Dr Solitaire: Assessing Cognitive Performance Through Meaningful Play
Dr Solitaire: Assessing Cognitive Performance Through Meaningful Play
To assess cognitive performance by means of the game of Solitaire. In this study, the
 investigators want to define relevant game metrics, when playing Solitaire, that may be
 indicative of cognitive performance.
12-15 healthy older persons will be observed, as well as 12-15 persons with cognitive
 impairment, while playing Solitaire. This will take the shape of contextual inquiries, i.e.
 the researcher visits the older person in his/her natural context and ask his/her to play
 Solitaire. Older persons will be observed playing 8-10 rounds of playing Solitaire, both with
 a physical deck of card and on a tablet. Gameplay actions and player behaviors will be
 observed and recorded for later analysis, via screen capturing software installed on the
 tablet, including the recordings of facial expressions and verbal utterances via the
 integrated touchpad camera and microphone. According to the contextual inquiry method, which
 is a 'light' form of participant observation, the researcher will take the role of an
 'apprentice'; he/she will observe and may ask questions for a better understanding of the
 player actions. At the end of the visit, following cognitive domains will be measured through
 pen-and-paper testing: visual scanning and psychomotor speed (Digit symbol substitution
 test), attention and executive function (Trail making test, digit span, verbal fluency, maze
 test), Camden topographical memory,... The duration of such a visit will last approximately
 120 minutes.

 These observations of game play actions and behaviors and the results that participants
 obtained on the cognitive test battery will be analyzed with experts in light of cognitive
 performance. More particular, the investigator will look for the measurable aspects of
 cognitive performance in the game, guided by earlier measures put forward by Jimison et al
 and Kaye et al. While they still list generic measures (e.g. 'target detection' or 'correctly
 retrieving item from previous knowledge'), this study will now operationalize these
 specifically for the game of Solitaire and for the target group (e.g. 'detection of card to
 move onto the build stack' or 'retrieving the card as available from the pile'). Hence,
 possible game metrics will be discussed and defined.
Inclusion Criteria:

 For the HEALTHY participants

 1. The participant has a minimum age of 65 years.

 2. The participant is living independently or semi-independently at home, service flat or
 care home.

 3. The participant has no subjective memory concern as reported by the participant,
 informant, or clinician.

 4. The participant has a normal brain function documented by scoring above 27 on the
 MMSE, above 26 on the MOCA and has a score of 0 for the CDR.

 5. In the opinion of the investigator, the participant is in stable medical condition and
 willing and able to perform study procedures in the opinion of the investigator.

 6. The participant is fluent in written and verbal Dutch.

 For the participants with COGNITIVE IMPAIRMENT:

 1. The participant has a minimum age of 65 years.

 2. The participant is living independently or semi-independently at home, service flat or
 care home.

 3. In the opinion of the investigator, the participant is in stable medical condition and
 willing and able to perform study procedures in the opinion of the investigator.

 4. The participant is fluent in written and verbal Dutch.

 5. For MCI: MCI patients, at baseline, are diagnosed applying Petersen's diagnostic
 criteria, i.e., (1) cognitive complaint, preferably corroborated by an informant; (2)
 objective cognitive impairment, quantified as performance of more than 1.5 SD below
 the appropriate mean on the neuropsychological subtests (z-score below -1.5); (3)
 largely normal general cognitive functioning; (4) essentially intact activities of
 daily living (ADL) (basic and instrumental activities of daily living (iADL) were
 determined by a clinical interview with the patient and an informant); and (5) not
 demented.

 6. For AD:Probable AD according to the National Institute on Aging/Alzheimer's
 Association Diagnostic Guidelines

 Exclusion Criteria:

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