JMIR Publications

ABSTRACT

Background:

Learning disabilities are among the major cognitive impairments caused by aging. One of the interventions used to improve learning among older adults is serious games, which are interactive electronic games designed for purposes other than entertainment. Although some systematic reviews have examined the effectiveness of serious games on learning, they are undermined by some limitations.

Objective:

This review aims to evaluate the effectiveness of serious games for verbal and nonverbal learning among older adults with cognitive impairment.

Methods:

Eight electronic databases were searched to retrieve studies relevant to this systematic review and meta-analysis. Further, we checked the studies that cited the included studies and screened the reference lists of the included studies and relevant reviews. Two reviewers independently checked the eligibility of the identified studies, extracted data from the included studies, and appraised their risk of bias and the quality of the evidence. Results of included studies were summarized using a narrative synthesis or meta-analysis, as appropriate.

Results:

Of the 559 citations retrieved, 11 trials ultimately met all eligibility criteria in review. A meta-analysis of 5 RCTs revealed that serious games are effective in improving verbal learning among older adults with cognitive impairment in comparison with no/sham interventions (P=0.04), and serious games do not have a different effect on verbal learning between mild cognitive impairment (MCI) and Alzheimer's disease (AD) patients (P=0.89). A meta-analysis of 2 RCTs revealed that serious games are as effective as conventional exercises in promoting verbal learning (P=0.98). We also found that serious games outperformed no/sham interventions (n=4, P=0.03) and conventional cognitive training (n=2, P<0.001) in enhancing nonverbal learning.

Conclusions:

Serious games have the potential in enhancing verbal and nonverbal learning among older adults with cognitive impairment. However, our findings remain inconclusive due to the low quality of evidence, the small sample size in most meta-analyzed studies, and the paucity of studies included in the meta-analyses. Thus, until further convincing evidence is offered, serious games should be used to supplement current interventions of verbal and nonverbal learning rather than replace them entirely. Further studies are needed to compare serious games to conventional cognitive training, conventional exercises, and different types of serious games, different platforms, different intervention periods, and different follow-up periods.