Researchers at the University of Alberta have found a way to measure how engaged people living with dementia are when they're playing a computer game — which could pave the way to new treatments that use gaming to stave off the onset or progression of cognitive decline.
"We're living longer, the risk of developing dementia is rising and there is no cure for these kinds of disorders," says Adriana Ríos Rincón, associate professor in the Faculty of Rehabilitation Medicine. "We need alternative ways to treat them, prevent them or make the lives of those who live with dementia better."
With dementia projected to affect almost a million Canadians by 2030, the need for innovative treatments is increasingly urgent. Computer games are showing promise, but the issue is that they require sustained engagement to be effective — something that can be very challenging for people living with dementia. And the standard method of measuring engagement — questionnaires such as the game engagement questionnaire and flow state scale of occupational therapy — can also be hard for people with cognitive impairments to complete.
"You need a certain level of cognition to understand and fill out a self-reported questionnaire," says Ríos Rincón. This makes it tough for researchers to adapt the intervention to better engage the people it's designed to serve.
That's why she turned her attention to a different measure — measuring engagement using electroencephalography data (EEG) to seek insights that would allow people to stay engaged long enough to reach the recommended minimum "dosage" of at least two 30-minute gaming sessions per week.
"Engagement is a very interesting concept because it's something you feel. It is a personal experience of how mentally and emotionally involved you are in a task," says Ríos Rincón. "In my lab, we're exploring alternative, more objective ways to measure engagement when someone isn't able to tell us."
For the study, participants, which included both younger and older adults, played a stunt plane game developed at the Glenrose Rehabilitation Hospital. Ríos Rincón and team selected the game because it was designed to engage several cognitive processes, including sustained attention and dual-tasking, and had simple rules that were easy to understand. While they played, participants wore headsets with EEG technology to monitor their brain waves in real time and filled out the flow state scale of occupational therapy.
The researchers then used the EEG data to calculate engagement using three measures — called engagement indices — that use different brainwaves to show how alert and mentally active a person is. They focus on three types of brain activity: theta, alpha and beta.
"When someone is really focused, beta activity goes up, while theta and alpha go down," explains Ríos Rincón.
They found that participants reached the highest level of engagement when there was "a perfect match between their skills and the challenge of the activity" — not so easy that it became boring, yet not so difficult that they were discouraged and gave up.
Ríos Rincón and team also developed a machine learning model to categorize participant engagement as either high or low, and found the results were most accurate when all three brain wave measures were included.
"We demonstrated that it is possible to get objective data of how engaged people are when they cannot elaborate or tell us about it."
Next steps involve using the engagement indices with older adults living with dementia and creating adaptive games that automatically adjust the difficulty level during gameplay to help maintain that optimal level of engagement, sometimes referred to as flow theory.
She also plans to examine whether the cognitive improvements seen in response to playing these games extend to other tasks.
"If you get better at playing the game and your attention or memory improves, how does your functioning in your daily life improve? Your independence level, your confidence in doing daily activities? That's something we're exploring in other studies."
The first author on the study was Yusuf Ahmed, who completed the work to earn his master's in rehabilitation science. The research was supported by funding through the AGE-WELL technology and aging network.
