Detecting Cognitive Ability Changes in Patients With Moderate Dementia Using a Modified “Whack-a-Mole” Game

This paper presents the results from a one-year study of 12 patients with moderate dementia in an adult day program who played a novel whack-a-mole game-based measurement instrument for cognitive behavior and performance. The ongoing measurement of cognition and changes associated with dementia is a challenge for healthcare providers. Measurement methods based on a tablet-based instrument are proposed. Partnership with the adult day program greatly eased recruitment: all but 1 eligible participant joined our study, compared to one in five, or lower, for previous studies with similar populations. There are three unique aspects to the design of our game: first, it has two distinct targets requiring different actions, which increases the cognitive processing for the users; second, each level is systematically more difficult; third, it records and analyzes player performance. The results show that the patients' game performance improves over the first few weeks; this indicates that they are learning the game and retaining ability gains from week-to-week, suggesting some procedural learning is still intact. Over the year, 4 participants showed cognitive decline, 4 were stable and 3 improved based on their Minimental State Exam (MMSE) score. Two measures are proposed based on level progression within the sessions and mole hit performance. The level progression measure identifies declining participants with one false negative (FN) and one false positive error. The mole hit performance measure identifies declining participants with one FN error. These results demonstrate the potential for the proposed instrument to provide an ongoing measurement as an alternative for the repeated application of the MMSE.