JMIR Publications

ABSTRACT

Background:

Memory, one of the main cognitive functions, is known to decline by age. Serious games have been used for improving memory among the elderly. The effectiveness of serious games in improving memory has been assessed by many studies. To draw definitive conclusions about the effectiveness of serious games, findings from these studies need to be pooled and aggregated.

Objective:

This study aims to assess the effectiveness of serious games in improving memory among the elderly with cognitive impairment.

Methods:

A systematic review of randomized controlled trials (RCTs) was carried out. The search sources included searching 8 databases, screening reference lists of the included studies and relevant reviews, and checking studies that cited the included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Extracted data were synthesized using a narrative approach and a statistical approach (i.e., meta-analysis), as appropriate.

Results:

Out of 466 citations retrieved, 18 studies met the eligibility criteria of this review. Of those, 15 RCTs were eventually included in 10 meta-analyses. We found that serious games are more effective than no or passive interventions in improving non-verbal memory (P=0.002, standardized mean difference (SMD)=0.54, 95% confidence interval (CI)=0.19 to 0.89) and working memory (P=0.02, SMD=0.40, CI=0.07 to 0.73), but not verbal memory (P=0.13, SMD=0.37, CI=-0.11 to 0.86). The review also showed that serious games are more effective than conventional exercises in improving verbal memory (P=0.004, SMD=0.46, CI=0.18 to 1.09), but not for non-verbal memory (P=0.12, SMD=-0.22, CI -0.5 to 0.06) and working memory (P=0.49, SMD=-0.08, CI=-0.31 to 0.15). Serious games were as effective as conventional cognitive activities in improving verbal memory (P=0.07, SMD=0.61, CI=-0.06 to 1.27), non-verbal memory (P=0.94, SMD=-0.01, CI=-0.32 to 0.30), and working memory (P=0.08, SMD=0.37, CI=-0.05 to 0.78) among the elderly with cognitive impairment. Lastly, the effect of adaptive serious games on working memory was comparable to non-adaptive serious games (P=0.08, SMD=0.18, CI=-0.02 to 0.37).

Conclusions:

Serious games have the potential to improve verbal, non-verbal, and working memory among elderly people with cognitive impairment. However, our findings should be interpreted cautiously given that most meta-analyses were based on a few studies (≤3) and judged to have a low quality of evidence. Therefore, serious games should be offered as supplemental to existing proven and safe interventions, rather than a complete substitute until further, more robust evidence is available. Future studies should investigate the short and long-term effects of serious games on memory and other cognitive abilities among people from different age groups with or without cognitive impairment.