Gamified CoGNIT: cognitive assessment with added game elements : Gamification of medical examination

Abstract: Background. CoGNIT is a computerized test battery for cognitive assessment, used in diagnosing and treating patients with idiopathic normal pressure hydrocephalus (INPH). The disorder causes symptoms of dementia, among other things. Apart from other diseases with similar symptoms, like Alzheimer’s, INPH can be countered. CoGNIT is performed by a patient before and after drainage of cerebrospinal fluid. If a significant improvement in cognition is detected after the extraction, the patient receives shunt surgery which reduces all symptoms. The test battery is long and tedious, which makes it difficult for people with cognitive impairments to complete. Objectives. The objectives of this study are to rework original CoGNIT with carefully selected game design elements and analyze the effects of the alteration on performance and user experience. If users perform better in a gamified environment, the validity of gathered data will have improved as the data should better reflect their cognitive capabilities. Another objective is to introduce gamification to the medical field. Methods. Game design elements were picked and designed based on suitability for elderly people and with the impairments of INPH patients in mind. A gamified prototype was developed and put to test with healthy individuals against the original version in an experiment. The effects of gamification on performance was examined by comparing resulting score values from both versions of the test. Participants also filled in a questionnaire as proxy for the test’s target group, meaning that questions were answered with how the participants expected a cognitively impaired person to answer. Answers were used to investigate the effect of gamification ofuser experience. Results. The gamified version of CoGNIT shows an improvement in test segments regarding attention, psychomotor speed, executive function, and manual dexterity, but a negative inclination in segments regarding memory. Results from the user experience questionnaire indicates that the gamified version feels less dramatic, more playful, less "test-like" and less tedious compared to the non-gamified version. This suggests that the added game elementsare affecting the user experience in the desired way. Conclusions. An overall positive impact on both performance and user experience from gamification is concluded. The negative effect on memory tests could not be determined to be a cause of the gamification per se.