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Alzheimer's, Dementia & Mental Health
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Stephanie Frederick and Norman
Barrow play FreeCell on computers at Calaroga Terrace, a
Portland, Ore. retirement community. (OHSU Photo) |
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Senior Citizens Play Computer Game to Determine
Memory Loss
Scientists say FreeCell can be adapted to spot
early signs of dementia
July 18, 2006 – Scientists said today they are
using a popular computer card game – FreeCell – to help distinguish
between senior citizens with memory problems and those without cognitive
problems.
Scientists with the Oregon Health & Science
University's Oregon Center for Aging & Technology, or ORCATECH, found
that a Solitaire-like game called FreeCell, when adapted with cognitive
performance assessment algorithms, may be able to distinguish between
persons with memory problems and cognitively healthy seniors.
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on
Alzheimer's, Dementia & Mental Health |
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People with mild cognitive impairment are at high
risk of developing dementia, which is most commonly caused by
Alzheimer's disease. The discovery could help doctors plan early
treatment strategies by detecting subtle cognitive changes over time in
the natural setting of an elder's home.
"We discovered that we can take an existing
computer game that people already have found enjoyable and extract
cognitive assessment measures from it," said ORCATECH investigator Holly
Jimison, Ph.D., associate professor of medical informatics and clinical
epidemiology, OHSU School of Medicine, and the study's lead author.
The study results are being presented today during
a poster session at the 10th International Conference on Alzheimer's
Disease and Related Disorders in Madrid.
In FreeCell, players are dealt 52 cards face up in
eight columns, with four columns having seven cards and the others
having six. The object is to move all the cards into four single-card
free "cells" in four suit piles stacked from lowest to highest rank.
"It requires significant planning to play well, and
planning is one measure that neuropsychologists attempt to test in
clinical situations," Jimison said. "We're trying to replicate that, and
we've been able to show that we can, at least in early studies with
small numbers of people, show distinctions between cognitively healthy
elders and those with even mild cognitive impairment."
Jimison and study co-author Misha Pavel, Ph.D.,
professor of biomedical engineering and computer science and electrical
engineering at OHSU's OGI School of Science & Engineering, studied nine
people with an average age of 80. All were regular computer users who
played the FreeCell game frequently over a six-month period. Each
participant was given a cognition score based on a brief battery of
tests, and three were found to have mild cognitive impairment.
To measure cognitive performance, researchers
compared each user's play efficiency to a game "solver" within the
program that checks card layouts throughout a game and calculates the
minimal number of moves to complete it. The solver is a "dynamic
algorithm that is solving the game at every moment in time, and it knows
the minimal number of steps you would need to complete it," Jimison
said. "We compare this 'optimal slope' to how the individual users are
doing."
The FreeCell study laid the groundwork for
follow-up research, funded by the National Institute of Standards and
Technology's Advanced Technology Program, or NIST ATP, examining games
with "dynamic adaptability," a system that keeps games fun and
challenging, but still able to simultaneously collect data. For example,
scientists can program the FreeCell game to automatically adjust
difficulty with each new card layout based on the user's performance on
the previous game, and users also can receive hints, if they choose,
along the way.
"In general, we're trying to keep people at a 75
percent win rate," said Jimison, who also serves as senior research
scientist for Portland-based computer game developer and ORCATECH
partner Spry Learning Co., which received the NIST ATP grant and helped
adapt and test the FreeCell game. "We're trying to keep difficulty at a
level that keeps them motivated. We want to challenge them to the point
where they just start having trouble. We don't want it to be too easy or
too hard."
Pavel believes that as the elderly population
increases, the incidence of chronic illness - an estimated 80 percent of
adults older than 65 report having at least one chronic illness, and
half of all adults have at least two - such home monitoring technology
will become a health care standard.
"In the near future, technology for unobtrusive
monitoring, assessment and coaching will become a part of our everyday
life, throughout the lifespan, much like telephones, credit cards, alarm
watches and automobiles," he explained. "In infancy, early detection of
dysfunctions will enable early treatment, development of special
programs, and the like. In youth and adulthood, we will use the
technology in sports, in alarms, reminders. So it will not be a drastic
change for us to accept monitoring as we age. It is always a tradeoff
between benefits and costs."
The FreeCell program is one of several "enabling
technologies" under development at ORCATECH, said the center's director,
Jeffrey Kaye, M.D., OHSU professor of neurology and biomedical
engineering. The interdisciplinary center, established in 2004 as a
National Institute on Aging Roybal Center for Aging & Technology,
studies and develops technology to assess elders in their home
environments. The goal is to help them retain independence by discretely
collecting data that may indicate health changes long before quality of
life is affected.
"It's a lot easier to treat someone when symptoms
are just starting as opposed to when a full-blown crisis occurs," Kaye
said. "These electronic and online methodologies help tell us early on
when trouble's brewing. We're not suggesting we can make detailed
diagnoses all remotely. What we're trying to do is identify trends that
might tell use someone may be in trouble in the future."
Devin Williams, Spry Learning Co.'s chief executive
officer, believes needs by the medical community to recognize and
classify such trends will drive the development of products like the
adapted FreeCell game and, as a result, "help identify early commercial
applications for the technology." ORCATECH, she said, "is an excellent
example of the benefits of such accelerated translational research."
Editor's Note:
Drs. Jimison and Pavel, and Ms. Williams are employees of
Spry Learning, a company that may have a commercial interest in the
results of this research. This potential conflict was reviewed and a
management plan approved by the OHSU Conflict of Interest in Research
Committee was implemented.
>> Rules of FreeCell -
http://www.freecell.org/rules.html
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