Mild Memory Loss and Receptivity to Gaming Device Assessments
To the Editor,
The idea of “brain fitness” as a means to retain cognitive skills is not a new concept to physicians, but it has recently become more familiar to the general population, including seniors. Over the past decade, physicians have prescribed various activities for patients to achieve “brain fitness,” including exercise,1 cognitively stimulating or novel activities,2 and social engagement.3,4 More recently, the computer age has stepped up to this challenge.5 There have been many articles and much attention paid to marketing the Internet and gaming systems to seniors. We believe that this is a vital topic and may offer additional opportunities for seniors to use Internet sites and video gaming to screen and assess their medical status. We are writing to report the findings from a small pilot study that indicated that seniors had significant difficulty with video gaming devices and demonstrated the need for new platforms adapted to the elderly population.
As previously mentioned, game designers have recently started targeting the aging baby boomers as their latest market. Many of the games designed for this population have been touted as a manner to felt boredom and to keep seniors engaged and vital. The Nintendo DS™ games “Brain Age™” and “Brain Age 2™” are examples of such games and have the added benefit of portability. They are designed for play on the handheld Nintendo DS gaming platform and are described as “user friendly.” The games test the individual and assign a “brain age” based upon the results of the testing.
While the actual “brain age” assessment does not stand up to scientific rigor, it does suggest future applications to the medical field. Wouldn’t it be great if geriatric patients with memory complaints could monitor their memory at home through a portable device that can, in turn, be presented to their physician for interpretation? What if, by multiple randomized testing over time, the device minimized or eliminated the learning effects and lack of sensitivity in measuring mild cognitive decline using current interview and paper and pencil measures (eg, the Mini-Mental State Examination)? And what if this game gave encouraging feedback and demonstrated function improvement or delayed function decline over time? In addition, imagine how beneficial it would be if the game provided other useful Internet resources to the identified patient and his or her family members to educate and provide support and coping mechanisms for the memory impairment.
The potential of such a device is unlimited, but what about its acceptability to the senior population? A pilot study conducted at our center attempted to investigate this question by testing the original Nintendo DS Brain Age game in patients with mild memory loss. These patients were trained to play the Brain Age game and were asked to track their scores. Findings from the pilot study revealed that at 2 weeks after training, one-half (n=5) of the participants were having difficulty playing the game. They reported that they did not remember the instructions as well as an inability to follow the written instructions that were given to them at the time of their initial training. These 5 participants were scheduled for re-training and practice. Three months after the original training session, it was revealed that only 4 of the 10 participants completed the study as instructed. Two of these 4 participants played the Brain Age game, but not consistently, while the other 2 played consistently. The remaining 6 participants did not play the game at all. Three of the participants who did not play the game had received a second training.
The reasons for this lack of receptivity were varied, but telling. Impediments to consistent use of the game included flaws in the engineering of the gaming device and memory and executive functioning impairment in the patients. First, the Nintendo DS platform was not developed to accommodate some of the health issues experienced by the elderly, such as tremors and poor vision and hearing. Writing recognition on the platform is limited and the screen and font size for instructions are small. Second, the Nintendo DS platform was not developed with cognitively impaired patients in mind, and is therefore not sensitive to their struggles. The game’s feedback, designed to “push” the player to continue via taunts and jibes, had the opposite effect on these individuals. Finally, this population of elderly persons with memory difficulties may prove difficult to train. A component of mild memory loss is executive function impairment, which may impede the ability to follow instructions. Impaired memory also makes it difficult to remember specific information about instruction. The game also has a timed component, and this appears to further fluster those with memory impairment who need a greater amount of time to access and retrieve information.
Games and specialty game platforms have been successfully developed for the very young, including the JumpStart® and LeapFrog® systems, so why is there not a system specifically designed for elderly persons with cognitive impairment? Surely, this is coming. We encourage fellow geriatric psychiatrists and other geriatric clinicians to get involved early with the development of these gaming systems. Their input is vital to making these “game” assessments fun for the user as well as clinically useful.
David Trinkle, MD, FAPA,
Donna-Jean P. Brock, MA, and
Anne M. Brown, BS,
Virginia Tech Carilion School of Medicine,
Carilion Clinic Center for Healthly Aging,
Roanoke, VA
Dr. Trinkle is Associate Professor of Psychiatric Medicine and Associate Dean for Community and Culture, Ms. Brock is a Research Associate, and Ms. Brown is a Research Assistant, Virginia Tech Carilion School of Medicine, Carilion Clinic Center for Healthy Aging, Roanoke, VA.
Acknowledgment: The pilot study referenced in this letter was funded by a Research Acceleration Program (RAP) grant from the Carilion Clinic.
The authors report no relevant financial relationships.
References
1. Williamson JD, Espeland M, Kritchevsky SB, et al; LIFE Study Investigators. Changes in cognitive function in a randomized trial of physical activity: Results of the lifestyle interventions and independence for elders pilot study. J Gerontol A Biol Sci Med Sci 2009;64(6):688-694.
2. Parisi JM, Stine-Morrow EA, Noh SR, Morrow DG. Predispositional engagement, activity engagement, and cognition among older adults. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2009;16(4):485-504.
3. Stine-Morrow EA, Parisi JM, Morrow DG, Park DC. The effects of an engaged lifestyle on cognitive vitality: A field experiment. Psychol Aging 2008;23(4):778-786.
4. Sampson EL, Bulpitt CJ, Fletcher AE. Survival of community-dwelling older people: The effect of cognitive impairment and social engagement. J Am Geriatr Soc 2009;57(6):985-991.
5. Basak C, Boot WR, Voss MW, Kramer AF. Can training in real-time strategy video game attenuate cognitive decline in older adults? Psychol Aging 2008;23(4):765-777.