Accepted for/Published in: JMIR Serious Games
Date Submitted: Feb 21, 2020
Date Accepted: Aug 11, 2021
Dissecting Digital Card Games to Yield Digital Biomarkers for the Assessment of Mild Cognitive Impairment: a Methodological Approach and Exploratory Study
ABSTRACT
Background:
Mild Cognitive Impairment, the intermediate cognitive status between normal cognitive decline and pathological decline, is an important clinical construct for signaling possible prodromes of dementia. Unfortunately, this condition is underdiagnosed. To assist monitoring and screening, digital biomarkers derived from commercial off-the-shelf video games may be of interest. These games maintain player engagement over a longer period of time and support longitudinal measurements of cognitive performance.
Objective:
First, eleven experts in the domain of cognitive impairments were asked to correlate 21 player actions to eleven cognitive functions. Expert agreement was verified through intraclass correlation, based on a two-way fully crossed design with type consistency. Based on these player actions, 23 potential digital biomarkers of performance for Klondike Solitaire were defined. Next, 23 healthy participants and 23 participants living with MCI were asked to play three rounds of Klondike Solitaire which took 17 minutes on average to complete. A Generalized Linear Mixed Model analysis was conducted to explore digital biomarkers differences between healthy participants and participants living with MCI while controlling for age, tablet experience and Klondike experience.
Methods:
Eleven experts in the domain of cognitive impairments were asked to correlate 21 player actions to eleven cognitive functions. Expert agreement was verified through intraclass correlation, based on a two-way fully crossed design with type consistency.
Results:
All intraclass correlations for player actions and cognitive function scored above 0.75, indicating good to excellent reliability. Furthermore, all player actions had, according to the experts, at least one cognitive function which was on average moderately to strongly correlated to a cognitive function. The Generalized Linear Mixed Model analysis found sizeable effects and significance levels for 12 out of 23 potential digital biomarkers. The analysis conducted indicates sensitivity of derived digital biomarkers to cognitive impairment caused by Mild Cognitive Impairment.
Conclusions:
COTS games such as digital card games show potential as a complementary tool for screening and monitoring cognition. Clinical Trial: ClinicalTrials.gov NCT02971124
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