Yesoda Bhargava

Cognition-assessing games (CAGs) are an evolving area of research, with collaboration between game developers and neuroscience researchers playing a critical role in their development. Game developers bring valuable expertise in game design and development, while neuroscience researchers contribute their knowledge of cognitive assessment. However, CAGs differ from both mainstream entertainment games (game developers’ expertise) and the traditional neuropsychological assessments (neuroscience researchers’ expertise). Given this context, it is essential to address the ideological challenges and conflicts that may arise between game developers and neuroscience researchers as they collaborate on CAG development. In this viewpoint, we present the perspectives of both game developers and neuroscience researchers on ten key themes relevant to CAGs: game intent, game tutorial, game art style and user interface, learning effects, ecological validity, game scoring, game realism, game testing, commercialization, and game platform. These themes are identified based on our over four years of collaborative work and are further supported by existing literature on CAGs. Our viewpoint is grounded in practical examples, offering concrete insights to facilitate impactful development of CAGs. The ten themes provide a structured framework for decision-making in CAGs emphasizing the importance of a systematic approach to CAG development. Finally, we hope that the findings from our viewpoint will assist game developers and neuroscience researchers in creating successful, translatable CAGs.

Dementia and pathological cognitive impairment are global public health challenges. Given that there is no reliable medical cure for dementia, it is critical to develop tools that forewarn of cognitive deterioration. Usually, dementia begins 1-2 decades before symptoms manifest; this time window provides an excellent opportunity to identify cognitive deterioration early, which can help in introducing interventions and rehabilitation timely. In this context, cognition tracking offers hope. Revolution in the fitness industry has proved that people can use mobile phones to track steps, heart rate, heart rate variability, blood pressure, blood sugar, sleep, water intake, medicine intake, etc. Cognition tracking is a natural progression to this revolution and can prove priceless for early detection of dementia. In this work, we present a proof-of-concept of a cognition tracker, CogTrack . CogTrack is a mobile app that visualizes cognitive scores obtained from virtual-reality and mobile-based goal-oriented games, designed and validated by us. The practical and clinical significance of CogTrack is discussed using two use cases : (1) Early indication of cognitive deterioration and (2) Tracking the impact of cognitive rehabilitation. A four-tier model is presented to illustrate the beneficiaries of CogTrack. The advantages and limitations of CogTrack are discussed in the context of available mobile applications, devices, and tools that track cognition. Additionally, we discuss how CogTrack may be advanced in the future and reflect on critical issues related to data privacy, confidentiality, ethics, scalability, and socio-medical factors that impact CogTrack adoption and acceptability. In summary, we show how an integrated system of goal-oriented games and smartphone app may be used for longitudinal cognitive assessment and tracking.

Background: Virtual reality (VR)–based goal-oriented games for cognitive assessment are rapidly emerging and progressively being used in neuropsychological settings. These games have been validated quantitatively, but minimal qualitative insights from users currently exist. Such insights on user experience are essential to answering critical questions linked to the games’ large-scale usability, adoption in hospital settings, and game design refinement. Current qualitative studies on these games have used general questionnaires or web-based reviews to answer these questions, but direct observation from primary settings is missing. We believe that direct observation of participants playing these games and subsequent interaction with them is critical to developing a more objective, clear, and unbiased view of the games’ efficacy, usability, and acceptability. Objective: In this study, we aimed to extract constructive and relevant insights directly from the participants who played VR-based goal-oriented games. We used these insights to answer vital questions linked to the practical utility of VR-based cognitive assessment. On the basis of these results, we also aimed to provide actionable insights to key stakeholders in the field, such as researchers, game developers, business personnel, and neuropsychology and allied professionals. Methods: Interview data from 82 younger (aged 18-28 years) and 42 older adult (aged >60 years) participants were used. The interview data were obtained from the 2 pilot studies we conducted on VR games for cognitive assessment. Inductive thematic analysis was conducted on the interview data, and later, the findings were carefully interpreted to develop implications for the key stakeholders. Results: We identified 5 themes: ergonomic issues, learning and training, postgame effects, game feedback, and system purpose. Regarding hardware, headset weight, adjustment straps, and controllers need to be improved to promote easy use of the device. Regarding software, graphics quality, immersion experience, and game mechanics are the primary deciding factors for a positive user experience. The younger group prioritized purpose and utility for long-term use, whereas the older participants cherished the entertainment aspect. Researchers and game developers must conceptualize and develop games that can provide maximum insights into real-world abilities. Manufacturing businesses need to improve the headset and accessories to make them more user-friendly. Finally, neuropsychology and allied practitioners must identify strategies to engage and train the participants to try VR-based cognitive assessment games. Conclusions: VR-based games for cognitive assessment are promising tools to improve the current practices of neuropsychological evaluations; however, a few changes are required to make the overall user experience enjoyable, purposeful, and sustainable. In addition, all the key stakeholders need to focus on meaning and purpose over the hype of VR and are advised to work in synergy.

BACKGROUND Virtual reality (VR)–based goal-oriented games for cognitive assessment are rapidly emerging and progressively being used in neuropsychological settings. These games have been validated quantitatively, but minimal qualitative insights from users currently exist. Such insights on user experience are essential to answering critical questions linked to the games’ large-scale usability, adoption in hospital settings, and game design refinement. Current qualitative studies on these games have used general questionnaires or web-based reviews to answer these questions, but direct observation from primary settings is missing. We believe that direct observation of participants playing these games and subsequent interaction with them is critical to developing a more objective, clear, and unbiased view of the games’ efficacy, usability, and acceptability. OBJECTIVE In this study, we aimed to extract constructive and relevant insights directly from the participants who played VR-based goal-oriented games. We used these insights to answer vital questions linked to the practical utility of VR-based cognitive assessment. On the basis of these results, we also aimed to provide actionable insights to key stakeholders in the field, such as researchers, game developers, business personnel, and neuropsychology and allied professionals. METHODS Interview data from 82 younger (aged 18-28 years) and 42 older adult (aged >60 years) participants were used. The interview data were obtained from the 2 pilot studies we conducted on VR games for cognitive assessment. Inductive thematic analysis was conducted on the interview data, and later, the findings were carefully interpreted to develop implications for the key stakeholders. RESULTS We identified 5 themes: ergonomic issues, learning and training, postgame effects, game feedback, and system purpose. Regarding hardware, headset weight, adjustment straps, and controllers need to be improved to promote easy use of the device. Regarding software, graphics quality, immersion experience, and game mechanics are the primary deciding factors for a positive user experience. The younger group prioritized purpose and utility for long-term use, whereas the older participants cherished the entertainment aspect. Researchers and game developers must conceptualize and develop games that can provide maximum insights into real-world abilities. Manufacturing businesses need to improve the headset and accessories to make them more user-friendly. Finally, neuropsychology and allied practitioners must identify strategies to engage and train the participants to try VR-based cognitive assessment games. CONCLUSIONS VR-based games for cognitive assessment are promising tools to improve the current practices of neuropsychological evaluations; however, a few changes are required to make the overall user experience enjoyable, purposeful, and sustainable. In addition, all the key stakeholders need to focus on meaning and purpose over the hype of VR and are advised to work in synergy.