Monitoring cognitive ability in patients with moderate dementia using a modified “whack-a-mole”

Abstract

This paper presents results from the first 2 months of a 1-year study of 12 moderate dementia patients that participate in a weekly adult day program within a local community-care access center. The 12 patients are using a tablet-based whack-a-mole game, instrumented to record the user's behavior; this record is analyzed to extract indicators, as potential proxies of cognitive ability. Our partnership with the adult day program greatly eased recruitment: all but 1 eligible participant joined our study. The measurements recorded by the game include the detailed user progression through the game levels. There are two unique aspects to the design of our game: first, it includes two distinct targets requiring different actions, which increases the cognitive processing in the tap task for the users; second, each level is systematically more difficult than the last. The results show that the patients' performance within the game improves over the first few weeks; this indicates that they are learning the game and retaining ability gains from week to week, which is unexpected in dementia patients. Subsequently they appear to reach a performance plateau, with consistent performance from one week to the next. The performance levels are compared to their MMSE Total score and MMSE Orientation for Time sub-score and they are shown to have a maximum correlation of 0.465 and 0.654 respectively. These results demonstrate the potential for the whack-a-mole game to provide an ongoing measurement alternative for the MMSE and specifically the Orientation for Time sub-score that is a predictor of future decline.