The Effectiveness of Serious Games in Improving Memory Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis

Abstract

Background Memory, one of the main cognitive functions, is known to decline with age. Serious games have been used for improving memory in older adults. The effectiveness of serious games in improving memory has been assessed by many studies. To draw definitive conclusions about the effectiveness of serious games, the findings of these studies need to be pooled and aggregated. Objective This study aimed to assess the effectiveness of serious games in improving memory in older adults with cognitive impairment. Methods A systematic review of randomized controlled trials was carried out. The search sources included 8 databases, the reference lists of the included studies and relevant reviews, and the studies that cited the included studies. In total, 2 reviewers (AA and MH) independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Extracted data were synthesized using a narrative approach and a statistical approach (ie, multilevel meta-analysis), as appropriate. Results Of the 618 citations retrieved, 18 (2.9%) met the eligibility criteria for this review. Of these 18 studies, 15 (83%) randomized controlled trials were included in 10 multilevel meta-analyses. We found that serious games were more effective than no or passive interventions in improving nonverbal memory (P=.02; standardized mean difference [SMD]=0.46, 95% CI 0.09-0.83) and working memory (P=.04; SMD=0.31, 95% CI 0.01-0.60) but not verbal memory (P=.13; SMD=0.39, 95% CI −0.11 to 0.89). The review also showed that serious games were more effective than conventional exercises in improving verbal memory (P=.003; SMD=0.46, 95% CI 0.16-0.77) but not nonverbal memory (P=.30; SMD=−0.19, 95% CI −0.54 to 0.17) or working memory (P=.99; SMD=0.00, 95% CI −0.45 to 0.45). Serious games were as effective as conventional cognitive activities in improving verbal memory (P=.14; SMD=0.66, 95% CI −0.21 to 1.54), nonverbal memory (P=.94; SMD=−0.01, 95% CI −0.32 to 0.30), and working memory (P=.08; SMD=0.37, 95% CI −0.05 to 0.78) among older adults with cognitive impairment. Finally, the effect of adaptive serious games on working memory was comparable with that of nonadaptive serious games (P=.08; SMD=0.18, 95% CI −0.02 to 0.37). Conclusions Serious games have the potential to improve verbal, nonverbal, and working memory in older adults with cognitive impairment. However, our findings should be interpreted cautiously given that most meta-analyses were based on a few studies (≤3) and judged to have a low quality of evidence. Therefore, serious games should be offered as a supplement to existing proven and safe interventions rather than as a complete substitute until further, more robust evidence is available. Future studies should investigate the short- and long-term effects of serious games on memory and other cognitive abilities among people of different age groups with or without cognitive impairment.

The Effect of Non-Immersive Virtual Reality Exergames versus Traditional Physiotherapy in Parkinson’s Disease Older Patients: Preliminary Results from a Randomized-Controlled Trial

“…Virtual reality (VR) technology and exergaming, especially, have been emerged as promising tools for studying and rehabilitating gait and balance impairments in people with PD, as it allows users to be engaged in an enriched and highly individualized complex environment [ 13 ]. In particular, exergaming is defined as technology-driven physical activities that requires participants to be active and/or exercise in order to play games, by using the full body motion as a principal mean of interaction [ 14 ]. Several studies have shown that interventions based on exergames promote the simultaneous training of cognitive and motor aspects and offer a number of stimuli and difficulty of the tasks adjusted to the patients’ needs, maintaining control and stimulus consistency [ 15 , 16 , 17 ].…”

Pioneering the Metaverse: The Role of the Metaverse in an Aging Population

“…Technological advancements have overcome some of these barriers, serving to improve functioning, tracking, and mobility, and have the potential to not only alleviate caregiver burden but also enable individuals to successfully age in place [ 13 ]. Alternately, there exist multiple forms of computerized cognitive training programs, or serious games (named as such due to their primary purpose being other than pure entertainment), that have been shown to help improve verbal, nonverbal, and working memory and therefore potentially have a role in slowing or preventing cognitive decline [ 14 , 15 ]. Incorporating cognitive training strategies is another application of the metaverse for this population.…”

Artificial Intelligence–Driven Serious Games in Health Care: Scoping Review

“…Summarizing the features of the current AI-driven serious games is very important to explore how they have been developed and used and their current state to plan on how to leverage them in the current and future health care needs. Previous reviews did not focus on AI-driven serious games [36] and focused on a specific disease rather than health care in general [8][9][10][11][12][13]. Therefore, this review aimed to explore the features of AI-driven serious games in health care as reported by previous studies.…”

“…In health care, serious games have been used for many purposes such as screening, diagnosing, education, prevention, and rehabilitation [ 4 , 5 ]. For example, serious games have shown promising results in improving health education [ 6 ]; acute pain management [ 7 ]; cognitive functions (eg, global cognition [ 8 ], memory [ 9 ], executive functions [ 10 ], and processing speed [ 11 ]); mental health disorders (eg, depression [ 12 ] and anxiety [ 13 ]); and functional, motor, and sensory functions [ 14 ]. Furthermore, serious games have the potential to diagnose and screen many diseases such as mild cognitive impairment [ 15 ], developmental dyslexia [ 16 ], and attention-deficit/hyperactivity disorder [ 17 ].…”