currently underway in the homes of people with dementia and their family caregivers, which includes tablets and direct access to Alzheimer's Association virtual and online education and support programs.

A Multi-Domain Intervention Protocol for the Potential Reversal of Cognitive Frailty: "WE-RISE" Randomized Controlled Trial

Following the rapid increase of the aging population, health promotion and prevention of physical disability and dementia in older persons are essential for healthy aging. For example, there may be a potential to prevent or reverse cognitive frailty, the co-existence of both physical frailty and cognitive impairment in older persons. However, evidence-based interventions targeting the prevention or potential reversibility of cognitive frailty among community dwelling older adults are scarce. In this paper, we described the rationale, development and delivery of a multi-domain intervention comprising multi-component physical exercise prescription, cognitive training, dietary counseling and promotion of psychosocial support, called the WE-RISE trial. The aim of WE-RISE intervention is to potentially reverse cognitive frailty. This is a two-armed, single blinded, randomized controlled trial conducted over a duration of 6 months, at senior citizen activity centers within the Klang Valley, Malaysia. Ambulating, community dwelling older adults aged 60 years and above with cognitive frailty are randomized into two groups; (1) intervention group: which receives an instructor based "WE-RISE" intervention for the first 3 months, and then a home-based "WE-RISE at Home" intervention for the following 3 months; (2) control group: usual care with no modifications to their daily routine. Primary outcome is cognitive frailty status and secondary outcome include physical function, cognitive performance, nutritional status, psychosocial status and quality of life which are obtained during baseline screening and subsequent follow ups at 3rd and 6th month. Description of the intervention is done using the template for intervention description and replication (TIDieR) checklist. This trial protocol has received approval from Research Ethics Committee of Universiti Kebangsaan Malaysia (UKM PPI/111/8/JEP-2018-558) and the Department of Social Welfare Malaysia (MyResearch Reference: JKMM 100/12/5/2: 2018/405). Trial registration number: ACTRN12619001055190.

Role of nurses in addressing modifiable risk factors for early Alzheimer's disease and mild cognitive impairment

A multidisciplinary advisory group of health professionals involved in dementia care assessed the current evidence base regarding modifiable risk factors (MRFs) for early Alzheimer's disease and mild cognitive impairment. Based on evidence from the published literature and clinical experience, MRFs in four areas were identified where there is evidence to support interventions that may help delay cognitive decline or reduce the risk of developing Alzheimer's disease: medical (eg cardiovascular risk factors), psychosocial (eg depression, anxiety, social isolation), lifestyle (eg lack of physical activity, smoking) and nutrition (eg poor diet, lack of micronutrients). Practical guidance on how health professionals, but in particular nurses, may actively seek to address these MRFs in clinical practice was also developed. Nurses are at the forefront of patient care and, as such, are ideally placed to offer advice to patients that may proactively help mitigate the risks of cognitive decline and the development of Alzheimer's disease.