A Serious Game for Clinical Assessment of Cognitive Status: Validation Study
Open accessAbstract
BACKGROUND: We propose the use of serious games to screen for abnormal cognitive status in situations where it may be too costly or impractical to use standard cognitive assessments (eg, emergency departments). If validated, serious games in health care could enable broader availability of efficient and engaging cognitive screening. OBJECTIVE: The objective of this work is to demonstrate the feasibility of a game-based cognitive assessment delivered on tablet technology to a clinical sample and to conduct preliminary validation against standard mental status tools commonly used in elderly populations. METHODS: We carried out a feasibility study in a hospital emergency department to evaluate the use of a serious game by elderly adults (N=146; age: mean 80.59, SD 6.00, range 70-94 years). We correlated game performance against a number of standard assessments, including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Confusion Assessment Method (CAM). RESULTS: After a series of modifications, the game could be used by a wide range of elderly patients in the emergency department demonstrating its feasibility for use with these users. Of 146 patients, 141 (96.6%) consented to participate and played our serious game. Refusals to play the game were typically due to concerns of family members rather than unwillingness of the patient to play the game. Performance on the serious game correlated significantly with the MoCA (r=-.339, P <.001) and MMSE (r=-.558, P <.001), and correlated (point-biserial correlation) with the CAM (r=.565, P <.001) and with other cognitive assessments. CONCLUSIONS: This research demonstrates the feasibility of using serious games in a clinical setting. Further research is required to demonstrate the validity and reliability of game-based assessments for clinical decision making.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the literature, older adults are defined from ages 50 and above, 55 and above, and 70 and above.
“In the literature too, older adults are defned from ages 50 and above [15,61,66], 55 and above [2,67] and 70 and above [59,60].”
From "Where is history": Toward Designing a Voice Assistant to help Older Adults locate Interface Features quickly (2023) · cites this paper as [59]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282 · see citing works
The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53221.x · Cited by 25,553 · see citing works
Kok, J. S., Berg, I. J., & Scherder, E. J. A. (2013) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000353441 · Cited by 20,589 · see citing works
Clarifying Confusion: The Confusion Assessment Method: A New Method for Detection of Delirium
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P., & Horwitz, R. I. (1990) · Annals of Internal Medicine · doi:10.7326/0003-4819-113-12-941 · Cited by 5,250 · see citing works
Sessler, C. N., Gosnell, M. S., Grap, M. J., Brophy, G. M., O'Neal, P. V., Keane, K. A., Tesoro, E. P., & Elswick, R. K. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.2107138 · Cited by 3,695 · see citing works
Video game training enhances cognitive control in older adults
Anguera, J. A., Boccanfuso, J., Rintoul, J. L., Al-Hashimi, O., Faraji, F., Janowich, J., Kong, E., Larraburo, Y., Rolle, C., Johnston, E., et al. (2013) · Nature · doi:10.1038/nature12486 · Cited by 1,666 · see citing works
Bishara, A. J., & Hittner, J. B. (2012) · Psychological Methods · doi:10.1037/a0028087 · Cited by 766 · see citing works
Initiative, A. D. N., Trzepacz, P. T., Hochstetler, H. M., Wang, S., Walker, B., & Saykin, A. J. (2015) · BMC Geriatrics · doi:10.1186/s12877-015-0103-3 · Cited by 616 · see citing works
Robbins, T. W., James-Galton, M., Owen, A. M., Sahakian, B. J., Lawrence, A. D., McInnes, L., & Rabbitt, P. (1998) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617798455073 · Cited by 607 · see citing works
Luis, C. A., Keegan, A. P., & MULLAN, M. J. (2008) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2101 · Cited by 511 · see citing works
From Edutainment to Serious Games: A Change in the Use of Game Characteristics
Charsky, D. (2010) · Games and Culture · doi:10.1177/1555412009354727 · Cited by 459 · see citing works
Schneider, E. L. (1990) · JAMA · doi:10.1001/jama.1990.03440170057036 · Cited by 442 · see citing works
Older people and mobile phones: A multi-method investigation
Kurniawan, S. (2008) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2008.03.002 · Cited by 357 · see citing works
The reliability and validity of the mini-mental state in a British community survey
O’Connor, D., Pollitt, P. A., Hyde, J. B., Fellows, J. L., Miller, N. D., Brook, C. P. B., & Reiss, B. B. (1989) · Journal of Psychiatric Research · doi:10.1016/0022-3956(89)90021-6 · Cited by 302 · see citing works
Manera, V., Petit, P., Derreumaux, A., Orvieto, I., Romagnoli, M., Lyttle, G., David, R., & Robert, P. H. (2015) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2015.00024 · Cited by 220 · see citing works
The effect of lifelong bilingualism on regional grey and white matter volume
Olsen, R. K., Pangelinan, M. M., BOGULSKI, C. A., Chakravarty, M. M., Luk, G., Grady, C. L., & Bialystok, E. (2015) · Brain Research · doi:10.1016/j.brainres.2015.02.034 · Cited by 166 · see citing works
Neuropsychological testing and assessment for dementia
Jacova, C., Kertesz, A., Blair, M., Fisk, J. D., & Feldman, H. (2007) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2007.07.011 · Cited by 142 · see citing works
McCusker, J., Cole, M. G., Dendukuri, N., & Belzile, É. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52471.x · Cited by 132 · see citing works
An Evaluation of Two Screening Tools for Cognitive Impairment in Older Emergency Department Patients
Wilber, S. T. (2005) · Academic Emergency Medicine · doi:10.1197/j.aem.2005.01.017 · Cited by 121 · see citing works
A study of the use of mobile phones by older persons
Kurniawan, S., Mahmud, M., & Nugroho, Y. (2006) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/1125451.1125641 · Cited by 108 · see citing works
Ludwig, C., Borella, E., Tettamanti, M., & Ribaupierre, A. D. (2009) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2009.09.040 · Cited by 80 · see citing works
The digit vigilance test: reliability, validity, and sensitivity to diazepam
Kelland, D. Z., & Lewis, R. F. (1996) · Archives of Clinical Neuropsychology · doi:10.1016/0887-6177(95)00032-1 · Cited by 76 · see citing works
A formal cognitive model of the go/no-go discrimination task: Evaluation and implications.
Yechiam, E., Goodnight, J. A., Bates, J. E., Busemeyer, J. R., Dodge, K. A., Pettit, G. S., & Newman, J. P. (2006) · Psychological Assessment · doi:10.1037/1040-3590.18.3.239 · Cited by 64 · see citing works
Developing a serious game for cognitive assessment: choosing settings and measuring performance
Tong, T., & Chignell, M. (2014) · Proceedings of the Second International Symposium of Chinese CHI · doi:10.1145/2592235.2592246 · Cited by 48 · see citing works
Self-citationSerious games for screening pre-dementia conditions: from virtuality to reality? A pilot project.
Zucchella, C., Sinforiani, E., Tassorelli, C., Cavallini, E., Tost, D., Grau, S., Pazzi, S., Puricelli, S., Bernini, S., Bottiroli, S., et al. (2014) · Europe PMC (PubMed Central) · Cited by 46 · see citing works
Subtle deficits of attention after surgery: quantifying indicators of sub syndrome delirium
Lowery, D., Wesnes, K. A., Brewster, N., & Ballard, C. G. (2010) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2430 · Cited by 19 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [24]Field A Discovering Statistics using IBM SPSS Statistics, 4th ed 2013 01 23 Thousand Oaks, CA Sage Publications
Cited by
Sorted by citations
Mobile Technology for Cognitive Assessment of older adults: a scoping review
Koo, B. M., & Vizer, L. M. (2019) · Innovation in Aging · doi:10.1093/geroni/igy038 · Cited by 194 · see citing works
ULTEMAT: A mobile framework for smart ecological momentary assessments and interventions
van de Ven, P., O’Brien, H., Henriques, R., Klein, M., Msetfi, R., Nelson, J., Rocha, A., Ruwaard, J., O’Sullivan, D., & Riper, H. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.07.001 · Cited by 26 · see citing works
Yu, J. E., Parde, N., & Chattopadhyay, D. (2023) · Proceedings of the 2023 CHI Conference on Human Factors in Computing Systems · doi:10.1145/3544548.3581447 · Cited by 22 · see citing works
Attention and impulsivity assessment using virtual reality games
Mendez-Encinas, D., Sujar, A., Bayona, S., & Delgado-Gomez, D. (2023) · Scientific Reports · doi:10.1038/s41598-023-40455-4 · Cited by 15 · see citing works
- Authors
- Tong, T., Chignell, M., Tierney, M. C., & Lee, J.
- Affiliations
- University of Toronto (CA)
- Sunnybrook Health Science Centre (CA)
- Corresponding author
- Tong, Tiffany
- Venue
- JMIR Serious Games
- Publisher
- JMIR Publications Inc.
- Published
- 2016-05-27
- Volume
- 4
- Issue
- 1
- Pages
- e7
- ISSN
- 2291-9279 (ISSN-L)
- PMC
- PMC4902858
- OpenAlex
- W2405549127
- Cited by
- 132
- References
- 26
- Citations by year
- 2026: 8 · 2025: 18 · 2024: 13 · 2023: 18 · 2022: 17 · 2021: 11 · 2020: 13 · 2019: 14 · 2018: 8 · 2017: 9 · 2016: 3
- FWCI
- 26.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Serious Games (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- serious games, cognitive screening, cognitive impairment, elderly patients, emergency department, tablet-based assessment, Mini-Mental State Examination, Montreal Cognitive Assessment, Confusion Assessment Method, validation, feasibility
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
