Developing a serious game for cognitive assessment: choosing settings and measuring performance

Gamification and serious games are becoming increasingly important for training, wellness, and other applications. How can games be developed for non-traditional gaming populations such as the elderly, and how can gaming be applied in non-traditional areas such as cognitive assessment? The application that we were interested in is detection of cognitive impairment in the elderly. Example use cases where gamified cognitive assessment might be useful are: prediction of delirium onset risk in emergency departments and postoperative hospital wards; evaluation of recovery from stroke in neuro-rehabilitation; monitoring of transitions from mild cognitive impairment to dementia in long-term care. With the rapid increase in cognitive disorders in many countries, inexpensive methods of measuring cognitive status on an ongoing basis, and to large numbers of people, are needed. In order to address this challenge we have developed a novel game-based method of cognitive assessment. In this paper, we present findings from a usability study conducted on the game that we developed for measuring changes in cognitive status. We report on the game's ability to predict cognitive status under varying game parameters, and we introduce a method to calibrate the game that takes into account differences in speed and accuracy, and in motor coordination. Recommendations concerning the development of serious games for cognitive assessment are made, and detailed recommendations concerning future development of the whack-a-mole game are also provided.