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Divided Attention in Computer Game Play: Analysis Utilizing Unobtrusive Health Monitoring
Abstract
Divided attention is a vital cognitive ability used in important daily activities (e.g., driving), which tends to deteriorate with age. As with Alzheimer's and other neural degenerative conditions, treatment for divided attention problems is likely to be more effective the earlier it is detected. Thus, it is important that a method be found to detect changes in divided attention early on in the process, for both safety and health care reasons. We present here a new method for detecting divided attention unobtrusively, using performance on a computer game designed to force players to attend to different dimensions simultaneously in order to succeed. Should this model prove to predict scores on a standard test for divided attention, it could help to detect cognitive decline earlier in our increasingly computer-involved aging population, providing treatment efficacy benefits to those who will experience cognitive decline.
... Conventional clinical cognitive assessment is not part of the older adult's everyday life [1] and usually only takes place when the patient or family has concerns regarding cognitive dysfunction [2]. Moreover, the clinical environment visit increases stress, which may in turn affect negatively the assessment [3] or act as amotivation for the patient to perform well on the tests [4] to avoid stigmatization. These factors contribute to questioning the ecological validity of neurophysiological tests [5] and may lead to delayed detection, or failure to detect cognitive decline, or even to false diagnosis among primary care providers [3,6]. ...
... Using long-term data from unobtrusive monitoring via computer games can be exploited for the detection of deterioration trends in cognitive performance beyond one shot screening tests/games with test-retest constraints. Moreover, the unobtrusive detection of changes in the cognitive baseline through SGs may address the gaps in clinical assessment [4]. The rationale behind this argument may lie in the fact that games motivate the patient to participate for enjoyment, thereby eliminating the stress induced by clinical assessment tests. ...
Conventional clinical cognitive assessment has its limitations, as evidenced by the environmental shortcomings of various neuropsychological tests conducted away from an older person's everyday environment. Recent research activities have focused on transferring screening tests to computerized forms, as well as on developing short screening tests for screening large populations for cognitive impairment. The purpose of this study was to present an exergaming platform, which was widely trialed (116 participants) to collect in-game metrics (built-in game performance measures). The potential correlation between in-game metrics and cognition was investigated in-depth by scrutinizing different in-game metrics. The predictive value of high-resolution monitoring games was assessed by correlating it with classical neuropsychological tests; the area under the curve (AUC) in the receiver operating characteristic (ROC) analysis was calculated to determine the sensitivity and specificity of the method for detecting mild cognitive impairment (MCI). Classification accuracy was calculated to be 73.53% when distinguishing between MCI and normal subjects, and 70.69% when subjects with mild dementia were also involved. The results revealed evidence that careful design of serious games, with respect to in-game metrics, could potentially contribute to the early and unobtrusive detection of cognitive decline.
... For example, several papers in our review created games to detect dyslexia based on theories of visual-spatial attention [55,89,96,100]. As another example, McKanna et al [32] created 21 Tally, described as "blackjack played in two dimensions," based on theories of divided attention. ...
... If the goal is to create a game for widespread dissemination for population-level research, then the focus can be on making the game truly engaging and fun to encourage natural use in-the-wild. As an example from our review, McKanna et al [32] identified the need for an unobtrusive way to continuously monitor and detect cognitive decline in older adults. This goal guided their development of a computer game that naturally appealed to older adults and targeted divided attention, a function associated with daily activities that often declines with age. ...
Background
Serious games are now widely used in many contexts, including psychological research and clinical use. One area of growing interest is that of cognitive assessment, which seeks to measure different cognitive functions such as memory, attention, and perception. Measuring these functions at both the population and individual levels can inform research and indicate health issues. Attention is an important function to assess, as an accurate measure of attention can help diagnose many common disorders, such as attention-deficit/hyperactivity disorder and dementia. However, using games to assess attention poses unique problems, as games inherently manipulate attention through elements such as sound effects, graphics, and rewards, and research on adding game elements to assessments (ie, gamification) has shown mixed results. The process for developing cognitive tasks is robust, with high psychometric standards that must be met before these tasks are used for assessment. Although games offer more diverse approaches for assessment, there is no standard for how they should be developed or evaluated.
Objective
To better understand the field and provide guidance to interdisciplinary researchers, we aim to answer the question: How are digital games used for the cognitive assessment of attention made and measured?
Methods
We searched several databases for papers that described a digital game used to assess attention that could be deployed remotely without specialized hardware. We used Rayyan, a systematic review software, to screen the records before conducting a systematic review.
Results
The initial database search returned 49,365 papers. Our screening process resulted in a total of 74 papers that used a digital game to measure cognitive functions related to attention. Across the studies in our review, we found three approaches to making assessment games: gamifying cognitive tasks, creating custom games based on theories of cognition, and exploring potential assessment properties of commercial games. With regard to measuring the assessment properties of these games (eg, how accurately they assess attention), we found three approaches: comparison to a traditional cognitive task, comparison to a clinical diagnosis, and comparison to knowledge of cognition; however, most studies in our review did not evaluate the game’s properties (eg, if participants enjoyed the game).
Conclusions
Our review provides an overview of how games used for the assessment of attention are developed and evaluated. We further identified three barriers to advancing the field: reliance on assumptions, lack of evaluation, and lack of integration and standardization. We then recommend the best practices to address these barriers. Our review can act as a resource to help guide the field toward more standardized approaches and rigorous evaluation required for the widespread adoption of assessment games.
... They systematically reviewed several games for health applications from January 2004 to December 2012. The five papers that we selected are based on current and diverse health issues: divided attention problems [23], hand health [24], surgery training [17], nurse training [25], and youth cancer [26]. Each of these games is based on the genres: puzzle, simulation, simulation, simulation and adventure, respectively. ...
... McKanna et al. [23] stated that divided attention is the inability to pay attention at a particular aspect, which becomes more prominent with age. To address the issue of divided attention, the authors developed a 2D puzzle game known as 21 Tally, which can be played on PC. ...
Cognitive load refers to the mental effort required or invested to achieve the objectives of a task. Cognitive load plays a vital role in various everyday tasks including security, management, video games, driving, and learning. Since its inception in the 1980s, cognitive load has been used as a key parameter for measuring task performance using various tools and techniques. One of the most significant areas that cognitive load affects is the performance of game players. Depending on the performance and cognitive load of gamers, certain games can be regarded as either exciting or boring. This paper aims to discuss games for health and the need to measure cognitive load in these games. Finally, we suggest methods to measure cognitive load in games for using some existing games for health as examples.
... Activity types can be physical exertion, for example, in games for well-being such as in [33,34] or games for health to fight childhood obesity [35]. The activity type can also be physiological such as in games for rehabilitation [36] or for the detection of some health conditions [37]. It can also be mental, for example, in games for education [29,38], training [39], or interpersonal communication [12]. ...
... The research and development related to the detection and treatment of various health conditions using serious games have grown significantly in the last few years. 21 Tally is a collection of 2D games used to detect divided attention unobtrusively, using a game designed to force players to attend to different dimensions simultaneously in order to succeed [37]. Two EEG-based concentration games, namely, Brain Chi (2D) and Dancing Robot (3D), were developed for concentration level control [74]. ...
Serious games are growing rapidly as a gaming industry as well as a field of academic research. There are many surveys in the field of digital serious games; however, most surveys are specific to a particular area such as education or health. So far, there has been little work done to survey digital serious games in general, which is the main goal of this paper. Hence, we discuss relevant work on serious games in different application areas including education, well-being, advertisement, cultural heritage, interpersonal communication, and health care. We also propose a taxonomy for digital serious games, and we suggest a classification of reviewed serious games applications from the literature against the defined taxonomy. Finally, the paper provides guidelines, drawn from the literature, for the design and development of successful serious games, as well as discussing research perspectives in this domain.
... Thus, for each new board, the player attempts to obtain as many totals of 21 in rows and columns as possible while receiving as few over-21 s (busts) as possible. New boards are shown for a certain period of time (the "stimulus period"), as in the left side of Fig. 8.6, after which they are flipped face-down (as in the right side) to await player response (McKanna et al. 2009). During the game testing we used algorithm-generated boards that were designed to emphasize divided Fig. 8.9 Screen shot on a computer game used to assess working memory. ...
Cognition is a significant determinant of our intellectual capacity and quality of life. Our cognition enables our perception, recognition, memory, attentional control, reasoning, and decision-making and is therefore involved in most of our behaviors. In this chapter we will discuss the large spectrum of cognitive functions ranging from high-level executive functions to their implication in the “simplest” repetitive, nearly automatic movements of one’s finger. The only behaviors that are not completely tied to cognition are purely reflexive and certain habitual behaviors. Because of the importance of cognition, the assessment and understanding of cognitive functionality have been the foci of many research initiatives and projects ranging from basic science to applied assessment. A recent report from the U.S. Center for Disease Control (Taylor et al. Morb Mortal Wkly Rep 67:753, 2018) included results showing that the prevalence of subjective cognitive decline in the U.S. was 11.1%, or 1 in 9 adults. It was slightly higher for adults 65 years and older (11.7%) and somewhat lower for adults 45–64 years of age. Clearly, cognitive impairment with its resulting impacts on health and welfare is widespread and important to address.KeywordsCognitive monitoringCognitive declineHealth coachingAgingNeurological conditions
... 2) Clinical assessment or detection system devices can diagnose the patient's symptoms of irregularity such as PlayWithEyes [92], Unobtrusive health [93], and EEG-based serious games [94]. ...
Facial palsy patients or patients under facial transplantation have facial dysfunctionalities and abnormal facial motion. This is due to the altered facial nerve and facial muscle systems. Current traditional facial rehabilitation is based mainly on a mirror approach to monitor the visual qualitative feedback from the rehabilitation exercise. Computer-aided systems based on physics-based models have also been developed to provide objective and quantitative information. However, the use of these systems in clinical routine practice still remains challenging due to several limitations: 1) the lack of building 3D information from images or the dependency on the selected cameras; 2) the lack of analyzing the face in terms of expression recognition and symmetry analysis and 3) the limitation of the predictive capacity of the facial motion patterns with emerging biomechanical properties. The objectives of this Ph.D. are to develop innovative engineering solutions toward a next-generation computer-aided decision support system for facial analysis and rehabilitation. The thesis provided four main contributions: 1) the fast reconstruction of the 3D face shape from a single 2D image using deep learning approaches; 2) the improvement of facial expression recognition using 3D point set and geometric deep learning; 3) the face symmetry analysis based on novel descriptors and the difference between two different populations (Caucasian and Asian) and 4) the proposition of a novel modeling workflow for learning facial motion by coupling reinforcement learning and the finite element modeling for facial motion learning and prediction. The thesis opens new avenues for developing and deploying an end-to-end computer-aided decision support system to guide and optimize the functional rehabilitation program.
... Serious games are games created for a purpose other than pure entertainment [9]. Serious games focused on health were used to help with health monitoring [10][11][12], detection and management of health conditions [13][14][15][16], and therapy and rehabilitation [17][18][19]. Serious games designed for the elderly have been developed over the years with a variety of goals in mind, ranging from physical therapy, balance training, and mood or stress management [20][21][22]. ...
Cognitive decline is one of the primary concerns in the elderly population. Serious games have been used for different purposes related to elderly care, such as physical therapy, cognitive training and mood management. There has been scientific evidence regarding the relationship between cognition and the autonomic nervous system (ANS) through heart rate variability (HRV). This paper explores the changes in the ANS among elderly people of normal and impaired cognition through measured HRV. Forty-eight subjects were classified into two groups: normal cognition (NC) (n = 24) and mild cognitive impairment (MCI) (n = 24). The subjects went through the following experiment flow: rest for 3 min (Rest 1), play a cognitive aptitude game (Game 1), rest for another 3 min (Rest 2), then play two reaction-time games (Game 2&3). Ten HRV features were extracted from measured electrocardiography (ECG) signals. Based on statistical analysis, there was no significant difference on the HRV between the two groups, but the experiment sessions do have a significant effect. There was no significant interaction between sessions and cognitive status. This implies that the HRV between the two groups have no significant difference, and they will experience similar changes in their HRV regardless of their cognitive status. Based on the game performance, there was a significant difference between the two groups of elderly people. Tree-based pipeline optimization tool (TPOT) was used for generating a machine learning pipeline for classification. Classification accuracy of 68.75% was achieved using HRV features, but higher accuracies of 83.33% and 81.20% were achieved using game performance or both HRV and game performance features, respectively. These results show that HRV has the potential to be used for detection of mild cognition impairment, but game performance can yield better accuracy. Thus, serious games have the potential to be used for assessing cognitive decline among the elderly.
... Based on the aforementioned, the term "serious games" has become a very popular topic in the scientific community [9]. Serious games are games which are used for purposes other than entertainment [10]. If games are interactive and present a feeling of fluidity with the user, an intrinsic motivation is generated to continue playing and learning [11]. ...
... Many types of activity, including physical activity, target health and movement activities such as recreational games [46,47] and games aimed at obese children [48]. Another type of activity is physiological, which can be used in rehabilitation games [49] and to diagnose health conditions [50]. The activity can also be mental, i.e., one that is used to learn [51,52] and provide training in different fields. ...
For people with Autism Spectrum Disorder (ASD), using technological tools, such as augmented reality (AR) and serious games remain a new and unexplored option. To attract people with ASD who have communicative, social, emotional and attention deficit disorders to behavioral treatments , an attractive environment is needed that ensures continuity during treatment. The aim of the current work is to efficiently examine systematic reviews and relevant primary studies on ASD solutions from 2015 to 2020, particularly those using the traditional Picture Exchange Communication System (PECS), the application of augmented reality and those that propose serious games, thereby providing an overview of existing evidence and to identify strategies for future research. Five databases were searched for keywords that may be included within the broad Autism Spectrum Disorder 'ASD' umbrella term, alongside 'augmented reality', 'serious games' and 'PECS'. We screened 1799 titles and abstracts, read, and retained 12 reviews and 43 studies. The studies scrutinized in our systematic review were examined to answer four primary and four sub-research questions , which we formulated to better understand general trends in the use of approaches for attracting people with ASD to behavioral therapies. Additionally, our systematic review also presents ongoing issues in this area of research and suggests promising future research directions. Our review is useful to researchers in this field as it facilitates the comparison of existing studies with work currently being conducted, based on the availability of a wide range of studies in three different areas (AR, SG and PECS).
... Like, some Monitoring games are CHF Tele-management System (Finkelstein J, 2010), Health Care Monitoring (Fergus, 2009) and U-Health Monitoring System (Lee, 2009). Unobtrusive Health (McKanna, 2009)and EEG-Base Serious Games (Wang, 2010) are related to detection process. Some Treatment Process related games are Match-3 (Scarle, 2011), Diagnosis and Management of Parkinson (Atkinson, 2010) and Social Skills (Bartolomé, 2010). ...
eHealth (Health Informatics/Medical Informatics) field is growing worldwide due to acknowledge of reputable Organizations such as World Health Organization, Institute of Medicine in USA and several others. This field is facing number of challenges and there is need to classify these challenges mentioned by different researchers of this area. The purpose of this study is to classify different eHealth challenges in broader categories. We also analyzed recent eHealth Applications to identify current trends of such applications. In this paper, we identify stakeholders who are responsible to contribute in a particular eHealth challenge. Through eHealth application analysis, we categories these applications based on different factors. We identify different socio-economic benefits, which these applications can provide. We also present ecosystem of an eHealth application. We gave recommendations for eHealth challenges relevant to Information Technology domain. We conclude our discussion by specifying areas for future research and recommending researchers to work on identify which type of disease can control and manage by different eHealth applications.
... Match-3 [23] is another game that is used to control obesity during childhood by the use of Wii-mote. Brain chi, Dancing Robot [24], 21 Tally [25] are a few other examples where the serious game is used for the detection and treatment of various diseases and disabilities. ...
... So, in conjunction with the possible unfamiliar environment (i.e if tests are being performed in the premises of the clinic), we face the problem of changed behavior. The subject is moved away from the familiar comfort zone of the home and being subjected to various tests by clinical staff and strange-looking equipment (McKanna, Jimison, & Pavel, 2009). That of course raises stress levels and leads to perhaps exaggerated reactions to the monitoring protocol. ...
Early detection and prediction of dementia through unobtrusive techniques or obtrusive tests is still in exploratory status and despite the increase of interest in recent years, many challenges remain open in designing methodologies that can accurately predict its onset. This chapter addresses the problem of the early detection of dementia from two points of view: Detection based on unobtrusive paradigms both in lab and home environments (behavioral monitoring, serious games, home based assisted living applications in telemedicine) and detection based on neuroimaging approaches. The chapter also provides information on setting up ecologically valid home labs for dementia related experiments. Consequently, the aim of this chapter is to provide an overview of a complete methodology of how researchers can possibly detect or predict the onset of dementia through the current state-of-the-art, underline open challenges and illustrate future work in the field.
... Data collection in community settings often prioritizes ecological validity at the expense of precision. In contrast, by deploying technologies which conform to individual's lifestyle and environment, clinical and translational investigations can benefit from intensive, unobtrusive measurement 6,7 in naturalistic settings with increased precision, reliability, and statistical power 8 . In addition, these methods should improve participant satisfaction and retention. ...
Background As technological advances modify the standard implementation approaches for health-related research, it becomes increasingly necessary to be comfortable with computers and the internet, to be able to participate in research. We sought to investigate how inclination toward technology (technophilia) and openness to research participation (ORP) co-vary, and what patient factors relate to technophilia. We focus on attitudes regarding research participation and technology in a diverse urban community. Methods 214 residents over age 50 participated in a community interview survey. Unidimensionality of the technophilia and ORP constructs was evaluated via factor analysis, and scores were calculated using the weighted sum of factor loadings. Among the subgroup with any reported computer experience, linear regression evaluated predictors of technophilia. Hierarchical modeling assessed predictors of ORP, including technophilia. Results The sample included African-American (58%), White (27%), and Hispanic (12%) participants with a mean age of 70.9 years; 77% were female, and 57% had a college education. 131 individuals (61%) reported "any experience with computers", among whom univariate predictors of technophilia were younger age (p=0.001), higher education (p=0.03), not being widowed (p=0.04), and better self-reported health (p=0.003). Multivariate modeling demonstrated that technophilia and one's sense of social cohesion were consistent predictors of ORP. Conclusions Technophilia was a consistent predictor of ORP, and social cohesion added additional predictive ability. Aging research which incorporates technology could be more efficiently recruiting participants by measuring and considering technophilia and social cohesion.
... This application displays the bio-signals of patient onto a monitor of personal computer and LCD of a Nintendo DS using a bio-signal measurement device connected via wireless protocol. • Unobtrusive Health [34]: 21 Tally is a collection of 2D games used to detecting divided attention unobtrusively, by using performance on a computer game designed to force players to attend to different dimensions simultaneously in order to succeed. • EEG-Based Serious Games [58]: ...
In this chapter, we present a state-of-the-art report on serious games dealing with e-health in a broad sense, including medicine, nursing, health care, and physical exercise. The games have been classified according to their main purpose (entertainment, teaching, or health), stages of the disease being treated and the type of users of the system (general population, patients, and health professionals). Additionally, 12 criteria dealing with the game technology have been selected for a fine-grain classification. Forty-one games from academic and commercial environments (including a variety of online games) have been described, analyzed, and classified.
... Detection focuses on analysis or trace the irregularity symptom of the patient. For example Unobtrusive health (Mckanna, Jimison, & Pavel, 2009), EEG-based serious games (Wang, Sourina, & Nguyen, 2010) and PlayWithEyes (Bortoli & Gaggi, 2011). Treatment or therapy is used to remedy a health problem. ...
Maintaining and restoring health is a basic aspect of well being. On the other hand, serious games is an emerging technology growing in importance for specialized training, taking advantage of 3D games and game engines in order to improve the realistic experience of users. Thus, according to the advancement of technology and the desire to achieve good health using an interesting and enjoyable way, different serious games for health have been proposed during the last few years. In this paper, we present the core process of serious games and explain their functionalities. Then, we survey more than one hundred serious games for health and propose new classifications in four different aspects. Finally, we use fifteen relevant characteristics to classify all the surveyed games and present them with plenty of graphs and charts with corresponding discussion.
Early detection and prediction of dementia through unobtrusive techniques or obtrusive tests is still in exploratory status and despite the increase of interest in recent years, many challenges remain open in designing methodologies that can accurately predict its onset. This chapter addresses the problem of the early detection of dementia from two points of view: Detection based on unobtrusive paradigms both in lab and home environments (behavioral monitoring, serious games, home based assisted living applications in telemedicine) and detection based on neuroimaging approaches. The chapter also provides information on setting up ecologically valid home labs for dementia related experiments. Consequently, the aim of this chapter is to provide an overview of a complete methodology of how researchers can possibly detect or predict the onset of dementia through the current state-of-the-art, underline open challenges and illustrate future work in the field.
The measurement of cognitive performance is important in diagnosing and monitoring interventions for a wide variety of neurological conditions, such as dementias (Alzheimer’s, vascular, etc.), multiple sclerosis, Parkinson’s disease, and stroke recovery. These risk factors for cognitive decline are further aggravated with advancing age. The encouraging news is that recent research has shown that there is significant neuroplasticity in the adult brain, and that even the elderly are capable of achieving measurable changes in brain organization and function. Maximizing effectiveness of such interventions requires continuous (or at least very frequent), unobtrusive assessment of cognitive functions. This chapter describes how new behavioral informatics with computational models can be used to assess various cognitive functions in the wild and over time using new behavioral metrics, including walking speed, computer interactions and embedded measures in cognitive computer games. This new approach to cognitive monitoring offers substantial improvements over conventional infrequent assessments performed in the clinic. Namely, repeated measures in the home environment offer the ability to measure within-subject trends and potentially detect cognitive problems and intervene at an earlier stage.
The emerging of new technologies (e.g., motion sensors) has enabled the creation of more realistic games. Due to its playful feature, these games have been successfully applied in health care, mainly as a supplementary therapy for rehabilitation treatments. There are many areas where games are, and can be, applied. In this sense, for a better understanding of the use of games in healthcare, we carried out a literature review to verify the different possibilities of use and its benefits. We performed a systematic review of literature which reveals that the best results, and areas where the games are most used, are in the rehabilitation of patients with brain damage, cerebral palsy, the reduction of fall's risk and therapies for overweight people. These results can be applied as requirements for researches and developments for healthcare.
Cognitive training refers to theory-driven behavioral intervention, ideally supported by a strong conceptual framework and specified neurocognitive mechanisms. Within this field, neurotechnology promises many advantages, and a growing literature establishes technology-enabled cognitive training as a promising modality to promote positive cognition in consumer, research, clinical, and public health settings. Methodologic challenges remain, and specific cognitive training recommendations for healthy elders must be tentative in the context of an emerging evidence base.
Payton Bissel (payton@sprylearning.com) Devin Williams (devin@sprylearning.com) Abstract Elders are the fastest growing demographic of new computer users, and those over the age of 75 are at risk for medically related cognitive decline and confusion. The early detection of cognitive problems enables earlier treatment that may be much more effective. To address this issue, we have developed a method for embedding cognitive assessment algorithms within computer games that are enjoyable for elders to play on a routine basis. The cognitive assessment algorithms also serve as input to tailored automated hints and help functions for users of various cognitive abilities. In this paper we describe a software architecture and methodology for monitoring cognitive performance using data from a suite of computer games designed to assess multiple dimensions of cognitive performance.
A 2D polar projection of a 3D wire cube (Necker cube) in clockwise rotation can be perceived either veridically as a clockwise-rotating cube (rigid percept) or as a counterclockwise-rotating rubbery, truncated pyramid (nonrigid percept). The 3D percept is influenced by various cues: linear perspective, stereo disparity, and proximity-luminance covariance (PLC, the intensification of edges in proportion to their proximity to the observer). Perspective, by itself or in combination, is a very weak cue whereas PLC is a powerful cue [Schwartz and Sperling (1983) Bull. Psychon. Soc. 21, 456-458]. Here we determined psychometric functions for perceptual resolution in static displays and dynamic rotating displays (with and without a static preview) as determined by stereopsis and PLC in isolation and with both cues jointly, possibly in conflict. Stereopsis was the dominant cue in static displays and in most dynamic displays. When a static display preceded a dynamic display, it strongly influenced the subsequent dynamic percept. Perceptual resolution in all conditions was accurately described by a winner-take-all model in which the strength of evidence for each percept from different cues is simply algebraically added.
The size of the functional field of view (FFOV) predicts driving safety in older adults (
Owsley et al., 1998), and practice-related changes in the FFOV may transfer to driving safety (
Roenker, Cissell, Ball, Wadley, & Edwards, 2003). We used functional magnetic resonance imaging (fMRI) and behavioral measures to examine how practice with the FFOV task
changes older adults' attentional function. Behavioral data collected outside of the MRI revealed that participants in the
training group showed larger improvements across conditions than did those in the control group. fMRI data revealed training-related
changes in activation in a number of brain regions. In the right precentral gyrus and right inferior frontal gyrus, increases
in activation between fMRI sessions correlated positively with increases in accuracy between behavioral sessions. Practice
with the FFOV task improves older adults' attentional function by increasing their recruitment of regions traditionally associated
with orienting visual attention.
Many countries are faced with a rapidly increasing economic and social challenge of caring for their elderly population. Cognitive issues are at the forefront of the list of concerns. People over the age of 75 are at risk for medically related cognitive decline and confusion, and the early detection of cognitive problems would allow for more effective clinical intervention. However, standard cognitive assessments are not diagnostically sensitive and are performed infrequently. To address these issues, we have developed a set of adaptive computer games to monitor cognitive performance in a home environment. Assessment algorithms for various aspects of cognition are embedded in the games. The monitoring of these metrics allows us to detect within subject trends over time, providing a method for the early detection of cognitive decline. In addition, the real-time information on cognitive state is used to adapt the user interface to the needs of the individual user. In this paper we describe the software architecture and methodology for monitoring cognitive performance using data from natural computer interactions in a home setting.
Maintaining cognitive performance is a key factor influencing elders' ability to live independently with a high quality of life. We have been developing unobtrusive measures to monitor cognitive performance and potentially predict decline using information from routine computer interactions in the home. Early detection of cognitive decline offers the potential for intervention at a point when it is likely to be more successful. This paper describes recommendations for the conduct of studies monitoring cognitive function based on routine computer interactions in elders' home environments
Objective: To describe the prevalence of cognitive impairment among elderly primary care patients and to compare diagnostic evaluations and use of health services among patients with and those without cognitive impairment. Design: Prospective cohort study. Setting: Academic primary care group practice. Patients: 3954 patients aged 60 years and older who completed the Short Portable Mental Status Questionnaire during routine office visits. Measurements: Demographics and comorbid illness at baseline, diagnostic evaluations for cognitive impairment, use of standard and preventive health services, use of psychoactive drugs, and death in the year after the screening date. Results: The prevalence of cognitive impairment among all patients aged 60 years and older at baseline was 15.7%; 10.5% had mild impairment and 5.2% had moderate to severe impairment. Patients with moderate to severe impairment were significantly older than patients with no impairment (76.2 years and 67.4 years, respectively), were more likely to be black (85.8% and 61.3%), had fewer years of education (7.3 years and 9.2 years), and were more likely to have cerebrovascular disease (20.4% and 6.3%) and evidence of undernutrition (30.6% and 16.9%). Dementia was recorded as a diagnosis for less than 25% of patients with moderate to severe cognitive impairment, but patients with documented impairment were more likely to have been evaluated for reversible causes. In the year after screening, patients with moderate to severe impairment were more likely than those with no impairment both to be hospitalized (29.1 % and 16.5%) and to visit the emergency department (55.8% and 38.5%) but had fewer outpatient visits (6.0 and 7.6) and greater mortality (8.2% and 2.8%). Conclusions: Cognitive impairment is associated with increased use of health services and increased mortality. Patients with undocumented cognitive impairment were significantly less likely to be evaluated for reversible causes. Research is needed to determine if better documentation of cognitive impairment would improve not only diagnostic evaluations but also patient management, counseling, and outcomes
Typescript. Thesis (Ph. D.)--University of Illinois at Urbana-Champaign, 1984. Vita. Includes bibliographical references (leaves 168-178). Available on microfilm from University Microfilms.
The conditions under which dual-task integrality can be fostered were assessed in a study in which we manipulated four factors likely to influence the integrality between tasks: intertask redundancy, the spatial proximity of primary and secondary task displays, the degree to which primary and secondary task displays constitute a single object, and the resource demands of the two tasks. The resource allocation policy is inferred from changes in the amplitude of the P300 component of the event-related brain potential. Twelve subjects participated in three experimental sessions in which they performed both single and dual tasks. The primary task was a pursuit step tracking task. The secondary tasks required subjects to discriminate between different intensities or different spatial positions of a stimulus. Task pairs that required the processing of different properties of the same object resulted in better performance than task pairs that required the processing of different objects. Furthermore, these same object task pairs led to a positive relation between primary task difficulty and the resources allocated to secondary task stimuli. Intertask redundancy and the physical proximity of task displays produced similar effects of reduced magnitude.
To describe the prevalence of cognitive impairment among elderly primary care patients and to compare diagnostic evaluations and use of health services among patients with and those without cognitive impairment.
Prospective cohort study.
Academic primary care group practice.
3954 patients aged 60 years and older who completed the Short Portable Mental Status Questionnaire during routine office visits.
Demographics and comorbid illness at baseline, diagnostic evaluations for cognitive impairment, use of standard and preventive health services, use of psychoactive drugs, and death in the year after the screening date.
The prevalence of cognitive impairment among all patients aged 60 years and older at baseline was 15.7%; 10.5% had mild impairment and 5.2% had moderate to severe impairment. Patients with moderate to severe impairment were significantly older than patients with no impairment (76.2 years and 67.4 years, respectively), were more likely to be black (85.8% and 61.3%), had fewer years of education (7.3 years and 9.2 years), and were more likely to have cerebrovascular disease (20.4% and 6.3%) and evidence of undernutrition (30.6% and 16.9%). Dementia was recorded as a diagnosis for less than 25% of patients with moderate to severe cognitive impairment, but patients with documented impairment were more likely to have been evaluated for reversible causes. In the year after screening, patients with moderate to severe impairment were more likely than those with no impairment both to be hospitalized (29.1% and 16.5%) and to visit the emergency department (55.8% and 38.5%) but had fewer outpatient visits (6.0 and 7.6) and greater mortality (8.2% and 2.8%).
Cognitive impairment is associated with increased use of health services and increased mortality. Patients with undocumented cognitive impairment were significantly less likely to be evaluated for reversible causes. Research is needed to determine if better documentation of cognitive impairment would improve not only diagnostic evaluations but also patient management, counseling, and outcomes.
To identify the most accurate cognitive measures in discriminating between individuals with presymptomatic AD and individuals who remained nondemented.
During a 10-year prospective community study, 120 nondemented subjects completed a battery of standard cognitive tests and clinically manifested AD 1.5 years later. Performance on each of 16 cognitive tests was compared between these 120 presymptomatic cases and 483 controls who remained nondemented over the 10-year follow-up period. The area under the receiver operating characteristic (AUC) curve for each test was used to measure its accuracy of discrimination between cases and controls.
Among the 16 neuropsychological tests, Word List Delayed Recall discriminated best between cases and controls (AUC = 0.806), followed by the Word List 3rd Learning Trial (0.787), Word List 1st Learning Trial (0.774), and Trail-making Test B (0.773), compared to the Mini-Mental State Examination (MMSE) (0.726). Both Word List Delayed Recall and Word List 3rd Learning Trial were significantly more accurate than the MMSE. The combination of Word List Delayed Recall and Trail-making Test B comprised the optimal set of cognitive measures, with the highest AUC (0.852).
Measures of delayed recall and executive functions were the best discriminators between those who would manifest AD 1.5 years later and those who would remain nondemented. These findings are relevant for the early detection of AD and, therefore, for prevention and early intervention trials. Executive dysfunction may be a subtle manifestation of incipient AD, along with memory dysfunction.
The Useful Field of View test (UFOV) is increasingly used in clinical and rehabilitation settings. To date there have been
no normative data for adjusted performance comparisons across demographically-similar, elderly peers. This study examined
demographic and cognitive influences on the UFOV in a sample of 2759 participants (65–94 years of age). Performance was found
to differ by age and education. Regression analyses examined the relative contributions of age, education, mental status,
vision, and health to UFOV performance. All of these factors were found to significantly contribute to UFOV performance, with
age accounting for the most variance and education accounting for the least. Normative tables for the UFOV by age and education
are provided. These norms will allow researchers and clinicians to compare UFOV performance with similar peers and may help
in identifying elderly persons who would benefit from speed of processing training.