Do-It-Yourself Gamified Cognitive Training: Viewpoint

Abstract

Cognitive decline is an important nonmotor symptom in Parkinson disease (PD). Unfortunately, very few treatment options are available. Recent research pointed to small positive effects of nonpharmacological cognitive training in PD. Most of these trainings are performed under supervision and solely computerized versions of (traditional) paper-pencil cognitive training programs, lacking rewarding gamification stimulants that could help to promote adherence. By describing 3 different self-invented ways of cognitive gaming in patients with PD, we aimed to raise awareness for the potential of gamified cognitive training in PD patients. In addition, we hoped to inspire the readers with our case descriptions, highlighting the importance of both personalization and cocreation in the development of games for health. In this viewpoint, we have presented 3 PD patients with different ages, with different disease stages, and from various backgrounds, who all used self-invented cognitive training, including elements of personalization and gamification. To indicate generalization into a larger PD population, the recruitment results from a recent cognitive game trial are added. The presented cases show similarities in terms of awareness of their cognitive decline and the ways this process could potentially be counteracted, by looking for tools to train their cognition. On the basis of the response of the recruitment procedure, there seems to be interest in gamified cognitive training in a larger PD population too. Gamification may add to traditional therapies in terms of personalization and adherence. Positive results have already been found with gamified trainings in other populations, and the cases described here suggest that PD is also an attractive area to develop and test gamified cognitive trainings. However, no results of gamified cognitive trainings in PD have been published to date. This suggests an unmet need in this area and may justify the development of gamified cognitive training and its evaluation, for which our considerations can be used.

Feasibility of a Cognitive Training Game in Parkinson’s Disease: The Randomized Parkin’Play Study

“…Intervention feasibility criteria are mostly met, but improvements are needed in order to increase usability. Even if online gamified CT may not be suitable for all patients, many PD patients are interested in such interventions [6], increasing the need to further investigate the efficacy of gamified CT in larger PD trials.…”

“…CT appears to be safe and cost-effective in PD, with modest positive effects on executive functions and working memory [5]. Gamification may further enhance traditional CT in terms of attractiveness and adherence [6], thereby making patients more inclined to continue playing, increasing possible treatment effectiveness, and maintaining benefits over time. So far, the merits of gamified CT have never been investigated in PD patients.…”

Development and Co-design of NeuroOrb: A Novel “Serious Gaming” System Targeting Cognitive Impairment in Parkinson’s Disease

“…The review concluded that gamified training is highly engaging and motivational and found evidence that gamification may be effective at enhancing CT in the elderly and ADHD populations ( Lumsden et al, 2016 ). Similarly, recently, the Parkin’Play study showed enhanced global cognition scores after 24-weeks of individuals with PD participating in a home-based, gamified CT intervention ( Van De Weijer et al, 2019 ).…”

“…Given that individuals with PD experience decreased reward sensitivity in an off-dopaminergic medication state, as well as increased apathy ( Muhammed et al, 2016 ), this may be a particularly relevant concern for use of CT in this population. One strategy that may improve engagement is the addition of game-like features (gamification) into CT programs ( Lumsden et al, 2016 ; Van De Weijer et al, 2019 ). This can be attributed to the incorporation of features such as high-score and reward incentives, narrative, personalization, self-directed challenge, exploration, free-play, competition and graphics into the training platform ( Nagle et al, 2015 ).…”

Optimizing Cognitive Training for the Treatment of Cognitive Dysfunction in Parkinson’s Disease: Current Limitations and Future Directions

“…These are particularly important for the PD population, where patients have a decreased reward sensitivity in an off-dopaminergic medication state, as well as increased apathy ( Muhammed et al, 2016 ). Therefore, enhancement of the rewarding elements of game play may improve perceived self-efficacy, motivation and adherence, subsequently improving outcomes ( Van De Weijer et al, 2019 ). Whilst this area of CT adaptation is in its infancy, one recent 2020 study investigated the efficacy of a gamified CT program called “Parkin’Play” in a cohort of PD-MCI patients ( n = 21) against a no-intervention waitlist control ( n = 20).…”