Puzzling With Online Games (BAM-COG): Reliability, Validity, and Feasibility of an Online Self-Monitor for Cognitive Performance in Aging Adults
Open accessAbstract
BACKGROUND: Online interventions are aiming increasingly at cognitive outcome measures but so far no easy and fast self-monitors for cognition have been validated or proven reliable and feasible. OBJECTIVE: This study examines a new instrument called the Brain Aging Monitor-Cognitive Assessment Battery (BAM-COG) for its alternate forms reliability, face and content validity, and convergent and divergent validity. Also, reference values are provided. METHODS: The BAM-COG consists of four easily accessible, short, yet challenging puzzle games that have been developed to measure working memory ("Conveyer Belt"), visuospatial short-term memory ("Sunshine"), episodic recognition memory ("Viewpoint"), and planning ("Papyrinth"). A total of 641 participants were recruited for this study. Of these, 397 adults, 40 years and older (mean 54.9, SD 9.6), were eligible for analysis. Study participants played all games three times with 14 days in between sets. Face and content validity were based on expert opinion. Alternate forms reliability (AFR) was measured by comparing scores on different versions of the BAM-COG and expressed with an intraclass correlation (ICC: two-way mixed; consistency at 95%). Convergent validity (CV) was provided by comparing BAM-COG scores to gold-standard paper-and-pencil and computer-assisted cognitive assessment. Divergent validity (DV) was measured by comparing BAM-COG scores to the National Adult Reading Test IQ (NART-IQ) estimate. Both CV and DV are expressed as Spearman rho correlation coefficients. RESULTS: Three out of four games showed adequate results on AFR, CV, and DV measures. The games Conveyer Belt, Sunshine, and Papyrinth have AFR ICCs of .420, .426, and .645 respectively. Also, these games had good to very good CV correlations: rho=.577 (P=.001), rho=.669 (P<.001), and rho=.400 (P=.04), respectively. Last, as expected, DV correlations were low: rho=-.029 (P=.44), rho=-.029 (P=.45), and rho=-.134 (P=.28) respectively. The game Viewpoint provided less desirable results with an AFR ICC of .167, CV rho=.202 (P=.15), and DV rho=-.162 (P=.21). CONCLUSIONS: This study provides evidence for the use of the BAM-COG test battery as a feasible, reliable, and valid tool to monitor cognitive performance in healthy adults in an online setting. Three out of four games have good psychometric characteristics to measure working memory, visuospatial short-term memory, and planning capacity.
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A common feature was that task sessions were kept as short as possible to make them more convenient and increase likelihood of completion.
“A common feature was that task sessions were kept as short as possible to make them more convenient and to increase likelihood of completion [28,32].”
From Gamification of Cognitive Assessment and Cognitive Training: A Systematic Review of Applications and Efficacy (2016) · cites this paper as [28]
Sample correlations from some simpler validation studies suggest intertask correlations of 0.45-0.60.
“However, sample correlations from some of the simpler validation studies suggest intertask correlations of 0.45-0.60 [28,37,39,63].”
From Gamification of Cognitive Assessment and Cognitive Training: A Systematic Review of Applications and Efficacy (2016) · cites this paper as [28]
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- Authors
- Aalbers, T., Baars, M. A. E., Olde Rikkert, M. G. M., & Kessels, R. P. C.
- Affiliations
- Radboud University Medical Center (NL)
- Radboud University Nijmegen (NL)
- Corresponding author
- Aalbers, Teun
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2013-12-03
- Volume
- 15
- Issue
- 12
- Pages
- e270
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC3868977
- OpenAlex
- W2159231746
- Cited by
- 59
- References
- 38
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 4 · 2020: 2 · 2019: 5 · 2018: 10 · 2017: 12 · 2016: 6 · 2015: 2
- FWCI
- 3.61
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- other-oa
- Locations
- Journal of Medical Internet Research (publishedVersion, other-oa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion, cc-by)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Funders
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- puzzle games, cognitive aging, working memory, visuospatial short-term memory, planning, convergent validity, discriminant validity, reference values, older adults, cognitive assessment, online intervention, feasibility
- MeSH terms
- Adult, Aged, Aging, Cognition, Feasibility Studies, Female, Humans, Male, Middle Aged, Online Systems, Reference Values, Reproducibility of Results, Cohort Studies, Telemedicine, Video Games, Internet, Diagnostic Self Evaluation
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 ›
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