Detecting cognitive impairment through an age-friendly serious game: The development and usability of the spatial performance assessment for cognitive evaluation (SPACE)

Abstract

The Spatial Performance Assessment for Cognitive Evaluation (SPACE) is a novel iPad serious game designed to identify differences in spatial ability indicative of early signs of cognitive impairment. This paper reports on the development of SPACE and presents the results from three usability studies across different ages. Study 1 compared the traditional tap and swipe control interface with a semiautomated interface. Study 2 investigated the benefits of a UI widget that displayed the rotation performed in the Virtual Environment (VE). Study 3 evaluated the effects of a simplified configuration of landmarks explored in the VE. Findings across the studies indicated that age was the primary factor influencing performance. Younger participants consistently outperformed older ones across various tasks and reported higher usability and lower workload. Despite notable performance improvements for the tasks in SPACE, the new control interface, UI widget, and simplified configuration only had a minimal impact on usability. Younger participants rated SPACE above the level of mature products, while older participants found it useable but not always engaging. Critically, the significant interactions between age and experimental conditions indicated that younger and older participants benefited differently from the design modifications. Here, the semi-automated control, the simplified configuration, and, to a lesser extent, the UI widget showed promise in mitigating age-related performance differences while maintaining the level of challenge necessary to assess differences in cognitive status. This research showcases the potential of SPACE as a serious game and emphasises the importance of balancing simplicity with task demands for future unsupervised deployment.