Episodix: a serious game to detect cognitive impairment in senior adults. A psychometric study

Abstract

IntroductionAssessment of episodic memory is traditionally used to evaluate potential cognitive impairments in senior adults. The present article discusses the capabilities of Episodix, a game to assess the aforementioned cognitive area, as a valid tool to discriminate among mild cognitive impairment (MCI), Alzheimer’s disease (AD) and healthy individuals (HC); that is, it studies the game’s psychometric validity study to assess cognitive impairment.Materials and MethodsAfter a preliminary study, a new pilot study, statistically significant for the Galician population, was carried out from a cross-sectional sample of senior adults as target users. A total of 64 individuals (28 HC, 16 MCI, 20 AD) completed the experiment from an initial sample of 74. Participants were administered a collection of classical pen-and-paper tests and interacted with the games developed. A total of six machine learning classification techniques were applied and four relevant performance metrics were computed to assess the classification power of the tool according to participants’ cognitive status.ResultsAccording to the classification performance metrics computed, the best classification result is obtained using the Extra Trees Classifier (F1 = 0.97 and Cohen’s kappa coefficient = 0.97). Precision and recall values are also high, above 0.9 for all cognitive groups. Moreover, according to the standard interpretation of Cohen’s kappa index, classification is almost perfect (i.e., 0.81–1.00) for the complete dataset for all algorithms.LimitationsWeaknesses (e.g., accessibility, sample size or speed of stimuli) detected during the preliminary study were addressed and solved. Nevertheless, additional research is needed to improve the resolution of the game for the identification of specific cognitive impairments, as well as to achieve a complete validation of the psychometric properties of the digital game.ConclusionPromising results obtained about psychometric validity of Episodix, represent a relevant step ahead towards the introduction of serious games and machine learning in regular clinical practice for detecting MCI or AD. However, more research is needed to explore the introduction of item response theory in this game and to obtain the required normative data for clinical validity.

Digital Cognitive Biomarker for Mild Cognitive Impairments and Dementia: A Systematic Review

“…Moreover, an earlier study by Müller and colleagues [ 36 ] was a preliminary study of a later study [ 37 ]; therefore, only the results of the later study were included for analysis. Similarly, 1 study by Valladares-Rodriguez and colleagues [ 38 ] was also a preliminary study of a later study [ 39 ]; we only kept the later one. Another 2 studies by Gielis and colleagues [ 17 , 18 ] worked on the same dataset but provided findings related to different aspects of our research question.…”

The Smart Aging Platform for Assessing Early Phases of Cognitive Impairment in Patients With Neurodegenerative Diseases

“…In particular, the small sample size may explain why we were able to detect differences when they were marked, as in healthy controls and early AD patients, but not when they were more subtle, as when comparing amnesic and executive deficits in different types of MCI. This is, unfortunately, a limitation common to many studies conducted in clinical populations in this field (e.g., Cipresso et al, 2014 ; Lee et al, 2014 ; Manera et al, 2015 ; Tarnanas et al, 2015 ; Serino et al, 2017 ; Valladares-Rodriguez et al, 2018 , 2019 ). Hence, a larger validation study should be performed.…”

A framework and immersive serious game for mild cognitive impairment

“…Researchers have examined strategies for slowing down cognitive deterioration in patients and the use of digital therapeutic games may improve upon traditional rehabilitation, which is often tedious, and may increase long-term motivation in players to facilitate active participation. Traditional neuropsychological assessments are not easy to administer and carry out and thus it is increasingly common to promote serious games as a solution in healthcare, typically as a screening tool or an alternative method for neuropsychological evaluations to overcome clinical limitations [48,65,66]. MentalPlus® [48] is a digital game proposed to assess cognitive functions including attention, memory and executive functioning, based on various scenarios.…”

“…Therefore, it can act as an alternative diagnostic tool for determining neuropsychological issues. Similarly, Episodix [66] assesses cognitive functions and differentiates the mental quality between MCI, AD and healthy individuals, in particular episodic memory quality, through the use of three game scenarios focusing on: immediate and short-term memory, semantic and procedural memory, and long-term memory with yes/no recognition functioning. Developed in Unity and running on a touchscreen-based device, it allows the elderly to better adapt to the game.…”