Serious Games for Learning Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis

Abstract

Background Learning disabilities are among the major cognitive impairments caused by aging. Among the interventions used to improve learning among older adults are serious games, which are participative electronic games designed for purposes other than entertainment. Although some systematic reviews have examined the effectiveness of serious games on learning, they are undermined by some limitations, such as focusing on older adults without cognitive impairments, focusing on particular types of serious games, and not considering the comparator type in the analysis. Objective This review aimed to evaluate the effectiveness of serious games on verbal and nonverbal learning among older adults with cognitive impairment. Methods Eight electronic databases were searched to retrieve studies relevant to this systematic review and meta-analysis. Furthermore, we went through the studies that cited the included studies and screened the reference lists of the included studies and relevant reviews. Two reviewers independently checked the eligibility of the identified studies, extracted data from the included studies, and appraised their risk of bias and the quality of the evidence. The results of the included studies were summarized using a narrative synthesis or meta-analysis, as appropriate. Results Of the 559 citations retrieved, 11 (2%) randomized controlled trials (RCTs) ultimately met all eligibility criteria for this review. A meta-analysis of 45% (5/11) of the RCTs revealed that serious games are effective in improving verbal learning among older adults with cognitive impairment in comparison with no or sham interventions (P=.04), and serious games do not have a different effect on verbal learning between patients with mild cognitive impairment and those with Alzheimer disease (P=.89). A meta-analysis of 18% (2/11) of the RCTs revealed that serious games are as effective as conventional exercises in promoting verbal learning (P=.98). We also found that serious games outperformed no or sham interventions (4/11, 36%; P=.03) and conventional cognitive training (2/11, 18%; P<.001) in enhancing nonverbal learning. Conclusions Serious games have the potential to enhance verbal and nonverbal learning among older adults with cognitive impairment. However, our findings remain inconclusive because of the low quality of evidence, the small sample size in most of the meta-analyzed studies (6/8, 75%), and the paucity of studies included in the meta-analyses. Thus, until further convincing proof of their effectiveness is offered, serious games should be used to supplement current interventions for verbal and nonverbal learning rather than replace them entirely. Further studies are needed to compare serious games with conventional cognitive training and conventional exercises, as well as different types of serious games, different platforms, different intervention periods, and different follow-up periods. Trial Registration PROSPERO CRD42022348849; https://tinyurl.com/y6yewwfa

The Impact of Hormesis, Neuronal Stress Response, and Reproduction, upon Clinical Aging: A Narrative Review

“…We know that digital cognitive training improves cognition and may reduce the risk of dementia [ 84 ]. Studies have repeatedly shown that ‘serious games’ have a positive impact on dementia patients [ 85 , 86 ]. ‘Serious games’ are participative digital/electronic games designed for purposes other than entertainment.…”

A Serious Game for Cognitive Stimulation of Older People With Mild Cognitive Impairment: Design and Pilot Usability Study

“…Serious games refer to the use of games and gaming technology for purposes other than just entertainment or fun, including health purposes. They can have direct or indirect positive physiological and psychological effects on people, which is precisely the objective of serious games in health and health care [ 28 ]. Our work applies to this definition because our serious game was designed for cognitive stimulation of older people with MCI and could have direct positive psychological effects on older people for the prevention or treatment of such cognitive impairment.…”

Entertainment activities and the risk of Alzheimer’s disease: a Mendelian randomization analysis

“…Entertainment activities typically encompass a range of pursuits that individuals engage in for relaxation, pleasure, or excitement, often characterized by their practical applicability. Previous research has demonstrated that serious games can enhance the quality of life for older adults with cognitive impairment by improving learning function and promoting physical activity (Abd-Alrazaq et al, 2023). Additionally, exercise games or training observed in patients with AD have been shown to support healthy aging and exert neuroprotective effects on the brain (Stanmore et al, 2017;Huuha et al, 2022).…”

“…Furthermore, these studies often focus on specific types of activities or populations and have not yet established a comprehensive and systematic research framework. Research on the effects of entertainment activities on AD is still in its early stages, and many findings require further validation and in-depth exploration (Ströhle et al, 2015;Stanmore et al, 2017;Abd-Alrazaq et al, 2023).…”