Development and Evaluation of an Artificial Intelligence-Based Cognitive Exercise Game: A Pilot Study.

Recently, cognitive serious games have successfully been employed to train cognitive abilities in elderly people with mild cognitive impairment, Alzheimer's disease, and related disorders. However, despite the continuous rehabilitation game design and its applications, the existing cognitive exercise games fall short of user interaction and personalized elements with regard to difficult levels, which leads to users leaving early and losing interests during the gameplay. In this regard, the purpose of the study was to design and develop the serious game inclusive of playful elements for user motivation, the web-based mobile application system for easy accessibility, and Artificial Intelligence- (AI-) based difficulty level adjustment system for prevention from earlier leaving out in the middle of the play so that the elderly users can feel entertaining and immersed into the cognitive game voluntarily. This study was designed as an eight-week pilot experiment with thirty-seven participants in their 60s to 80s for the game's usability assessment purpose. Results of the study showed that the AI-based cognitive exercise game was acceptable, interesting, and motivating for the elderly people and the test results before and after the eight-week training suggest a relationship between longer the training on the game and lower cognitive assessment scores including geriatric quality of life scale, geriatric depression scale, and Korean version of mini-mental state examination (MMSE). These correlations demonstrate the potential value of serious games in clinical assessment of cognitive status for the elderly users with varying cognitive ability. Based on these results, the elderly-centered serious game with playful element can be potentially used in clinical settings, allowing the cognitive training to be more enjoyable and more medically effective. Given these promising results, a more focused study can extend to the game system or additional game tools or features to be explored that solely target the elderly by applying AI and advanced visualization devices.