/Introduction

This proposed Human-Computer Interaction (HCI) research seeks to address a critical gap in our understanding of therapeutic interventions for Alzheimer's disease (AD) by exploring the potential benefits of video games. Grounded in cognitive psychology, this investigation aims to unravel the cognitive and psychological dimensions of individuals coping with AD. While cognitive stimulation has emerged as a promising non-pharmacological intervention, the role of video games in this context remains underexplored. Alzheimer's disease, characterized by progressive neurodegeneration, results in severe memory impairment and cognitive decline. As its prevalence rises with the aging global population, there is an urgent need to comprehensively address the multifaceted challenges it poses to individuals and society.

The spectrum of cognitive decline associated with AD includes disruptions in memory, attention, executive functions, and overall cognitive abilities. Motivated by the pressing need for effective interventions, the exploration of video games as a cognitive therapy tool aligns with the growing interest in non-pharmacological approaches. The objective is to uncover the potential efficacy of video game-based interventions in enhancing memory retention, and overall well-being for individuals with AD. This journey acknowledges the urgency and complexity of addressing AD and emphasizes the need for creative solutions at the intersection of cognitive psychology and HCI. Drawing inspiration from the evolving landscape of research and technological advancements, anecdotes will be interwoven to provide a human-centric perspective on the challenges faced by AD patients and their caregivers. Through this overview, the aim is to establish the context for the exploration, highlighting the interconnectedness of cognitive psychology and HCI in addressing the multifaceted aspects of AD.

/Article Summaries

The exploration of potential therapeutic benefits emerging from the convergence of video games and Alzheimer's disease (AD) serves as a focal point in contemporary research, integrating insights from cognitive psychology and Human-Computer Interaction (HCI). Within this context, the subsequent section contains summaries of four key articles spanning from 2007 to 2020. Each article presents distinctive perspectives on serious games, video game-based music therapy, and m-health gamification tailored to AD and dementia patients. These studies collectively contribute to a nuanced comprehension of the current landscape, elucidating the use of technology, particularly video games, to tackle cognitive challenges associated with AD. By synthesizing these articles, the objective is to unveil trends, identify existing gaps, and illuminate potential future directions in the development of effective interventions at the intersection of cognitive psychology and HCI.

The paper by Benveniste et al. (2012) introduces MINWii, a serious video game tailored for Alzheimer's and dementia patients, focusing on music therapy. The innovative tool aims to enhance patients' self-image and alleviate behavioral symptoms through Wiimote-based gameplay, allowing participants to improvise or play predefined songs on a virtual keyboard. Despite ongoing development, the paper reports positive feedback from patients and caregivers, emphasizing MINWii's usability and potential impact. The design choices, including low cognitive and motor interface requirements, failure-free gameplay, and the use of off-the-shelf components, reflect the authors' commitment to simplicity to cater to varying skill levels among dementia patients. MINWii represents a valuable addition to non-pharmacological interventions, offering an engaging and accessible serious video game tailored to the unique needs of Alzheimer and dementia patients. Considering the future research, the focus on low cognitive requirements and failure-free gameplay in MINWii's design serves as a noteworthy precedent, prompting further exploration of these design principles in upcoming studies aimed at enhancing cognitive interventions for Alzheimer's patients.

Baniqued et al.'s (2014) explores the potential cognitive benefits of casual video games and their transfer effects to untrained tasks. The study involved approximately 40 participants in each group and aimed to determine if playing casual video games could enhance various cognitive functions. The results indicated that playing games that specifically targeted working memory and reasoning demonstrated improvements in divided attention, particularly for individuals with lower initial reasoning ability. The study contributes to the existing literature on working memory and action video game training, highlighting the nuanced impact of casual video games on cognitive processes. Notably, the paper suggests that reasoning games are more effective in enhancing cognitive functions. This insight serves as a valuable consideration for future research, encouraging the utilization of reasoning games in upcoming studies aimed at further understanding and enhancing cognitive interventions.

Notably, both studies reveal a commonality in their design focus on single-player experiences, raising questions about the potential connection between loneliness and AD. Exploring this link, Wilson et al.’s (2007) longitudinal study establishes a clear association between loneliness and an elevated risk of developing AD, underscoring the critical role of emotional well-being in dementia risk. Inspired by the notion that emotional well-being plays a crucial role in dementia risk, the study aims to investigate interventions aimed at reducing loneliness as a potential means of alleviating memory loss severity in AD.

Furthermore, to broaden the perspective beyond diagnosed individuals, an investigation into the interest of those aged 50 and above in gamification therapy revealed insightful preferences. Tizuka et al.'s (2020) study on gamification rewards in m-health for adults 50+ emphasizes the importance of user engagement over the long term. For therapy to be effective, individuals must willingly participate in and enjoy the gaming experience. This insight aligns with the selection of a cooperative puzzle game genre for intervention. Cooperative puzzle games, with their inherent social interaction and problem-solving components, offer a promising avenue for enhancing user engagement in therapeutic settings. The cooperative puzzle genre, inspired by research findings, aims to provide an enjoyable and participatory platform for individuals, thereby contributing to the success of game-based interventions.

To bridge these insights and address potential gaps, the next section proposes a new study that expands the focus to encompass preventive measures and explore the impact of social interactions and gamification on individuals at risk of developing Alzheimer's Disease (AD).

/Future Directions

In exploring the role of video games as potential tools for enhancing memory in Alzheimer's disease (AD) patients, the proposed research aims to investigate the intricate connection between video games and memory improvement within the AD context. Expanding on insights from existing studies, which predominantly focused on games designed for solo play, this envisioned research seeks to uncover the nuanced impacts associated with distinct gaming modalities. The study is structured to examine the differential effects of single-player experiences, multiplayer interactions with computer teammates, online multiplayer engagements, and local multiplayer dynamics on the memory functions of individuals contending with AD.

Game Selection

The Nintendo Switch platform is selected for this investigation, with a specific focus on the game "Snipperclips." This choice is based on the game's adaptability across solo, online, and local multiplayer settings. "Snipperclips" is recognized for its simplicity, low cognitive and motor requirements, and its classification as a reasoning game. Rather than selecting games designed explicitly for memory cognition training, the study purposefully opts for a broader exploration. The aim is to discern whether different multiplayer modalities, as offered by "Snipperclips," contribute to memory improvement in individuals diagnosed with AD.

Participant Inclusion Criteria

For participant qualification, the study targets individuals between the age 50 to 70, diagnosed with a mix of early or middle stage Alzheimer's disease (AD), possessing the cognitive capacity and willing to engage with video games. The study will involve random assignment of participants into six groups (See details in Methodology). Each group will consist of 10 participants, and the random assignment aims to balance potential confounding variables across the groups. This approach ensures that the impact of different gaming modalities on memory functions can be systematically evaluated within a diverse yet controlled participant pool.

Methodology

The study employs a quasi-experimental design with a 8-week intervention period to investigate the impact of distinct gaming modalities on memory functions in individuals diagnosed with AD. Six groups will be formed, each comprising 10 participants:

Participants in each group will play the Nintendo Switch game "Snipperclips" for thirty minutes per session, three times a week, in a home living room environment, adhering to a consistent schedule throughout the 8-week period. The frequency and duration of gameplay sessions are designed to strike a balance between ensuring meaningful engagement and preventing potential cognitive fatigue. Pre- and post-intervention assessments will be employed to quantify any changes in memory performance, allowing for a robust analysis of the potential efficacy of different gaming modalities in the context of AD.

Data Collection

As part of the data collection process, participants will undergo a brief survey both before and after engaging in gameplay sessions with 'Snipperclips.' The survey serves the dual purpose of gauging participants' mood and assessing memory-related aspects. Prior to playing the game, participants will respond to questions crafted to capture their initial emotional states. Following gameplay, participants will answer the same set of questions to record their final emotional states. Subsequently, a memory assessment, such as Mini-cog, will be administered, complemented by questions designed to discern potential variations in memory functions following gameplay. Examples of survey questions may include:

Data Analysis

The data collected from participants' surveys and memory assessments will undergo a rigorous analysis to discern patterns and insights. Initial emotional states recorded before gameplay will be compared with final emotional states post-gameplay to identify any significant shifts. Additionally, memory-related responses will be analyzed to evaluate potential variations in memory functions following gameplay. The dataset, organized by participant groups, will be subjected to statistical methods to determine if there are noteworthy differences between groups.

Limitations and Challenges

Focusing on the specific game 'Snipperclips' may limit generalization, and the small sample size of 10 participants per group may affect broader applicability. The 8-week timeframe offers insights into short-term effects, but long-term impacts may necessitate extended observation. Individual variability in gaming responses, influenced by factors like prior gaming exposure and cognitive differences, poses a challenge. Additionally, external factors affecting mood and memory functions outside the gaming environment present another challenge.

/Conclusion

In conclusion, this proposed research endeavors to shed light on the intricate relationship between multiplayer gaming, mood, and memory functions among individuals with early and middle stage AD. By selecting the Nintendo Switch game 'Snipperclips' as a versatile tool adaptable to solo, online, and local multiplayer settings, this study aims to discern the differential impacts of these gaming modalities. The intentional focus on simplicity, low cognitive and motor requirements, and the game's classification as a reasoning game aligns with the goal of exploring interventions that transcend traditional boundaries. While potential limitations and challenges, such as the specific game choice and sample size, are acknowledged, the study aspires to offer tailored insights into the potential therapeutic benefits of multiplayer gaming for AD patients. By doing so, it contributes to the evolving landscape of innovative interventions for cognitive health, fostering a more comprehensive understanding of the role of video games in addressing the challenges posed by Alzheimer's disease.

/Citation

Baniqued, P., Kranz, M., Voss, M., Lee, H., Cosman, J., Severson, J., & Kramer, A. (2014). Cognitive training with casual video games: points to consider. Frontiers in Psychology, 4. https://doi.org/10.3389/fpsyg.2013.01010

S. Benveniste, P. Jouvelot, B. Pin, R. Péquignot, The MINWii project: Renarcissization of patients suffering from Alzheimer’s disease through video game-based music therapy, Entertainment Computing, Volume 3, Issue 4, 2012, Pages 111-120, ISSN 1875-9521, https://doi.org/10.1016/j.entcom.2011.12.004.

Tizuka, M. M., Clua, E. W. G., & de Castro Salgado, L. C. (2020). Investigating m-health gamification rewards elements for adults 50+. In 2020 IEEE 8th International Conference on Serious Games and Applications for Health (SeGAH) (pp. 1-8). Vancouver, BC, Canada. https://doi.org/10.1109/SeGAH49190.2020.9201658

Wilson, R. S., Krueger, K. R., Arnold, S. E., Schneider, J. A., Kelly, J. F., Barnes, L. L., Tang, Y., & Bennett, D. A. (2007). Loneliness and risk of Alzheimer disease. Archives of General Psychiatry, 64(2), 234-240. https://doi.org/10.1001/archpsyc.64.2.234