Abd-Alrazaq Alaa, Alajlani Mohannad, Alhuwail Dari, Toro Carla T, Giannicchi Anna, Ahmed Arfan, Makhlouf Ahmed, Househ Mowafa
Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.
AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar.
JMIR Serious Games. 2022 Mar 10;10(1):e34592. doi: 10.2196/34592.
Cognitive impairment is a mental disorder that commonly affects elderly people. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological intervention for improving cognitive abilities. The effectiveness and safety of serious games for improving cognitive abilities have been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses.
This study aims to assess the effectiveness and safety of serious games for improving cognitive abilities among elderly people with cognitive impairment.
A systematic review of randomized controlled trials (RCTs) was conducted. The following 8 electronic databases were searched: MEDLINE, Embase, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also screened reference lists of the included studies and relevant reviews, as well as checked studies citing our included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies.
Fifteen studies met the eligibility criteria among 466 citations retrieved. Of those, 14 RCTs were eventually included in the meta-analysis. We found that, regardless of their type, serious games were more effective than no intervention (P=.04) and conventional exercises (P=.002) for improving global cognition among elderly people with cognitive impairment. Further, a subgroup analysis showed that cognitive training games were more effective than no intervention (P=.05) and conventional exercises (P<.001) for improving global cognition among elderly people with cognitive impairment. Another subgroup analysis demonstrated that exergames (a category of serious games that includes physical exercises) are as effective as no intervention and conventional exercises (P=.38) for improving global cognition among elderly people with cognitive impairment. Although some studies found adverse events from using serious games, the number of adverse events (ie, falls and exacerbations of pre-existing arthritis symptoms) was comparable between the serious game and control groups.
Serious games and specifically cognitive training games have the potential to improve global cognition among elderly people with cognitive impairment. However, our findings remain inconclusive because the quality of evidence in all meta-analyses was very low, mainly due to the risk of bias raised in the majority of the included studies, high heterogeneity of the evidence, and imprecision of total effect sizes. Therefore, psychologists, psychiatrists, and patients should consider offering serious games as a complement and not a substitute to existing interventions until further more robust evidence is available. Further studies are needed to assess the effect of exergames, the safety of serious games, and their long-term effects.
认知障碍是一种常见于老年人的精神障碍。严肃游戏是指具有娱乐之外目的的游戏，已被用作改善认知能力的非药物干预手段。多项系统评价对严肃游戏改善认知能力的有效性和安全性进行了研究；然而，这些研究受到设计和方法学缺陷的限制。
本研究旨在评估严肃游戏对改善认知障碍老年人认知能力的有效性和安全性。
对随机对照试验（RCT）进行系统评价。检索了以下8个电子数据库：MEDLINE、Embase、CINAHL、PsycINFO、ACM数字图书馆、IEEE Xplore、Scopus和谷歌学术。我们还筛选了纳入研究和相关综述的参考文献列表，并检查引用我们纳入研究的文献。两名评审员独立进行研究选择、数据提取、偏倚风险评估和证据质量评价。我们酌情采用叙述性和统计性方法来综合纳入研究的结果。
在检索到的466篇文献中，有15项研究符合纳入标准。其中，最终有14项RCT纳入荟萃分析。我们发现，无论类型如何，严肃游戏在改善认知障碍老年人的整体认知方面比无干预（P = 0.04）和传统锻炼（P = 0.002）更有效。此外，亚组分析表明，认知训练游戏在改善认知障碍老年人的整体认知方面比无干预（P = 0.05）和传统锻炼（P < 0.001）更有效。另一亚组分析表明，健身游戏（一类包括体育锻炼的严肃游戏）在改善认知障碍老年人的整体认知方面与无干预和传统锻炼效果相当（P = 0.38）。尽管一些研究发现使用严肃游戏会出现不良事件，但严肃游戏组和对照组的不良事件数量（即跌倒和既往关节炎症状加重）相当。
严肃游戏，特别是认知训练游戏，有改善认知障碍老年人整体认知的潜力。然而，我们的研究结果仍不明确，因为所有荟萃分析中的证据质量都非常低，主要原因是大多数纳入研究中存在偏倚风险、证据的高度异质性以及总效应量的不精确性。因此，在有更确凿的证据之前，心理学家、精神科医生和患者应考虑将严肃游戏作为现有干预措施的补充而非替代。需要进一步研究来评估健身游戏的效果、严肃游戏的安全性及其长期影响。
