A Computer Game for Enhancing Cognitive Control in Older Adults

Aging & Cognitive Decline Cognitive Training & Computer-Game Training Art Dealer by Minds Refined LLC

Jeffrey P. Toth, Ph.D.

University of North Carolina Wilmington & Minds Refined LLC

Cognitive Aging in the U.S.A.

Copyright 2006 Minds Refined LLC. All Rights Reserved

Age-related Cognitive Decline

Automatic Processes

Cognitive Control Processes Source: Salthouse (2004)

'Age-related declines are large, begin early in life, are evident in many cognitive abilities, and show little increase in between-person variability.'
Copyright 2006 Minds Refined LLC. All Rights Reserved

Can Cognitive Exercise Slow Age-Related Decline?

Early Research:
Relaxation, Edu., Mnemonics, Cognitive Drills, etc.

Small effects, limited transfer.

Research Targeting Cognitive Control:

Attentional Control
(Gopher et al.; Kramer et al.)

Working memory
(Klingberg et al.)

Conscious Recollection
(Jennings & Jacoby)

Large effects, extensive transfer.

Copyright 2006 Minds Refined LLC. All Rights Reserved

Can We Make Cognitive-Control Training Fun?

Potential benefits of Computer Game Training Increased motivation playing, not training. Decreased anxiety stealth training. Increase adherence to the "training" program. Play-at-home training - more inclusive. Inexpensive.

Copyright 2006 Minds Refined LLC. All Rights Reserved

Video Game Training: 1st-Generation Games

Drew & Waters (1986). Clark et al. (1987). Dustman et al. (1992). Goldstein et al. (1997).

Results: Faster RTs, but little or no effects on Stroop, Trails-B, WM or LTM.

Small Effects, Limited Transfer
Copyright 2006 Minds Refined LLC. All Rights Reserved

Video Game Training: Modern Games

Complex 3D environments. 1st-person perspective. Extension to Older Adults? Attention demanding.

Rapid detection, response Age-appropriate content? selection, & execution. Multiple SR mappings. Goal management.

Large Effects, Extensive Transfer

Copyright 2006 Minds Refined LLC. All Rights Reserved

Can Video Games Slow Cognitive Aging?

Examine use of COTS games for training cognitive control in older adults.

Embed principles of cognitivecontrol training into games with age-appropriate themes.

Characteristics of Cognitive Control Training

Train under conditions of interference. Require inhibition of automatic responses. Change stimuli to avoid build-up of SR associations. Increase difficulty gradually, based on performance. Give immediate, hierarchical feedback.
Copyright 2006 Minds Refined LLC. All Rights Reserved

Art Dealer is based on the Avoiding-Repetitions, Incremented-Difficulty Training Procedure developed by Jennings & Jacoby (2003)

Copyright 2006 Minds Refined LLC. All Rights Reserved

Art Dealer Training Study - Results

Figure 1. Lag Levels Achieved Across Game Rounds
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Lags
16 & 32

False Alarms to 1st and 2nd Presentations of Lures ('Forgeries') Across Game Rounds
0.12

Proportion 'Buy' (False Alarms)

Lag Level

T1* T2* T3 T4 T5 T6* T7 T8* T9 T10 T11 Mean

10 & 24 8 & 16 6 & 12 4&8 3&6 2&4 1&2

0.11 0.10 0.09 0.08 0.07 0.06 0.05 0.04 0.03 0.02 0.01 0.00

1st Presentation of Lures 2nd Presentation of Lures

1-5

6-10

11-15

16-20

21-25

26-30

* no repeated lag levels

Game Round

Game Rounds

Performance Change from Pre- to Post-Test: Near Transfer - Recognition Hits & Accuracy
0.14 0.12
Change Score (Post minus Pre)

Performance Change from Pre- to Post-Test: Far Transfer Measures

5.00 4.00

0.10 0.08 0.06 0.04 0.02 0.00 -0.02 -0.04 -0.06 -0.08

Change Score (Post minus Pre)

Training Control

Training Control

3.00 2.00 1.00 0.00 -1.00 -2.00 -3.00 -4.00

PA-Delay * PA-Imm. Patt.Comp.**

Lett.Comp.^

Hits*

Hits-FAs*

Hits*

Hits-FAs^

-5.00

Ospan-Rel.** Ospan-Abs.** Raven's

* p < .05; ^ p < .075

Paintings

Words

** p < .01; * p < .05; ^ p < .075

Criterion Measure

Copyright 2006 Minds Refined LLC. All Rights Reserved

Can Cognitive Exercise Slow Age-Related Decline? Perhaps. Art Dealer produced notable gains (~10%) on

a number of measures associated with cognitive control (speed, working memory, LTM) and generalized beyond the specific stimuli and procedures used in the game.

Can We Make Cognitive-Control Training Fun? Fun to play? "Yes" (10 of 11 participants)
Did it feel like a game or a memory test? "A Game" (10 of 11 participants) "Fun, challenging, & educational. A great invention!"

Copyright 2006 Minds Refined LLC. All Rights Reserved

Training by Gaming - Future Directions

Theoretical
Maximizing Training & Generalization. Understand the Role of Motivation. Unity or Diversity of Cognitive Control?

Application
Art Dealer 2.0 (LTM). Trivia Poker (WM). Crazy Shopper (Attentional Control).

Copyright 2006 Minds Refined LLC. All Rights Reserved

Mind Refined LLC - Business Model

Value Proposition
Target Cognitive Control. Produce games that are compelling, affordable, & efficacious.

Market Segment
Initial focus on Older Adults (55+) (under rep'ed in VG industry). Anyone concerned with mental fitness or specific game content.

Marketing & Sales

Market directly to older adults & senior centers; word of mouth.
Internet sales (CD-ROM); plans for web-based play.

Business Strategy
Tightly link product to research (evidence-based games).

Copyright 2006 Minds Refined LLC. All Rights Reserved

"We don't stop playing because we grow old, we grow old because we stop playing"

Acknowledgements
The Art Dealer study was partially supported by a grant from the NIA to Larry Jacoby (Wash U) and benefited from theoretical input from Karen Daniels (UNCW) and graphic magic from Cindi Toth (WebFresco).

Copyright 2006 Minds Refined LLC. All Rights Reserved

Limitations of Lab-based Cognitive Training

Theoretical Limitations
Training specific skills or abstract processes? Training one or more forms of cognitive control? What are the best ways to implement training? Individual differences in responsiveness to training.

Applied Limitations
Effortful. Mundane tasks & materials Low Motivation. Training & testing cognition High Anxiety. Expensive for both trainers and trainees.

Copyright 2006 Minds Refined LLC. All Rights Reserved

Art Dealer Training Study - Design

2 Groups: Game Play vs. No-Contact Control.
11 Participants per group (18f/4m), well matched in terms of age (~73), education (~14), self-rated health (~3.7 out of 5) and verbal knowledge (~35 on Shipley vocabulary).

Pre-Training/Post-Training Design.
Both groups assessed twice, ~ 1 week apart.

Game-Play Group given Art Dealer 1.0 & User's Guide.

Criterion Measures
Recognition Memory for Paintings. Recognition Memory for Words. Recall of Paired-Associates (Immediate and Delayed). Cognitive Speed: Letter- & Pattern-Comparison. Working Memory: Operation-Span.

Reasoning: Raven's Progressive Matrices.

Copyright 2006 Minds Refined LLC. All Rights Reserved