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Can Card Games Be Used to Assess Mild Cognitive Impairment?: A Study of Klondike Solitaire and Cognitive Functions

October 2017

DOI:10.1145/3130859.3131328

Conference: Extended Abstracts Publication of the Annual Symposium

Authors:

Karsten Gielis

KU Leuven

Filipa Ferreira-Brito

Universidade de Lisboa, Faculdade de Medicina

Jos Tournoy

KU Leuven

This paper investigates whether Klondike Solitaire can be used as an assessment tool for mild cognitive impairment (MCI). It does so by providing a structured analysis and mapping player actions to cognitive functions. For Klondike Solitaire, 22 player actions were defined and mapped to 10 cognitive functions by 3 health professionals in the field of MCI. The results indicate that Attention, Executive Function, Object Recognition, Abstraction and Memory can be assessed through gameplay of Solitaire. Healthcare professionals confirmed that this can potentially be valuable, as it can screen for cognitive impairments longitudinally, in a non-intrusive way, without practice effects.

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Can Card Games Be Used to Assess

Mild Cognitive Impairment? A Study of

Klondike Solitaire and Cognitive

Functions

Abstract

This paper investigates whether Klondike Solitaire can

be used as an assessment tool for mild cognitive

impairment (MCI). It does so by providing a structured

analysis and mapping player actions to cognitive

functions. For Klondike Solitaire, 22 player actions were

defined and mapped to 10 cognitive functions by 3

health professionals in the field of MCI. The results

indicate that Attention, Executive Function, Object

Recognition, Abstraction and Memory can be assessed

through gameplay of Solitaire. Healthcare professionals

confirmed that this can potentially be valuable, as it

can screen for cognitive impairments longitudinally, in a

non-intrusive way, without practice effects.

Author Keywords

Cognitive Assessment; Solitaire; Cognitive Functions;

Serious Games

ACM Classification Keywords

H.5.m. Information interfaces and presentation (e.g.,

HCI): Miscellaneous.

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CHI PLAY'17 Extended Abstracts, October 15–18, 2017, Amsterdam,

Netherlands

ACM ISBN 978-1-4503-5111-9/17/10.

https://doi.org/10.1145/3130859.3131328

Karsten Gielis

KU Leuven

Andreas Vesaliusstraat 13, 3000

Leuven, Belgium

karsten.gielis@kuleuven.be

Filipa Brito

University of Lisbon

Av. Prof. Egas Moniz MB, 1649-

028 Lisboa, Portugal

filipa.r.brito@gmail.com

Jos Tournoy

UZ Leuven

Herestraat 49,

Leuven, Belgium

jos.tournoy@uzleuven.be

Vero Vanden Abeele

KU Leuven

Andreas Vesaliusstraat 13, 3000

Leuven, Belgium

vero.vandenabeele@kuleuven.be

INTRODUCTION

In the past years, there has been an increasing

emphasis on the early detection of mild cognitive

impairment (MCI), a precursor of dementia [27]. Many

studies confirm that older adults benefit from being

diagnosed early [26]; this can help get the right

treatment and mitigate disease progression [2,20,33].

In addition, early diagnosis ensures finding the best

sources of support, as well as making informed

decisions about the future [15,16,23,26]. As stated by

Knapp et al. “Diagnosis is the gateway for care” [14].

Currently, many instruments exist to screen for

dementia, such as the Mini-Mental State Examination

(MMSE) [31] and the Montreal Cognitive Assessment

(MOCA) [22]. These screening tests are by definition

brief. As a consequence, for the detection of early

stages of dementia and mild cognitive impairment,

these tests have been reported as lacking in sensitivity

[30]. It has also been reported that results of screening

tests need to be interpreted with care. The patient may

feel examined and stressed, or might suffer a

momentary lapse, or simply be tired because the test is

taken at the end of the day. In addition, it has been

reported that these tests are vulnerable to practice

effects [6,18,32]. These external factors hamper the

validity and reliability of these screenings tests. More

reliable and comprehensive cognitive test batteries do

exist [24] that screen for specific cognitive functions

such as attention, executive function, visuospatial skill,

motor skills, memory, language, abstraction and

orientation. However, the administration of these test

batteries is lengthy and necessitates a trained health

professional. Consequently, such a lengthy and formal

assessment of cognitive decline is carried out only

sporadically in older adults and requires older adults to

visit a health clinic. Moreover, to distinguish mild

cognitive impairment from age-related, normal

cognitive decline, specialists still need to rely on

additional reports from proxies [28], such as family and

professional caregivers. As a result, there is an

underdetection of cognitive impairment [3,5], especially

in care homes. In sum, there is a need for more reliable

and frequent assessments that allow an earlier referral

to a physician. Some researchers even plea for on-

going cognitive assessments [4].

To fill this gap, we investigate the assessment of

cognitive impairment through meaningful play. With

meaningful play, we refer to games that are played

often by older adults and perceived as enjoying and

meaningful in and of themselves; games like card

games, board games, puzzle games, etc. [9,10,21,25].

When using the term meaningful play we aim to

exclude games-based assessments or suites of gamified

tools that are designed specifically for cognitive

assessment or rehabilitation. Rather, we aim at those

games that are part of the social fabric of elderly life.

These games have been appropriated by older persons

[12] and while seniors do not play these games for

serious/medical purposes, we aim to investigate

whether these games may still be used to assess

cognitive performance. We hypothesize that such

games equally demand attention, memory, visuospatial

processing, reasoning, and executive skills [1,7].

By using meaningful play as an assessment instrument

of cognitive performance, older adults can be assessed

more frequently, in a natural context, without the extra

effort of doing a tedious battery of tests.

Klondike Solitaire

One game that immediately draws attention is Klondike

Solitaire. Microsoft included this game in their OS since

Windows 3.0 in 1990, and up to today, this remains a

popular card game worldwide [19]. Solitaire is perhaps

the most played game worldwide, particularly enjoyed

by older adults[1,8]. The rules are simple, yet the

game remains challenging: expert players only win

36.6% of the time [17]. Although founded in the 18th

century when fortune-telling cards became popular

[35], researchers still try to understand the optimal

game strategies. Yan et al. [35] modelled Solitaire and

found it to be a deterministic Markov decision problem

with over 52 states, and defined a strategy to achieve a

win rate of 70%. Longpré and McKenzie [17]

researched how to define whether a game is winnable

based on the initial deal. Given the popularity of

Solitaire among older adults, in our research we aim to

investigate whether the game of Klondike Solitaire can

be used for continuous screening of cognitive

impairment.

Related work on card games and cognitive performance

Other researchers have already investigated the use of

card games for cognitive screening. Allaire et al. [1]

show that card games such as Solitaire and FreeCell do

correlate with several factors indicating a more

successful aging and a better cognitive and

psychological functioning. Jimison et al. [13] did

research on FreeCell, another Solitaire version popular

in the United States. She investigated whether an older

user’s performance calculated based on game difficulty,

number of moves, efficiency of the moves and duration

of the moves. They found that based on card play they

could distinguish between mild cognitive impaired users

and cognitively healthy elders. Hence, these results

suggest the possibility of measuring cognitive decline

with card games not specifically designed for this

cause. However, Jimison’s research relied on Freecell,

not Solitaire. Moreover, there is no further insight in

what cognitive functions are specifically addressed.

Hence, a scientific foundation is needed for the

hypothesis that Solitaire may be used for the

assessment of MCI. Moreover, there is a need for

insight in which cognitive functions may (or not) be

assessed when analyzing player actions of Solitaire.

Such an insight can guide multidisciplinary teams,

consisting of game researchers and health professionals

[11] when using Solitaire for assessment.

Therefore, in this paper we present a first structured

analysis and mapping of player actions and cognitive

functions, with health professionals active in the field of

mild cognitive impairment and dementia.

Figure 1. Klondike Solitaire,

consists of seven build

stacks, four suit stacks or

foundation, a pile and a

talon. The goal of the game

is to move all the cards to

the suit stacks in the

correct suit, starting from

the ace to the king.

METHOD

In order to assess whether Solitaire can be used to

screen for MCI, we performed the following steps.

1: Defining Player Actions

In a series of iterations, three researchers (two PhD

researchers on games and cognition, and one HCI

professor) analyzed the literature on Klondike Solitaire,

played the game and dissected possible player actions.

After drawing up a list of actions that was found

exhaustive (i.e. none of the researchers could still think

of an action), these 39 actions were further analyzed. It

was noted that player actions can be described at

different levels of granularity: one single action (e.g. a

tap), or a series of actions (flipping through the pile).

Moreover, depending on the game state, player actions

could be noted as neutral (player uses right hand or left

hand), or as negatively valenced (e.g. a player does not

make a possible move). Finally, it was also noted that

some player actions were hard to interpret without

understanding the (elusive) state of mind of the player.

Ultimately, the decision was made to limit player

actions to those that can be captured unambiguously,

and that could be indicative of cognitive function (i.e.

that carry valence). From the first set, 17 actions were

removed. The remaining 22 player actions were defined

as potentially flags for cognitive impairments which can

be measured unambiguously such as “User idles a lot”,

“User moves card onto a card with the same color” and

“User’s scores vary by a great amount”. A full list of the

player actions can be found at https://goo.gl/bhbKXJ.

2: Defining Cognitive Functions

In parallel, screening tools were analysed that are

currently used for the screening and assessment of

mild cognitive impairment (e.g. Clinical Dementia

Rating (CDR) [29]). An initial list of 8 cognitive

functions was drafted that are measured when

screening for cognitive impairment by these tests:

Attention, Executive Function, Visuospatial Skill, Motor

Skills, Memory, Language, Abstraction and Orientation.

After discussing this list with a health professional as

part of a pilot, it was decided to add two more cognitive

functions. First, to cover user actions implicating not

finding the right card, ‘Object Recognition’ was

suggested. Second, for player actions involving ignoring

a part of the player board, as often found in hemispatial

neglect (a disabling condition caused primarily by

stroke), it was suggested to add hemispatial neglect.

3: Coding of cognitive functions by health professionals

Next, three cognitive health professionals from the

Memory clinic of the University Hospital of Leuven (a

neuropsychologist (HP1), and a professor Gerontology

and Geriatrics (HP2) and a clinical psychologist (HP3),

active in the field of neuropsychology), were recruited.

Each health professional received an individual

introduction of 15 minutes. First, the Solitaire Game

(Microsoft Solitaire Collection) was explained via a 5-

minute introductory video. Secondly, a short

explanation was given of the cognitive functions. After

this introduction, the health professionals received a

coding scheme and were asked to code every player

action for the presence of the aforementioned cognitive

functions. They could score between 0 (not correlated),

1 (weakly), 2 (moderately), and 3 (strongly correlated

to the cognitive function). Based on the scoring of the

health professionals, reliability Checks were performed.

Both the Spearman’s Correlation coefficient with

Spearman-Brown correction and the intra-class

correlation coefficient were calculated for each Player

Action (PA) as specified in [34].

The reliability proved sufficient for most actions. Except

for two Player Actions (PA20 and PA22), all Spearman-

Brown corrections were above 0.75 with an average of

0.80. The average Intraclass Correlation of all Player

Actions is 0.79 with four player actions being under

0.70 (PA14, PA18, PA20 and PA22). Significance levels

vary from <.001 to 0.019 except PA22.

4: Interview

Health professionals were encouraged to think out loud

and voice their thoughts and opinions while scoring. In

addition, after the mapping, further questions were

asked for clarification of their coding. We transcribed

and analyzed the verbal utterances of the health

professionals to provide a qualitative analysis.

Table 1. Overview of

player actions, cognitive

functions and the

average scorings of

health professionals, a

larger view can be

found at

https://goo.gl/utkAaC

RESULTS

The results of the mapping exercise can be found in

Table 1. Health professionals found Attention, Executive

Function, Object Recognition, Abstraction and Memory

most present in the player actions. Hemi-neglect,

Language, Orientation, Motor Skills and Visuospatial

Skill were found less present.

From the post-coding interviews, it became clear that

all HPs believed in the possibility to measure cognitive

impairments through Klondike Solitaire. They uttered

that there are more cognitive functions in Solitaire than

meets the eye. Yet they also noted that it remains hard

to determine specifically which cognitive functions are

impaired. Whereas in cognitive tests only one cognitive

domain is screened at a time, during Solitaire game

play multiple cognitive functions are often intertwined.

Executive function and attention were noted to be most

strongly correlated, and the same was stressed for

object recognition and abstraction.

The format of the tool was described as unique, with

elements from screenings (being an indication, low

effort, not time-consuming for the caregiver) and

assessments (more thorough). HP1 commented, “It will

go deeper as a screening but will be less conclusive

than an assessment”. The fact that the game can be

played daily also allows the possible detection of

cognitive fluctuations, found in Lewy-body and vascular

dementia. It was also noted that practice effects would

be non-existent as every Solitaire game is different.

When coding the player action “User takes a long time

to think of a move”, the remark was made that by HP2

that ‘processing speed’ was lacking. While processing

speed is often associated with executive functioning, it

was deemed necessary to add this cognitive function

separately, to be able to make the difference between

the speed and the power of executive functioning. HP3

told that the problems he had defining the severity of

attention and executive function would be solved with

adding this cognitive function, resulting in a more

uniform rating amongst coders. It was unanimously

noted among the three HPs that while the executive

function often remains intact among MCI, processing

speed often deteriorates. Lastly ‘Apraxia’, a motor

disorder that tackles execution of movements, was

suggested as an additional dysfunction.

DISCUSSION AND CONCLUSION

This preliminary study suggests that Klondike Solitaire

has potential for the assessment of MCI. However,

health professionals emphasized that it would remain

hard to detect specifically which cognitive functions are

impaired. Yet, this was deemed less of an issue as the

goal should be to assess MCI, not to differentiate

between cognitive functions. However, it became

apparent that the set of cognitive functions was not

complete yet when coding the player actions. Our first

list of cognitive functions was based on the cognitive

domains tested by the MoCA, MMSE and CDR. Health

professionals indicated additional cognitive

dysfunctions, such as hemispatial neglect or apraxia.

Moreover, during the coding it was noted that a more

fine-grained mapping should be added. In addition,

some cognitive functions were not uniformly interpreted

and needed a better delineation. Finally, the current

study only involved 3 health professionals. Hence, it is

our intent to refine and replicate this first study to more

cognitive functions and more health professionals.

However, we conclude that the current results support

the hypothesis that Solitaire may be a useful tool for

the assessment of cognitive impairment.

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Interactive simulation technology, especially virtual reality, plays a significant role in practical teaching and training. Several subjects are modified in VR, and students are exploring it. However, this technology is not much used for teaching art and design until now. But VR researchers and educators are trying to apply this technology to show creativity. But is this virtual reality-based technology equally useful for learning the art or innovative design learning? If it is useful then what will be the evaluation criteria for VR-based art teaching? The learning creativity through VR aid is challenging and to evaluate the efficacy of learning is required appropriate rubrics to justify the learning outcome. In the Indian art and design education syllabus National Council of Educational Research and Training (NCERT) prescribed assessing learning strategies (ALS) for traditional pedagogy. Based on the NCERT evaluation rubric, the study created a learning performance assessment instrument and approaches for VR-based pedagogy. To formulate the evolution strategy the methodology follows revised Bloom’s taxonomy that deals with the vast amount of objectives and analysed the related systematic literature survey (SLR). The process includes a synthesis of qualitative findings that helps to render the objectives more precisely and organizing the framework.

Feasibility of common, enjoyable game play for assessing daily cognitive functioning in older adults

Article

Full-text available

Oct 2023

Background Frequent digital monitoring of cognition is a promising approach for assessing endpoints in prevention and treatment trials of Alzheimer’s disease and related dementias (ADRD). This study evaluated the feasibility of the MIND GamePack© for recurrent semi-passive assessment of cognition across a longitudinal interval. Methods The MIND GamePack consists of four iPad-based games selected to be both familiar and enjoyable: Word Scramble, Block Drop, FreeCell, and Memory Match. Participants were asked to play 20 min/day for 5 days (100 min) for 4 months. Feasibility of use by older adults was assessed by measuring gameplay time and game performance. We also evaluated compliance through semi-structured surveys. A linear generalized estimating equation (GEE) model was used to analyze changes in gameplay time, and a regression tree model was employed to estimate the days it took for game performance to plateau. Subjective and environmental factors associated with gameplay time and performance were examined, including daily self-reported questions of memory and thinking ability, mood, sleep, energy, current location, and distractions prior to gameplay. Results Twenty-six cognitively-unimpaired older adults participated (mean age ± SD = 71.9 ± 8.6; 73% female). Gameplay time remained stable throughout the 4-months, with an average compliance rate of 91% ± 11% (1946 days of data across all participants) and weekly average playtime of 210 ± 132 min per participant. We observed an initial learning curve of improving game performance which on average, plateaued after 22–39 days, depending on the game. Higher levels of self-reported memory and thinking ability were associated with more gameplay time and sessions. Conclusion MIND GamePack is a feasible and well-designed semi-passive cognitive assessment platform which may provide complementary data to traditional neuropsychological testing in research on aging and dementia.

Evaluation of CogWorldTravel: A Serious Game for Cognitive Screening

Conference Paper

Aug 2022

A Systematic Review of Serious Games Relating to Cognitive Impairment and Dementia

Article

Full-text available

Mar 2022

The use of cognitive training with tDCS for the reduction of impulsiveness and improvement of executive functions: a case study

Conference Paper

Jun 2021

Longitudinal Change in Performance on the Montreal Cognitive Assessment in Older Adults

Article

Full-text available

Sep 2015
CLIN NEUROPSYCHOL

Objective: The Montreal Cognitive Assessment (MoCA) is a brief screening measure commonly used to determine cognitive status among older adults. Despite the popularity of the MoCA, there has been little research into how performance on the MoCA changes over time in healthy older adults. Methods: The present study examined a sample of older adults (n = 53) recruited for a longitudinal study of healthy aging. Change in total MoCA score at three time points (baseline, 12 months, and 48 months) and scores from the Repeatable Battery for the Assessment of Neuropsychological Status at five time points (RBANS; baseline 12 months, 24 months, 36 months, and 48 months) were assessed using repeated measures analyses. Results: Total MoCA score significantly increased across time, particularly between the first and second administrations. Scores did not significantly differ between the second (12 month) and third (48 month) administrations. When grouped by baseline performance, individuals who scored low at baseline significantly improved performance at 12-month testing, but had little change between 12- and 48-month testing. Conversely, individuals who scored high at baseline did not significantly change between baseline and 12-month testing, but improved between 12- and 48-month testing. RBANS scores did not significantly change over time. Conclusions: These results suggest that the MoCA may be susceptible to practice effects, particularly between the first and second administrations. These practice effects should be taken into consideration when repeatedly employing the MoCA to screen for cognitive status in healthy older adults.

Game playbooks: Tools to guide multidisciplinary teams in developing videogame-based behavior change interventions

Article

Full-text available

Mar 2014

As mobile technologies and videogaming platforms are becoming increasingly prevalent in the realm of health and healthcare, so are the opportunities to use these resources to conduct behavioral interventions. The creation and empirical testing of game style interventions, however, is challenged by the requisite collaboration of multidisciplinary teams, including researchers and game developers who have different cultures, terminologies, and standards of evidence. Thus, traditional intervention development tools such as logic models and intervention manuals may need to be augmented by creating what we have termed "Game Playbooks" which are intervention guidebooks that are created by, understood by, and acceptable to all members of the multidisciplinary game development team. The purpose of this paper is to describe the importance and content of a Game Playbook created to aide in the development of a videogame intervention designed specifically for health behavior change in young teens as well as the process for creating such a tool. We draw on the experience of our research and game design team to describe the critical components of the Game Playbook and the necessity of creating such a tool.

Diagnostic accuracy and practice effects in the National Alzheimer's Coordinating Center Uniform Data Set neuropsychological battery

Article

Full-text available

Nov 2014
ALZHEIMERS DEMENT

Introduction The Uniform Data Set (UDS) neuropsychological battery is frequently used in clinical studies. However, practice effects, effectiveness as a measure of global cognitive functioning, and detection of mild cognitive impairment have not been examined. Methods A normative total score for the UDS has been developed. Linear discriminant analysis determined classification accuracy in identifying cognitively normal and impaired groups. Practice effects were examined in cognitively normal and cognitively impaired groups. Results The total score differentiates between cognitively normal participants and those with dementia, but does not accurately identify individuals with mild cognitive impairment (MCI). Mean total scores for test-exposed participants were significantly higher than test-naive participants in both the normal and MCI groups and were higher, but not significantly so, in the dementia group. Conclusion The total score’s classification accuracy discriminates between cognitively normal versus participants who have dementia. The total score appears subject to practice effects.

The domestication of digital games in the lives of older adults

Article

Full-text available

Feb 2014
NEW MEDIA SOC

The current study aims to integrate the findings of previous research on the use of video games by older adults by applying the domestication framework (Silverstone et al., 1992). A qualitative study was performed with 35 participants aged between 49 and 73, who were targeted purposefully from a larger sample of 213. The analysis revealed how older adults appropriated digital games using pre-existing, public and co-constructed meanings, as well as how such meanings influence the incorporation of digital games in their daily routine. The study also reveals how the transformation of personal meanings into the public realm can be obstructed by social factors. Finally, the usefulness of the domestication framework for this topic of study as well as implications for future research are discussed.

Mild Cognitive Impairment

Article

Apr 2016

Ronald C Petersen

Purpose of review: As individuals age, the quality of cognitive function becomes an increasingly important topic. The concept of mild cognitive impairment (MCI) has evolved over the past 2 decades to represent a state of cognitive function between that seen in normal aging and dementia. As such, it is important for health care providers to be aware of the condition and place it in the appropriate clinical context. Recent findings: Numerous international population-based studies have been conducted to document the frequency of MCI, estimating its prevalence to be between 15% and 20% in persons 60 years and older, making it a common condition encountered by clinicians. The annual rate in which MCI progresses to dementia varies between 8% and 15% per year, implying that it is an important condition to identify and treat. In those MCI cases destined to develop Alzheimer disease, biomarkers are emerging to help identify etiology and predict progression. However, not all MCI is due to Alzheimer disease, and identifying subtypes is important for possible treatment and counseling. If treatable causes are identified, the person with MCI might improve. Summary: MCI is an important clinical entity to identify, and while uncertainties persist, clinicians need to be aware of its diagnostic features to enable them to counsel patients. MCI remains an active area of research as numerous randomized controlled trials are being conducted to develop effective treatments.

Advances in the early detection of Alzheimer's disease

Article

Jan 2004
NAT REV NEUROSCI

Clinical Dementia Rating

Chapter

Jan 2011

SynonymsCDRDescriptionThe Clinical Dementia Rating (CDR; Hughes, Berg, Danziger, Coben, & Martin, 1982) is a semi-structured, clinician-rated interview widely used to stage the progression of dementia using information provided by the patient and an informant. A global CDR score is generated to stage the severity of dementia. It is based on ratings of the patient’s functioning in six domains commonly affected in Alzheimer’s disease (AD): memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care. The CDR rates only impairments due to cognitive deficits rather than to physical disability. Based solely on clinical information obtained from the patient and informant, and without reference to psychometric performance, a box score describing the level of impairment is generated for each domain. The box score ranges from 0 to 3, representing “none” to “severe” impairment. Using a scoring algorithm, one of five possible stages ...

Innovative diagnostic tools for early detection of Alzheimer's disease

Article

Nov 2014

Current state-of-the-art diagnostic measures of Alzheimer’s disease (AD) are invasive (cerebrospinal fluid analysis), expensive (neuroimaging) and time-consuming (neuropsychological assessment) and thus have limited accessibility as frontline screening and diagnostic tools for AD. Thus, there is an increasing need for additional noninvasive and/or cost-effective tools, allowing identification of subjects in the preclinical or early clinical stages of AD who could be suitable for further cognitive evaluation and dementia diagnostics. Implementation of such tests may facilitate early and potentially more effective therapeutic and preventative strategies for AD. Before applying them in clinical practice, these tools should be examined in ongoing large clinical trials. This review will summarize and highlight the most promising screening tools including neuropsychometric, clinical, blood, and neurophysiological tests.

Status of Acetylcholinesterase and Butyrylcholinesterase in Alzheimer's Disease and Type 2 Diabetes Mellitus

Article

Oct 2014

Both Alzheimer's disease (AD) and Type 2 diabetes mellitus (T2DM) share the presence of systemic and neuro-inflammation, enhanced production and accumulation of β-amyloid peptide and abnormal levels of the enzymes acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE). Altered levels of AChE and BuChE both in AD as well as in T2DM imply that those two enzymes may be playing a pivotal role in the pathogenesis of the two disorders. AD and T2DM are both characterized by elevated levels of AChE and BuChE in the plasma. On the other hand, in AD the brain levels of AChE go down while those of BuChE go up, resulting in deregulation in balance between AChE and BuChE. This imbalance and change in the AChE / BuChE ratio causes cholinergic deficit in the brain, i.e. deficiency in the brain neurotransmitter acetylcholine. With better understanding of the inter-relationship of AChE and BuChE levels in normality as well as abnormality, AD and T2DM can be effectively treated. Thus, general cholinesterase inhibitors that inhibit both AChE and BuChE as well as highly selective BuChE inhibitors may have potential therapeutic benefits in the treatment of AD and other related dementias.

Memantine improves attention and episodic memory in Parkinson's disease dementia and dementia with Lewy bodies

Article

Apr 2014
INT J GERIATR PSYCH

Objective In both dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), attentional dysfunction is a core clinical feature together with disrupted episodic memory. This study evaluated the cognitive effects of memantine in DLB and PDD using automated tests of attention and episodic memory.MethodsA randomised double-blind, placebo-controlled, 24-week three centre trial of memantine (20 mg/day) was conducted in which tests of attention (simple and choice reaction time) and word recognition (immediate and delayed) from the CDR System were administered prior to dosing and again at 12 and 24 weeks. Although other results from this study have been published, the data from the CDR System tests were not included and are presented here for the first time.ResultsData were available for 51 patients (21 DLB and 30 PDD). In both populations, memantine produced statistically significant medium to large effect sized improvements to choice reaction time, immediate and delayed word recognition.Conclusions These are the first substantial improvements on cognitive tests of attention and episodic recognition memory identified with memantine in either DLB or PDD. Copyright © 2014 John Wiley & Sons, Ltd.