Using ‘serious games’ to monitor memory and cognitive health

By Annie Atkinson

Anyone who has accompanied a friend or relative to a memory test, or had one themselves, knows how stressful it can be. Research teams supported by AGE-WELL, Canada’s technology and aging network, are hard at work on new ways to monitor cognitive health and detect changes—by using tests that could actually be enjoyable.

A team led by Dr. Frank Knoefel, a physician at the Bruyère Memory Clinic in Ottawa, is testing a tablet-based version of the well-known game whack-a-mole to measure brain abilities such as reaction time and accuracy levels. By monitoring a player over time, researchers can track the individual’s speed of processing and inhibition. The “serious” tablet game was designed by AGE-WELL researchers at the University of Alberta.

Dr. Knoefel usually conducts standard paper-and-pencil memory testing with his patients every six months or annually. He is hoping that games like whack-a-mole can help him to monitor his patients more frequently and accurately. “If I can have other data of how they are functioning, that would be a huge addition to my diagnostic skills,” he says, adding that the current paper-and-pencil tests become increasingly unreliable as a person’s cognition declines.

In Edmonton, Dr. Eleni Stroulia is also exploring the potential of “serious games” as a clinical tool. A professor of computing science at the University of Alberta, Dr. Stroulia is testing a suite of computer games as assessment and intervention tools for people with cognitive impairment. The tablet-based games include favourites like word search, bejeweled and mahjong for older adults. They were developed by Dr. Stroulia with AGE-WELL project co-lead Dr. Lili Liu and other colleagues.

Senior Ken Yu is helping an Alberta team to develop “serious games.”

The team is analyzing findings from a trial comparing outcomes of game play among healthy older adults and older adults with cognitive impairment. Meanwhile, testing of their word search game is underway in Greece and Italy.

Gaming is also being applied to a challenge that confronts hospital emergency departments: identifying whether older people are at risk for onset of delirium, an acute state of confusion or brain failure associated with increased risk of death, medical and surgical complications, confusion and memory loss. Delirium can come and go, and the “hypoactive” form is easy for clinicians to miss as patients are inactive or drowsy.

AGE-WELL investigators have been using a customized version of whack-a-mole as a new way to spot those at risk of delirium. Emergency department trials of the tablet game showed that measuring changes in patient response times and error rates are useful as a screening tool to predict delirium, according to Dr. Jacques Lee, an emergency physician and scientist at Sunnybrook Health Sciences Centre.

Dr. Lee is collaborating on the project with Dr. Mark Chignell, a psychologist in the Department of Mechanical and Industrial Engineering at the University of Toronto, and Dr. Tiffany Tong, an AGE-WELL trainee alumna.

“This project is something Mark, Tiffany or myself could not have done alone,” says Dr. Lee, commenting on the transdisciplinary nature of the AGE-WELL-supported project team. “Complex problems have complex solutions, and we need the collaboration of different disciplines to address these complex problems.”

Dr. Lee is now conducting a national randomized clinical trial of the tablet game with more than 1,300 older adults in emergency departments, with support from the Centre for Aging and Brain Health Innovation.

Annie Atkinson is a freelance writer. AGE-WELL is a federally-funded Network of Centres of Excellence. The pan-Canadian network brings together researchers, older adults, caregivers, partner organizations and future leaders to accelerate the delivery of technology-based solutions for healthy aging. For more information, visit