Games as cognitive screening instruments for older adults

 By 2050, an estimated 152.8 million people will be living with dementia. This syndrome affects essential cognitive functions, including memory, judgement, language and comprehension. It is the seventh leading cause of death globally and one of the leading causes of disability and dependency among older people.  

At UTS, a Social Impact Grant provided funding support for new innovations in the field of dementia screening. A research team led by UTS PhD student Fernanda Taveres Vasconcelos Oliveira developed Cog World Travel, a game-based alternative to traditional dementia screening tools that could increase the number and frequency of people tested for dementia.  

“The traditional instruments have been used for nearly 50 years, and they’re well studied, but there are barriers for the proper use of these tools,” Fernanda says.  

For clinicians, these barriers include a lack of time to apply the tools correctly and a lack of consistency in how the tools are used for different patients. The stress of being tested for an incurable condition can impact how patients respond to the screening process.  

In response, Fernanda decided to develop a ‘serious game’ — a type of game with a purpose other than entertainment — that captured the core aspects of traditional screening tools in a novel, play-based format.  

The six domains of cognitive function  

Fernanda started by investigating the screening process to understand its parts better. Specifically, she says, she wanted to understand better the six cognitive function domains outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and how traditional dementia screening tools test these functions for decline. 

[These are] complex attention, executive function, learning and memory, language, perceptomotor function, and social cognition.

She then created a framework that outlined the requirements a game would need to satisfy to function as a screening tool. Next, she designed the game and used her Social Impact Grant to hire two developers who could bring her ideas to life.  

[I wanted to produce a] real game instead of only the concept to demonstrate this game to health care professionals who are experts in the application of traditional tools.  

A game-based screening tool  

The result is Cog World Travel, a game-based screening tool for people with suspected dementia. Cog World Travel challenges participants to complete a series of time-based tasks corresponding to the six cognitive function domains described above.  

There are six mini-games, all in the context of travelling. 

For example, players arrive at a beach filled with rapidly moving flamingos in one game. Players must take photos of the birds as soon as they appear on the screen without being distracted by other things happening around them. 

In another, players speak to family members back home and must identify the emotions expressed in the conversation through emoji stickers. In a third, they must pack their suitcase to return home at the end of the trip, slotting the objects into one another like a game of Tetris to ensure they all fit.  

[While they play], I’m measuring scores related to [their] performance [as it] relates to the cognitive domains.

Building on lessons learnt 

Once the first Cog World Travel was completed, Fernanda tested it with several clinicians and patients, asking for their feedback on whether the game met its intended outcomes and how it could be further improved.  

Both groups responded positively: “The games are straightforward in design. This is a positive thing because they’re not overwhelming,” said one clinician; “This is much better than watching TV at home,” said one patient.  

Users also suggested several upgrades, including changing the colours of some in-game items to make them easier to see and making clear at the outset that each game module was timed. These insights will inform future enhancements to the game’s functionality and usability.  

All these lessons learnt I captured in my thesis and in papers. I’m hoping [these findings will be] useful for other researchers as well.

Since completing the work, Fernanda has been contacted by researchers at a leading neuroscience research centre who have expressed interest in finding out more about Cog World Travel.  

She plans to continue iterating the game, pending further funding, to reflect the feedback gathered from clinicians and patients. The ultimate aim is to validate Cog World Travel via a clinical trial as a medical tool for dementia screening and diagnosis.

The Problem
By 2050, an estimated 152.8 million people will be living with dementia. This cognitive syndrome is the seventh leading cause of death globally and one of the leading causes of disability and dependency among older people. New approaches are urgently required to progress the field of dementia diagnosis for patients in the early stages of cognitive decline. 

The Response
UTS research student Fernanda Taveres Vasconcelos Oliveira led the design and development of a game-based dementia screening tool called Cog World Travel. The game challenges participants to complete a series of tasks that measure their cognitive abilities across six key domains; to date, it has received positive responses from clinicians, patients and leading neuroscience research organisations.   

What helped accomplish this?
The Social Impact Grant funded salaries of two developers who brought Cog World Travel to life. More generally, extensive collaboration between the multidisciplinary research team, clinicians and patients was a defining feature of the project’s success.  

What has changed as a result?
The research contributes to a growing evidence base that supports using game-based cognitive screening tools. Linking the cognitive domains of traditional screening tools to specific elements of Cog World Travel provides essential insights to researchers and game developers seeking to progress future work in this field.

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