What is it about?

This paper is about validating the ability of a serious game for cognitive assessment to screen for the presence of delirium in elderly emergency patients. It reports on a clinical study with 203 patients in a Canadian urban hospital. 16 of the participants had clinically unrecognized delirium and 14 of them were able to play a cognitive assessment game. Based on the observed game performance patients were classified as either having or not having delirium with 100% sensitivity and 60% specificity (using the confusion assessment method, i.e, CAM, as the gold standard measure of delirium. Completion rate for the game was over 96% as against 63% and 25% for two other tasks that have been proposed for use in screening for delirium. The paper concludes by noting the potential of the cognitive assessment game to dentify older ED patients with clinically unrecognized delirium.

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Why is it important?

Delirium is an acute form of brain failure that is estimated to affect around 10% of Emergency Department patients leading to costs of around $7 billion per year in the US alone. Delirium leads to prolonged hospitalization, functional decline, and loss of independence. and impedes accurate history and physical examination. Having an accurate way to screen for the possibility of delirium will make it possible to do thorough screening for delirium in selected cases, reducing the overall effort required to detect the large majority of delirium cases and thus improving health outcomes for a large number of emergency patients, while also significantly lowering overall healthcare costs.


There has been a tendency in the past to apply a disease model to cognitive status where different disease processes are assumed to produce progressively more severe forms of cognitive impairment, leading eventually to dementia. However, there is increasing evidence that lifestyle factors have a major impact on the risk of late onset dimentia, and that medications and other factors may lead to cognitive decline (sometimes permanent) after medical treatment. Developing better methods to recognize and treat delirium is likely one of the best potential interventions for reducing cognitive decline in the elderly population. In busy clinical settings it is hard to do detailed cognitive assessments but this should change as validated games for cognitive assessment (with their fun factor to encourage use and compliance) become available.

Mark Chignell
University of Toronto

Read the Original

This page is a summary of: Predictive Ability of a Serious Game to Identify Emergency Patients With Unrecognized Delirium, Journal of the American Geriatrics Society, July 2019, Wiley, DOI: 10.1111/jgs.16095.
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