Can video games help personalize cognitive care for vulnerable groups?
Northeastern scientists are using video games to understand how to one day customize cognitive care for people with HIV.
A group of 50 participants from across the United States sat at their computers and logged in to a bespoke video game designed by Northeastern University researchers.
The game begins as their playable character, a small astronaut named Lerner, observes a sequence of glowing gems beamed into the air, each with a different shape and color, flashing one-by-one in a specific order. Participants then steer Leaner horizontally across a rocky, alien landscape until they reach a platform holding copies of those same gems. The goal? To recall the precise sequence from the start and zap the gems in the correct order with a bright pink space laser.
The simple side-scrolling game was an original creation from Northeastern’s Brain Game Center for Mental Fitness and Wellbeing. The series of remotely administered tests came as a step forward in Northeastern scientists’ understanding of how specific groups of people experiencing cognitive decline respond to experimental interventions that are personalized to their conditions, according to Brain Game Center director Aaron Seitz.
“A lot of our research is looking at how we can find ways to personalize interventions and to figure out what types of approaches are going to be most useful for different people and different populations,” said Seitz. “This idea that there’s like a one-size-fits-all solution is not quite perfect.”
This study was designed specifically to train subjects over 50 years old aging with HIV, who are at greater risk for cognitive fatigue, on their working memory – the ability to remember small bits of information over short periods of time.
The research uncovered meaningful differences in the effectiveness of the video game on improving memory between older participants living with HIV and those without the virus, Seitz said. Even among HIV participants with a range of cognitive decline, different learning patterns emerged, showing that additional gaps may exist in cognitive research for other underserved groups, he said.
The work builds on the growing understanding of how the transmittable virus, which primarily attacks the body’s immune system, can also cause premature brain aging detectable as early as 10 years before people without HIV, researcher Morgan Gomez told Northeastern Global News.
The difficulties, which are captured under a group of conditions known as HIV-associated neurocognitive disorders (HAND), range from impairment without symptoms, which might not be noticeable day-to-day, to HIV-associated dementia at the most severe end, Seitz said. HAND affects working memory, processing speed, executive function or attention in about 30% to 50% of people living with the virus.
“In a practical sense, this can mean more difficulty managing medications, following conversations, or handling finances independently,” Gomez said. “In return, this can increase reliance on caregivers, raise the risk of early retirement, and reduce quality of life.”
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And while robust research exists on cognitive disorders more broadly, there is little being done to address HIV-specific cognitive decline in aging adults, Gomez added. That’s why the Brain Game Center has situated itself on the front lines of this type of research, she said, using homemade video games as a vehicle to examine groups with particular vulnerabilities that may not respond the same way to medical interventions as the broader population.
Previous research from the Brain Game Center on aging adults without HIV found that people with lower inhibitory control scores – meaning more difficulty with focusing, exhibiting self-control and ignoring distractions – tended to perform worse on the astronaut memory-test video game, Seitz said. Instead, these participants said in later surveys that they preferred a non-gamified version, which consisted not of an alien planet and space lasers, but simple flashcards showing the sequence of colorful shapes.
The research team initially tested the participants’ cognitive health on a range of tests to establish a baseline to measure against. After the experiment, they found that those with higher inhibitory control scores – meaning stronger self-regulation and focus – exhibited better working memory while playing the video game, he said. That trend assured Seitz and his team that there was something measurable and predictable in older adults with cognitive decline that could help them understand whether games would be better for their learning needs.
However, when he and Gomez performed the same analysis on the group of older adults with HIV, they were surprised to see that trend flip.
“It’s actually a little bit switched,” Gomez said. “Even though [some participants with HIV] showed low inhibitory control, they’re actually still benefiting from a gamified version.”
Seitz and Gomez also broke down the participants into three groups with distinct cognitive profiles, comparing their performance across the tests. Each group showed different strengths and difficulties across inhibitory control, working memory and general cognitive ability, Gomez said, showing that even two people with the same HAND classification can look very different when examined.
“These are not the same clinical picture, and they should not lead to the same intervention,” Gomez wrote. “If the goal is to eventually ameliorate the cognitive effects of HAND, we first need tools that can see what HAND actually looks like in each person, not just whether it is present or absent.”
The participants’ performance patterns also differed from people with the same cognitive profiles in non-HIV groups, Seitz added, further showing that meaningful individual differences may exist between people living with and without HIV that current research approaches have missed.
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The Brain Game Center plans to continue its cognitive training research, Seitz said, including conducting a study with eight different interventions. Like the HIV-related study, its goal will be to measure the learning capabilities of individual groups that might have different needs than the general population.
Understanding whether cognitive interventions benefit these specific populations, and whether the same factors predict who benefits, is critical to support cognitive health across all aging adults, according to Gomez.
“The simple story we have at this point is, you can’t do research in one population and assume that result is automatically going to reflect another population,” Seitz said. “If we had never done the research in people with HIV, and just assumed that the studies that we did in neurotypical older adults would represent them, then we would be overlooking some things.”
