JMIR Publications

ABSTRACT

Background:

Recent studies suggest that computerized puzzle games are enjoyable, easy to play and engage attentional, visuospatial and executive functions. They may help mediate impairments seen in cognitive decline in addition to being an assessment tool. Eye tracking provides a quantitative and qualitative analysis of gaze, which is highly useful in understanding visual search behaviour.

Objective:

To test the feasibility of eye tracking during a puzzle game to increase the scope of outcomes with digital markers (association of eye movement metrics to cognitive performance etc.) for cognitive functioning.

Methods:

A desktop version of the Match-3 puzzle game with 15 difficulty levels was developed using Unity 3D. The goal of the Match-3 puzzle was to find configurations (‘target patterns’) that could be turned into a row of three identical game objects (‘tiles’) by swapping two adjacent tiles. The difficulty levels were created by manipulating the puzzle board size (all combinations of width and height from 4 to 8) and the number of unique tiles on the puzzle board (from 4 to 8). Each level consisted of four boards (i.e. target patterns to match) with one target pattern each. In this study, the desktop-version was presented on a laptop computer set-up with eye tracking. Healthy older subjects were recruited to play a full set of 15 puzzle levels. A paper-pencil based assessment battery was administered prior to the Match -3 game. The gaze behaviour of all participants was recorded during the game. Correlation analyses were performed on eye tracking data to examine if gaze behaviour 1) pertains to target patterns and distractor patterns and 2) changes with puzzle board size (set size or level of difficulty). Additionally, correlations between cognitive performance and eye movement metrics were calculated.

Results:

Thirteen healthy older subjects (mean age = 70.67±4.75 years; range 63-80 years) participated in this study. In total, three training and 12 test levels were played by the participants. Eye tracking recorded 672 fixations in total, 525 fixations on distractor patterns and 99 fixations on target patterns. Significant correlations were found between executive functions and number of fixations on distractor patterns (P = .011) and average fixations (P = .011). Level of difficulty correlated significantly with set size (P = .002) and visual search

Conclusions:

Overall, this study shows that eye tracking for puzzle games is feasible and eye tracking data might be used as marker for cognitive abilities like executive functions. However, further research is needed to evaluate its potential as visual search and attentional marker.