Whack-a-mole pops up in dementia skills testing
Researchers find participants get better as they play — ‘which was not expected’
Nobody enjoys being tested for memory problems, a stressful process with questions that can seem irrelevant.
Dr. Frank Knoefel, a physician at the Bruyère Memory Clinic, knows about the stress. Besides, these tests are notoriously inaccurate as cognitive abilities decline. So, with help from partners ranging from universities to an Ottawa day program for adults, he tried using a computer game based on whacka-mole.
“There’s something about a competitive game. As we know, it can be addictive,” said Knoefel, a researcher interested in technologies that can help seniors be more independent.
The idea was to examine the cognitive abilities of people with moderate dementia without putting the person on the spot.
Instead of whacking toy moles with a mallet, like the arcade game, the subjects used a tablet and stylus. The game, designed at the University of Alberta especially for the project, also added a new element — bunnies. Players have to whack the moles, but refrain from whacking the bunnies.
As the player gets faster and more accurate at whacking moles, the game speeds up. The scores and patterns are analyzed using technology developed at Carleton University.
To the surprise of the researchers, not only has the small test group learned to use the game, they love it and work hard to improve their scores.
“And if that wasn’t weird, they were getting better,” Knoefel said. “I was quite surprised by how much improvement we were able to show.”
Dementia affects procedural memory, the part of long-term memory responsible for storing information for how to do things. People with dementia find it hard to relearn old skills, like tying their shoelaces. The subjects’ responses to the game shows their procedural memory was still working.
Whack-a-mole is a test of reaction time and accuracy. The bunnies add an “inhibition” component, which requires players to switch between tasks, said Amanda Baker, a researcher at the University of Ottawa.
“For me, it’s fascinating to see how much joy they get out of this,” she said. “It’s not that we’re finding a cure for dementia, but they are improving their performances, which was not expected.”
The study also looks at the overlap between cognition and mobility. To do this, the researchers enlisted the program at Algonquin College that teaches assistants to occupational therapists and physiotherapists and the college’s Biodex machine, which tests balance and stability. After playing whacka-mole, the subjects use the machine for balance tasks.
“Our goal is to train future leaders in health care. Innovation is an amazing opportunity,” said Tim Tosh, an instructor in the Algonquin program.
There is a link between cognition and the ability to walk, and evidence that physical exercise can do more than medication to help dementia, Knoefel said. “The best thing you can do for an aging brain is to exercise.”
People with dementia tend to allow other people to take over tasks, like buttoning their clothes, as their cognitive abilities decline. But dementia gets worse through brain disuse.
“It becomes a vicious cycle. Eventually, we just sit and watch TV and our brains go to mush,” he said.
The subjects in the study were recruited from Algonquin’s Garbarino Girard Centre, an aging lab. Knoefel said the project would never have come together without the AGE-WELL Network of Centres of Excellence, which includes 37 universities and research centres and 200 industry, government and post-secondary institutions.
The researchers are careful about not reading too much into the early success of the study. The value of the game may be not in diagnosing dementia, but in triaging to decide who is a candidate for testing.
“Game-playing could be a great way to screen for things, but I would never make a diagnosis on game-playing,” Knoefel said.
If a dementia patient visits a doctor a few times a year, it’s difficult to track the rate of decline. Playing a game would allow patients to be monitored on a more routine basis — and they can be monitored from home, he said.
“There are not enough nurses and doctors to test everybody,” he said. “We’re going to have to be creative.”