Effects of a serious game training on cognitive functions in older adults.

Abstract

To the Editor: There have been many trials to prevent or recover aging-induced cognitive impairment in the elderly population without cognitive impairment because of rapid increases in the elderly population.1-3 Many cognitive training interventions designed for “brain fitness” (serious games) have been developed over the last few years. Previously developed games for cognitive function were not attractive to elderly people.4 In this context, this study was conducted to examine the potential benefits of a newly developed music game training program, Smart Harmony, on cognitive function in healthy older adults. Community-dwelling healthy adults (n = 28, mean age 72.3 ± 5.1) aged 65 and older were randomly assigned to a training group (n = 14) or a control group (n = 14). People who could not follow the investigators’ directions because of cognitive impairment (Mini-Mental State Examination Korean version (MMSE-K) score ≤ 19), had a serious uncontrolled medical problem, or were determined not qualified to participate in the study for other reasons were excluded. Neurocognitive function tests such as the prospective and retrospective Digit Span Test, Trail-Making Test Parts A and B, Stroop Word–Color Test, Rey Complex Figure Test, and a verbal fluency test were administered within 2 weeks before starting the program and within 1 week after completing the program in both groups. The Geriatric Depression Scale (GDS) was administered as an assessment tool for depression in elderly people and the Medical Outcomes Study 8-item Short-Form Survey (SF-8) for the evaluation of life quality. The training group (n = 14) was divided into two teams (seven participants in each team). Each team played the game for 40 minutes a day three times a week for 8 weeks. At the preparation stage of the game, each participant receives a stick that is synchronized with one of seven musical notes (C, D, E, F, G, A, B). When a song starts to play, the main screen shows the score of the song currently being played, and a timing bar passes through the corresponding note in the song. Participants shake their own sticks when the timing bar passes through the designated note. As the song ends, the screen shows each participant's score and the group's total score. The control group was involved in typical senior community center-based activities during the same 8 weeks. Wilcoxon signed-rank test was performed for comparison of variables before and after the training, with significance set at P < .05. Experiments were conducted with the understanding and written consent of each participant, and the institutional review board provided ethical approval. There was no statistically significant difference between the two groups in neuropsychological assessments and questionnaires of health-related quality of life before the training. After participating in the music game training program, scores on the Trail Making Test Parts A and B, Rey Figure Test, Stroop Test, Verbal Fluency Test, and SF-8 questionnaires improved significantly (Table 1) (P < .05). Scores on the Verbal Fluency Test (category score) and SF-8 questionnaires also improved in the control group (Table 1) (P < .05). Using a music game designed to improve cognitive abilities, 8 weeks of intervention resulted in improvements in high-level cognitive functions, including visuomotor coordination, flexibility of cognition, visuospatial cognition, memory, and verbal cognition. Several features of the game, such as simultaneous visual and auditory stimulation, a task-oriented setting, and ease of play, might enhance the cognition of elderly people. Training with complex stimulations reportedly leads to improvement in selective attention to the stimulation.5 Moreover, the type of goal-directed cognitive training (e.g., group task (completing a song), individual task (completing a personal objective)) could stimulate prefrontal lobe activity.6, 7 It is important that anybody can learn how to play the game, unlike previously developed serious games. In conclusion, the cognitive training program using the newly developed Smart Harmony was effective at improving cognitive function in elderly people, which suggests that it may prevent cognitive impairment as well, which should be investigated in further studies. This paper was supported by the Biomedical Research Institute Fund, Chonbuk National University Hospital. Conflict of Interest: The authors declare that there is no conflict of interest. Author Contributions: Study concept and design: Ko, You, Kim, Choi. Analysis and interpretation of data: Ko, You, Kim. Drafting of the manuscript: Ko, Kim. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: Ko, Kim. All authors approved the final version. The corresponding author (Myoung-Hwan Ko) had the final responsibility to submit for publication. Sponsor's Role: None.