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

Abstract

BACKGROUND Mild Cognitive Impairment, the intermediate cognitive status between healthy cognitive decline and pathological decline, is an important clinical construct for signaling possible prodromes of dementia. Unfortunately, there is an underdetection of this condition. To provide monitoring and screening, commercial off-the-shelf video games may be of interest. They maintain player engagement over a longer period of time and support longitudinal measurements of cognitive performance. OBJECTIVE This paper aims to explore how player actions of Klondike Solitaire relate to cognitive functions and to which extent they are indicative of Mild Cognitive Impairment. METHODS Eleven experts in the domain of cognitive impairments were asked to correlate 21 player actions to eleven cognitive functions. Expert agreement was verified through intraclass correlation, based on a two-way fully crossed design with type consistency. RESULTS All intraclass correlations for player actions and cognitive function scored above 0.75, indicating good to excellent reliability. Further scrutinizing of the results revealed that all player actions had at least one cognitive function which was on average moderately to strongly correlated to a cognitive function. Similarly, each cognitive function had at least one player action which was on average moderately to strongly correlated. Similarities and patterns were found amongst player actions, providing insight into the mechanics of Klondike Solitaire gameplay. CONCLUSIONS Together, these results suggest that Klondike Solitaire has potential as a complementary tool for screening and monitoring cognition, warranting further research which analyses Klondike Solitaire gameplay data of older adults with mild cognitive impairment.