Psychology
2012. Vol.3, No.7, 525-526
Published Online July 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.37076
Copyright © 2012 SciRes. 525
Examining the Neurocognitive Validity of Commercially
Available, Smartphone-Based Puzzle Games
Oonagh Thompson, Suzanne Barrett, Christopher Patterson, David Craig
Centre for Public Health, Qu e e n ’s University Belfast, Belfast, U n i t e d K i n g d o m
Email: othompson03@qub.ac.uk
Received April 6th, 2012; revised May 2nd, 2012; accepted Ju n e 1st, 2012
Cognitive assessment typically involves assessing a person’s cognitive performance in unfamiliar and ar-
guably unnatural clinical surroundings. User-centred approaches to assessment and monitoring, driven by
issues such as enjoyability and familiarity, are largely absent. Everyday technologies, for example,
smartphones represent an opportunity to obtain an objective assessment of a person’s cognitive capabili-
ties in a non-threatening, discreet and familiar way, e.g. by everyday puzzle games undertaken as a leisure
activity at home. We examined the strength of relationships that exist between performance on common
puzzle games and standard measures of neuropsychological performance. Twenty-nine participants, aged
50 - 65 years, completed a comprehensive neuropsychological test battery and played three smart-
phone-based puzzle games in triplicate: a picture puzzle [Matches Plus], a word puzzle [Jumbline] and a
number puzzle [Sudoku]. As anticipated, a priori, significant correlations were observed between scores
on a picture puzzle and visual memory test (r = 0.49; p = 0.007); a word puzzle and estimated verbal IQ (r
= 0.53; p = 0.003) and verbal learning (r = 0.30; p = 0.039) tests; and a number puzzle and reason-
ing/problem solving test (r = 0.42; p = 0.023). Further analyses making allowance for multiple compari-
sons identified a significant unanticipated correlation (r = 0.49; p = 0.007) between number puzzle scores
and a measure of nonverbal working memory. Performance on these smartphone-based games was in-
dicative of relative cognitive ability across several cognitive domains at a fixed time point. Smart-
phone-based, everyday puzzle games may offer a valid, portable measure of assessing and monitoring
cognition in older adults.
Keywords: Cognitive Assessment; Alzheimer’s Disease; Information & Communication Technology
(ICT); Smartphone
Introduction
Current methods for assessing and monitoring Alzheimer’s
disease (AD) can be l engthy and obtrusive and rely upon testing
cognitive performance at fixed time-points, often in arguably
unnatural clinical settings. The majority of assessment method-
ologies are developed with neurocognitive assessment princi-
ples as the starting point.
Clinical assessment and diagnosis of dementia in the UK is
based upon a clinical interview and assessment of activities of
daily living, often involving the input of a relative or friend; the
administration of standardised assessment scales to assess the
severity of impairment in the individual; and a physical exami-
nation and/or brain scan where considered appropriate by the
physician. The most commonly used assessment scale is the
30-item Mini-Mental State Examination [MMSE] (Folstein et
al., 1975). The MMSE includes key domains of cognitive func-
tioning: orientation, registration, attention, recall, visuospatial
capabilities and language delivered in a structured setting. Pa-
tient monitoring usually takes the form of follow-up clinic ap-
pointments with the physician or nurse, including further clini-
cal interviews and formal cognitive assessment to identify
change.
Interest is growing in new assessment methods that combine
assessment and monitoring and which reduce the need for mul-
tiple, fixed time-point clinic visits while offering a more con-
venient, home-based alternative. Such user-centred approaches
to assessment and monitoring, driven by issues such as enjoy-
ability, familiarity, convenience and availability, are largely
absent.
Information and communication technology (ICT), particu-
larly the smartphone, represents an opportunity to obtain an
objective assessment of a person’s cognitive capabilities in a
non-threatening, discreet and familiar way, e.g. by everyday
puzzle games undertaken as a leisure activity. The mobile
phone is an accessible, portable, everyday technology with 77%
uptake among older adults in the UK, and smartphone market
penetration is rising (Ofcom, 2011). If performance on every-
day puzzles maps to scores attained on conventional neuropsy-
chological tests, then smartphone-based puzzles may offer a
valid portable measure of cognition. To investigate this idea
further, we sought to examine the strength of relationships that
exist between performance on three widely available puzzle
games and standard measures of neuropsychological perform-
ance.
Twenty-nine older adults (gender [f:m] = 19[66%]:10[34%];
mean age = 56.2; range = 50 - 65 years) were recruited through
local ageing networks to participate in this study. During single
researcher-supervised sessions participants completed a com-
prehensive neurocognitive assessment and played three time-
limited, smartphone-based puzzles in triplicate (tests and games
listed in Table 1). A standard operating procedure was used to
ensure consistency of test adminstration and game instruction. i
