||A Study of Game-Based Cognitive Assessment APP for Dementia Screening
||Department of BioMedical Engineering
失智症盛行率隨著年紀增長而逐年增加，失智症篩檢已成為老年化社會的重要議題，其中輕度認知功能衰退(MCI)族群相較於正常老化者，較有可能轉變為失智症(每年約10-15%)。從醫療成本方面，台灣輕度失智症患者每月平均花費約兩萬元，對於普通收入的家庭有一定的經濟壓力，而隨著病情惡化，花費則以1.4倍增長。若能及早發現疾病及早治療，不僅能夠延緩病情惡化，同時也可以維持患者的生活品質，為減少後續照護人力及成本的關鍵。目前雖然有多種評估認知功能的工具如簡易心智量表(MMSE)、臨床失智評估量表(CDR)、認知功能障礙篩檢量表(CASI)、蒙特利爾認知評估量表(MoCA)等可供臨床應用，但是根據統計我國失智症患者的就診率仍然偏低。現代生活中，智慧型手機與平板電腦等電子產品應用相當普遍，因此本論文主要以平板電腦為基礎在Android與Window平台研發，用以早期失智症篩檢的遊戲型認知功能評估應用程式，其內容包含取得使用者背景資訊以及測試五個認知領域(視覺空間概念、注意力、語言能力、記憶力及執行功能) 共13關卡；關卡設計是參考臨床上常用評估量表，遊戲元素則以台灣文化為主，加入較貼近台灣日常生活的故事。本研究實驗共收集103筆有效的個案資料，包括正常組50位、輕微認知衰退組 14位及失智症組39位。資料內容包含CDR、CASI、MMSE量表分數，和使用本研究所研發之應用程式所測得分數與問卷調查。研究結果顯示本應用程式分別與CASI(r=0.93)和MMSE(r=0.91)有高度的線性相關性。三組在CASI、MMSE與本應用程式的結果亦有明顯差異，尤其是視覺空間概念、記憶力及執行功能的表現差異最為明顯。根據實驗結果，使用本應用程式所測得的平均分數對於正常組為90.2分，輕微認知衰退組為76.5分，失智組為47.3分。基於分析比較之結果，本應用程式深具潛力發展為早期失智症篩檢工具，可以運用於一般普及化初步篩檢。
Due to the prevalence of dementia as increasing with age, the dementia screening becomes an important issue in aging or aged society. Compared to general elders, the groups of Mild Cognitive Impairment (MCI) is shown to have higher ratio about 10-15% being changed into dementia annually. From the aspect of healthcare cost, about NT$20,000 in average is spent for a mild dementia patient per month. The cost is increasing with disease severity and puts heavy burden on their family. If the patients can be diagnosed and treated earlier, not only disease progression can be slowed down but also the quality of life may be maintained. In addition, it may save more labors and cost on caregiving. There are several cognitive assessments for clinical application, such as Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Cognitive Abilities Screening Instrument (CASI), Montreal Cognitive Assessment (MoCA), etc., however, according to statistics, the clinical OPD following-up rate of dementia patients is still low. Nowadays, smart phones and tablet are easily available and become a part of daily life. Therefore, in this study, Game-Based Cognitive Assessment (GBCA) is proposed and developed for early screening of cognitive impairment. GBCA is a type of an interactive game APP implemented on Android and Windows platforms. It includes the user background information acquisition and 13 test games in 5 main cognitive domains (visuospatial perception, attention, language, memory and executive functioning). The testing contents are designed by taking the general assessments in clinic as reference. The game theme and elements are based on Taiwanese culture, so it would go with daily life experience. In this study, 103 valid data (NC=50, MCI=14, Dementia=39) have been collected, including scores of CDR, CASI, MMSE, the proposed GBCA and a questionnaire. The results show the highly linear correlation between GBCA and CASI (r=0.93) as well as between the APP and MMSE (r=0.91). From the results of GBCA, the average score for the groups of NC, MCI, and dementia are 90.2, 76.5, and 47.3, respectively. Based on the comparison analysis, the proposed APP is demonstrated to be a potential tool for dementia screening.
LIST OF FIGURES VI
LIST OF TABLES VII
Chapter 1 Introduction 1
1.1 Background 1
1.1.1 Global dementia overview 1
1.1.2 Status in Taiwan 1
1.2 Research Purpose 4
1.3 Research Area 4
Chapter 2 Literature Review 5
2.1 Dementia 5
2.1.1 Definition and symptoms 5
2.1.2 Classification 5
2.1.3 Mild cognitive impairment 6
2.2 Cognitive assessments 8
2.2.1 Mini-Mental State Examination 8
2.2.2 Montreal Cognitive Assessment 8
2.2.3 Cognitive Abilities Screening Instrument 9
2.2.4 Clinical Dementia Rating 9
2.2.5 Comparison of different clinical cognitive assessments 10
2.3 Computerization 11
2.4 Gamification and Serious game 11
Chapter 3 Material and Methods 13
3.1 Structure of Experiment 13
3.2 Subject 13
3.3 Game-Based Cognitive Assessment APP 14
3.3.1 Concept of design 14
3.3.2 Interaction design 15
3.3.3 Design of User interface 16
3.3.4 Scoring criteria 22
3.3 Questionnaire of user experience 23
3.4 Data collection procedure 24
Chapter 4 Results and Discussion 25
4.1 Results 25
4.1.1 Results of Game-Based Cognitive Assessment 25
4.1.2 Correlation analysis 29
4.1.3 Results of Questionnaire 29
4.2 Discussion 31
4.2.1 Discussion of Game-Based Cognitive Assessment APP 31
4.2.2 User experience 31
4.2.3 User scenario 32
4.2.4 Limitation 32
Chapter 5 Conclusion and Prospects 33
Appendix A Questionnaire of Game-Based Cognitive Assessment (GBCA) APP 38
Appendix B Interface of Game-Based Cognitive Assessment (GBCA) APP 41
Repeat the number and Reverse the number 41
Recognize the number 42
Repeat after me 43
Ten fruits 44
Overlapped pentagons drawing test 44
Tower of London test 44
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