Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.06.027
Brazilian Journal of Anesthesiology
Original Investigation

Comparison of digital games as a cognitive function assessment tool for current standardized neuropsychological tests

Jogo digital como ferramenta para avaliação de funções cognitivas comparado a testes neuropsicológicos normatizados atuais

Ananaira Alves Goulart; André Lucatelli; Paulo Sergio Panse Silveira; José de Oliveira Siqueira; Maria José Carvalho Carmona; Livia Stocco Sanches Valentin; Joaquim Edson Vieira

Downloads: 0
Views: 219

Abstract

Objective
Cognitive dysfunction may occur postoperatively. Fast and efficient assessment of Postoperative Cognitive Dysfunction (POCD) can minimize loss of quality of life, and therefore, a study comparing a digital game with standard neuropsychological tests to assess executive, mnemonic, and attention functions to evaluate POCD seems to be relevant both for research and clinical practice.

Methods
A battery of standardized tests and a digital game (MentalPlus®) were administered to 60 patients at the Central Institute of Hospital das Clínicas in São Paulo (36 women and 24 men), ages between 29 and 82 years, pre-and post-surgery performed under anesthesia. Correlation and linear regression model were used to compare the scores obtained from the standardized tests to the scores of the six executive and cognitive functions evaluated by the game (short- and long-term memory, selective and alternating attention, inhibitory control, and visual perception).

Results
After correlation analysis, a statistically significant result was found mainly for the correlation between the scores from the phase of the digital game assessing the visuoperception function and the scores from the A and B cards of the Stroop Test (p < 0.001, r = 0.99 and r = 0.64, respectively), and the scores from TMTA (p = 0.0046, r = 0.51). We also found a moderate correlation between the phase of the game assessing short-memory function and VVLT (p < 0.001, r = 0.41). No statistically significant correlations were found for the other functions assessed.

Conclusion
The digital game provided scores in agreement with standardized tests for evaluating visual perception and possibly short-term memory cognitive functions. Further studies are necessary to verify the correlation of other phases of the digital game with standardized tests assessing cognitive functions.

Keywords

Neuropsychology;  Neuropsychological tests;  Videogames;  Cognitive function;  Cognitive dysfunction;  Anesthesia

Resumo

Objetivo: A disfunção cognitiva pós-operatória (DCPO) é um evento que pode ocorrer após um procedimento cirúrgico. Avaliar essa disfunção de forma rápida e eficiente pode minimizar perdas na qualidade de vida e, portanto, um estudo comparativo de um jogo digital como teste neuropsicológico para avaliação de DCPO com testes normatizados para avaliar funções executivas, mnemônicas e atencionais é relevante para pesquisa e para aplicabilidade clínica.

Métodos: Uma bateria de testes padronizados e um jogo digital (MentalPlus®) foram aplicados a 60 pacientes do Instituto Central do Hospital das Clínicas de São Paulo (36 mulheres e 24 homens), com idades entre 29 e 82 anos, antes e depois de procedimento cirúrgico sob anestesia. A comparação foi realizada por meio de correlação e modelo de regressão linear entre as pontuações dos testes padronizados e as pontuações de seis funções executivas e cognitivas avaliadas no jogo (memória de curto e longo prazo, atenção seletiva e alternada, controle inibitório e visuopercepção).

Resultados: Resultados da análise de correlação foi estatisticamente significante para a correlação entre a fase de percepção visual do jogo digital e os pranchas A e B do Teste de Stroop (p <0,001, r = 0,99 e r = 0,64, respectivamente ) e com TMTA (p = 0,0046, r = 0,51). Também foi encontrada correlação intermediária entre a fase de memória de curto prazo do jogo e o VVLT (p <0,001, r = 0,41). Para as demais funções avaliadas não foram encontradas correlações estatisticamente significativas.

Palavras-chave

Neuropsicologia, Testes neuropsicológicos, Videogames, Função cognitiva, Disfunção cognitiva, Anestesia

References

1. Luria AR. Fundamentos de Neuropsicologia: Tradução de Juarez Ricardo Aranha - Rio de Janeiro: Livros Técnicos e Científicos. São Paulo: Ed. da Universidade de São Paulo;
1981. 

2. Mader MJ. Avaliação neuropsicológica: aspectos históricos e situação atual. Psicologia, ciência, profissão [Internet]. 1996 [cited 2019 Dec 5];16(3):12-18. http://dx.doi.org/10.1590/S1414-98931996000300003.

3. Capovilla AGS. Contribuições da neuropsicologia cognitiva e da avaliação neuropsicológica à compreensão do funcionamento cognitivo humano. Cadernos de Psicopedagogia [on-line]. 2007; 6(11).

4. Lesak MD. Neuropsychological Assessment. 5th ed. New York: Oxford University Press; 2012.

5. Strauss E, Sherman EMS, Spreen O. A Compendium of Neuropsychological Tests: Administration, Norms and Commentary. 3rd ed. New York: Oxford University Press; 2006.

6. Malloy-Diniz LF, Fuentes D, Mattos P, Abreu N. Avaliação Neuropsicológica. 2nd ed. Porto Alegre: Artmed Editora; 2018.

7. Reppold CT, Gurgel LG, Hutz CS. O processo de construção de escalas psicométricas. Avaliação Psicológica.2014;13(2):307-310.

8. Rivero TS, Querino EHG, Starling-Alves I. Videogame: seu impacto na atenção, percepção e funções executivas. Neuropsicologia Latinoamericana. 2012;4(3): 38-52.

9. Green CS, Li R, Bavelier D. Perceptual learning during action video game playing. Top Cogn Sci. 2010 Apr;2(2):202-16. https://doi.org/10.1111/j.1756-8765.2009.01054.x.

10. Blumberg FC, Fisch SM. Introduction: digital games as a context for cognitive development, learning, and developmental research. New Dir Child Adolesc Dev. 2013; 2013 (139):1-9. https://doi.org/10.1002/cad.20026. 

11. Merabet LB, Connors EC, Halko MA, Sánchez J. Teaching the blind to find their way by playing video games. PLoS One. 2012; 7(9): e44958. https://doi.org/10.1371/journal.
pone.0044958.

12. Bavelier D, Green CS, Pouget A, Schrater P. Brain plasticity through the life span: learning to learn and action video games. Annu Rev Neurosci. 2012; 35: 391-416. https://doi.
org/10.1146/annurev-neuro-060909-152832.
 
13. Valentin LSS, Pereira VFA. Digital game: a scale to evaluate the perioperative cognitive function (MentalPlus®), https://www.mnkjournals.com/journal/ijlrst/pdf/Volume_
6_1_2017/10705.pdf [accessed 18 January, 2021]

14. Valentin LSS, Pereira VFA. MentalPlus® digital game is reliable to measure cognitive function in healthy adults. A future accessible tool to assess postoperative cognitive dysfunction and rehabilitation. International Journal of Psychiatry. 2017;2(1):1-6. https://doi.org/10.33140/IJP/02/01/00003.

15. Canet J, Reader J, Rasmussen LS, et al. Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiologica Scandinavica. 2003;47(10):1204-10. https://doi.org/
10.1046/j.1399-6576.2003.00238.x.

16. Steinmetz J, Funder KS, Dahl BT, Rasmussen LS. Depth of anaesthesia and post-operative cognitive dysfunction. Acta Anaesthesiologica Scandinavica. 2010; 54(2): 162-8. https://doi.org/10.1111/j.1399-6576.2009.02098.x.

17. Rasmussen LS; ISPOCD2 investigators. Post-operative cognitive dysfunction in the elderly. Acta Anaesthesiol Scand. 2005; 49(10): 1573. https://doi.org/10.1111/j.1399-6576.2005.00860.x.

18. Silverstein JH, Steinmetz J, Reichenberg A, Harvey PD, Rasmussen LS. Postoperative cognitive dysfunction in patients with preoperative cognitive impairment: which domains are most vulnerable? Anesthesiology. 2007; 106(3): 431-5. https://doi.org/10.1097/00000542-200703000-00006.

19. LSS, Pietrobon R, Aguiar Junior W, et al. Definition and application of neuropsychological test battery to evaluate postoperative cognitive dysfunction. Einstein (São Paulo).
2015; 13(1): 20-26. https://dx.doi.org/10.1590/S1679-45082015AO3152.

20. Ellis PD. The Essential Guide to Effect Sizes, 1st ed., Cambridge University Press, 2010.

21. Cohen, J. Statistical power analysis for the behavioral sciences, 2nd ed.. Hillsdale, NJ: Lawrence Erlbaum, 1988.

22. Benedict RHB, Schretlen D, Groninger L, Dobraski M, Shpritz B. Revision of the Brief Visuospatial Memory Test: Studies of normal performance, reliability, and validity.
Psychological Assessment 1996; 8(2): 145-53. https://doi.org/10.1037/1040-3590.8.2.145.

23. Scarpina F, Tagini S. The Stroop Color and Word Test. Front Psychol. 2017; 8: 557. https//doi.org/10.3389/fpsyg.2017.00557.

24. Llinàs-Reglà J, Vilalta-Franch J, López-Pousa S, Calvó--Perxas L, Torrents Rodas D, Garre-Olmo J. The Trail Making Test. Assessment. 2017; 24(2): 183-96. https//doi.
org/10.1177/1073191115602552.

25. Radtke FM, Franck M, Papkalla N, et al. Postoperative cognitive dysfunction: computerized and conventional tests showed only moderate inter-rater reliability. J Anesth. 2010;
24(4): 518-25. https//doi.org/10.1007/s00540-010-0952-z.

26. Pérez-Belmonte LM, Florido-Santiago M, Osuna-Sánchez J, et al. Screening Versus Brief Domain-specific Tests to Assess Long-term Postoperative Cognitive Dysfunction After Concomitant Aortic Valve Replacement and Coronary Artery Bypass Grafting. J Cardiovasc Nurs. 2019; 34(6): 511-6. https//doi.org/10.1097/JCN.0000000000000596.

27. Stoicea N, Koehler KN, Scharre DW, Bergese SD. Cognitive self-assessment scales in surgical settings: Acceptability and feasibility. Best Pract Res Clin Anaesthesiol. 2018; 32(3-4): 303-9. https//doi.org/10.1016/j.bpa.2018.08.001.

28. Hughes CG, Boncyk CS, Culley DJ, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention. Anesth Analg. 2020; 130(6): 1572-90. https//doi.org/10.1213/ANE.0000000000004641.

29. Cottrell JE, Hartung J. Anesthesia and Cognitive Outcome in Elderly Patients: A Narrative Viewpoint. J Neurosurg Anesthesiol. 2020; 32(1): 9-17. https//doi.org/10.1097/
ANA.0000000000000640.
 
30. Ancelin ML, de Roquefeuil G, Scali J, et al. Long-term post-operative cognitive decline in the elderly: the effects of anesthesia type, apolipoprotein E genotype, and clinical
antecedents. J Alzheimers Dis. 2010; 22 Suppl 3: 105-13. https//doi.org/10.3233/JAD-2010-100807.

31. Piggin LH, Newman SP. Measuring and monitoring cognition in the postoperative period. Best Pract Res Clin Anaesthesiol. 2020; 34(1): e1-e12. https//doi.org/10.1016/j.
bpa.2018.11.002.


Submitted date:
01/13/2020

Accepted date:
06/26/2021

611fed86a9539573d5194878 rba Articles

Braz J Anesthesiol

Share this page
Page Sections