title: A Serious Game for Clinical Assessment of Cognitive Status: Validation Study.
abstract: BACKGROUND
  We propose the use of serious games to screen for abnormal cognitive status in situations where it may be too costly or impractical to use standard cognitive assessments (eg, emergency departments). If validated, serious games in health care could enable broader availability of efficient and engaging cognitive screening.
  
  
  OBJECTIVE
  The objective of this work is to demonstrate the feasibility of a game-based cognitive assessment delivered on tablet technology to a clinical sample and to conduct preliminary validation against standard mental status tools commonly used in elderly populations.
  
  
  METHODS
  We carried out a feasibility study in a hospital emergency department to evaluate the use of a serious game by elderly adults (N=146; age: mean 80.59, SD 6.00, range 70-94 years). We correlated game performance against a number of standard assessments, including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Confusion Assessment Method (CAM).
  
  
  RESULTS
  After a series of modifications, the game could be used by a wide range of elderly patients in the emergency department demonstrating its feasibility for use with these users. Of 146 patients, 141 (96.6%) consented to participate and played our serious game. Refusals to play the game were typically due to concerns of family members rather than unwillingness of the patient to play the game. Performance on the serious game correlated significantly with the MoCA (r=-.339, P <.001) and MMSE (r=-.558, P <.001), and correlated (point-biserial correlation) with the CAM (r=.565, P <.001) and with other cognitive assessments.
  
  
  CONCLUSIONS
  This research demonstrates the feasibility of using serious games in a clinical setting. Further research is required to demonstrate the validity and reliability of game-based assessments for clinical decision making.
authors.affiliation: Interactive Media Lab, Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada. tiffany.tong@mail.utoronto.ca.
authors.forename: Tiffany
authors.identifier: http://orcid.org/0000-0002-9364-1274
authors.initials: T
authors.lastname: Tong
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0001-8120-6905
authors.initials: M
authors.lastname: Chignell
authors.forename: Mary C
authors.identifier: http://orcid.org/0000-0003-1400-4371
authors.initials: MC
authors.lastname: Tierney
authors.forename: Jacques
authors.identifier: http://orcid.org/0000-0002-9143-6285
authors.initials: J
authors.lastname: Lee
keywords: cognitive assessments; cognitive screening tools; computerized assessments; games; human computer interaction; human factors; neuropsychological tests; screening; serious games; tablet computers; technology assessment; usability; validation studies; video games