Efficacy of a Web App for Cognitive Training (MeMo) Regarding Cognitive and Behavioral Performance in People With Neurocognitive Disorders: Randomized Controlled Trial.

BACKGROUND: Cognitive and behavioral symptoms are the clinical hallmarks of neurocognitive disorders. Cognitive training may be offered to reduce the risks of cognitive decline and dementia and to reduce behavioral symptoms, such as apathy. Information and communication technology approaches, including serious games, can be useful in improving the playful aspect of computerized cognitive training and providing motivating solutions in elderly patients. OBJECTIVE: The objective of this study was to assess the effectiveness of employing the MeMo (Memory Motivation) Web app with regard to cognitive and behavioral symptoms in patients with neurocognitive disorders. METHODS: MeMo is a Web app that can be used on any Web browser (computer or tablet). The training activities proposed in MeMo are divided into the following two parts: memory and mental flexibility/attention. The study included 46 individuals (mean age 79.4 years) with a diagnosis of neurocognitive disorders at the Institut Claude Pompidou Memory Center in Nice. This randomized controlled study compared the evolution of cognition and behavior between patients not using MeMo (control group) and patients using MeMo (MeMo group) for 12 weeks (four sessions per week). Patients underwent memory and attention tests, as well as an apathy assessment at baseline, week 12 (end of the training period), and week 24 (12 weeks after the end of the training sessions). In addition, to assess the impact of high and low game uses, the MeMo group was divided into patients who used MeMo according to the instructions (about once every 2 days; active MeMo group) and those who used it less (nonactive MeMo group). RESULTS: When comparing cognitive and behavioral scores among baseline, week 12, and week 24, mixed model analysis for each cognitive and behavioral score indicated no significant interaction between testing time and group. On comparing the active MeMo group (n=9) and nonactive MeMo group (n=13), there were significant differences in two attention tests (Trial Making Test A [P=.045] and correct Digit Symbol Substitution Test items [P=.045]) and in the Apathy Inventory (AI) (P=.02). Mixed analysis (time: baseline, week 12, and week 24 × number of active days) indicated only one significant interaction for the AI score (P=.01), with a significant increase in apathy in the nonactive MeMo group. CONCLUSIONS: This study indicates that the cognitive and behavioral efficacies of MeMo, a Web-based training app, can be observed only with regular use of the app. Improvements were observed in attention and motivation. TRIAL REGISTRATION: ClinicalTrials.gov NCT04142801; https://clinicaltrials.gov/ct2/show/NCT04142801.

Children with autism spectrum disorder produce more ambiguous and less socially meaningful facial expressions: an experimental study using random forest classifiers.

Background: Computer vision combined with human annotation could offer a novel method for exploring facial expression (FE) dynamics in children with autism spectrum disorder (ASD). Methods: We recruited 157 children with typical development (TD) and 36 children with ASD in Paris and Nice to perform two experimental tasks to produce FEs with emotional valence. FEs were explored by judging ratings and by random forest (RF) classifiers. To do so, we located a set of 49 facial landmarks in the task videos, we generated a set of geometric and appearance features and we used RF classifiers to explore how children with ASD differed from TD children when producing FEs. Results: Using multivariate models including other factors known to predict FEs (age, gender, intellectual quotient, emotion subtype, cultural background), ratings from expert raters showed that children with ASD had more difficulty producing FEs than TD children. In addition, when we explored how RF classifiers performed, we found that classification tasks, except for those for sadness, were highly accurate and that RF classifiers needed more facial landmarks to achieve the best classification for children with ASD. Confusion matrices showed that when RF classifiers were tested in children with ASD, anger was often confounded with happiness. Limitations: The sample size of the group of children with ASD was lower than that of the group of TD children. By using several control calculations, we tried to compensate for this limitation. Conclusion: Children with ASD have more difficulty producing socially meaningful FEs. The computer vision methods we used to explore FE dynamics also highlight that the production of FEs in children with ASD carries more ambiguity.

Comparison between a Paper-Pencil Version and Computerized Version for the Realization of a Neuropsychological Test: The Example of the Trail Making Test.

BACKGROUND: Neuropsychological tests are particularly important for the clinical evaluation and Alzheimer's disease (AD) diagnosis. However, the tests currently employed for neuropsychological assessment have been developed several decades ago, and thus they do not fully exploit the potential provided by modern digital tools. One of the tests most commonly employed to assess attention and executive functions is the Trail Making Test (TMT). OBJECTIVE: The aim of this study was to evaluate whether the TMT developed and used for the serious exergame X-Torp (TMTX-Torp) can be used to evaluate cognitive functions such as mental flexibility. METHODS: Adjusted multivariate mixed model was used to compare performances in the TMTX-Torp to performances in the standard variant (TMTs) in three populations. 21 participants with AD (78.6y±8.5 y), 27 with mild cognitive impairment (MCI) (76.8y±8.5 y), and 27 healthy (HEC) (71.8y±7.4 y) were included. RESULTS: A difference was observed for the TMT A between AD and HEC and for the TMT B between AD and MCI and between AD and HEC. Whatever the variant of the TMT, we found a positive linear correlation between the time to complete the TMTX-Torp and the TMTs for HEC (TMT A: r = 0.75, p < 0.001; TMT B: r = 0.52, p = 0.008) and MCI participants (TMT A: r = 0.53, p = 0.005; TMT B: r = 0.48, p = 0.025) but not for AD participants. CONCLUSION: Although these versions of the TMT were not identical, the results showed that both versions were able to discriminate between HEC, MCI, and AD populations.

Children Facial Expression Production: Influence of Age, Gender, Emotion Subtype, Elicitation Condition and Culture.

The production of facial expressions (FEs) is an important skill that allows children to share and adapt emotions with their relatives and peers during social interactions. These skills are impaired in children with Autism Spectrum Disorder. However, the way in which typical children develop and master their production of FEs has still not been clearly assessed. This study aimed to explore factors that could influence the production of FEs in childhood such as age, gender, emotion subtype (sadness, anger, joy, and neutral), elicitation task (on request, imitation), area of recruitment (French Riviera and Parisian) and emotion multimodality. A total of one hundred fifty-seven children aged 6-11 years were enrolled in Nice and Paris, France. We asked them to produce FEs in two different tasks: imitation with an avatar model and production on request without a model. Results from a multivariate analysis revealed that: (1) children performed better with age. (2) Positive emotions were easier to produce than negative emotions. (3) Children produced better FE on request (as opposed to imitation); and (4) Riviera children performed better than Parisian children suggesting regional influences on emotion production. We conclude that facial emotion production is a complex developmental process influenced by several factors that needs to be acknowledged in future research.

Teaching Literacy Skills to French Minimally Verbal School-Aged Children with Autism Spectrum Disorders with the Serious Game SEMA-TIC: An Exploratory Study.

Learning to read is very challenging for children with Autism Spectrum Disorders (ASD), but also very important, as it can give them access to new knowledge. This is even more challenging in minimally verbal children, who do not have the verbal abilities to learn through usual methods. To address the learning of literacy skills in French minimally verbal school-aged children with ASD, we designed the serious game SEMA-TIC, which relies on non-verbal cognitive skills and uses specific learning strategies adapted to the features of autistic individuals. This study investigated the usability of SEMA-TIC (in terms of adaptability, efficiency, and effectiveness) for the acquisition of literacy skills in French minimally verbal school-aged children with ASD. Twenty-five children with ASD and no functional language participated in the study. Children in the training group received the SEMA-TIC training over 23 weeks (on average), while no intervention was provided to children in the non-training group. Results indicated that SEMA-TIC presents a suitable usability, as all participants were able to play (adaptability), to complete the training (efficiency) and to acquire significant literacy skills (effectiveness). Indeed, the literacy skills in the training group significantly improved after the training, as measured by specific experimental tasks (alphabet knowledge, word reading, word-non-word discrimination, sentence reading and word segmentation; all p ≤ 0.001) compared to the non-training group. More importantly, 3 out of 12 children of the training group could be considered as word decoders at the end of the intervention, whereas no children of the non-training group became able to decode words efficiently. The present study thus brings preliminary evidence that French minimally verbal school-aged children with ASD are able to learn literacy skills through SEMA-TIC, a specific computerized intervention consisting in a serious game based on non-verbal cognitive skills.

Recommendations for the Use of Serious Games in Neurodegenerative Disorders: 2016 Delphi Panel.

The use of Serious Games (SG) in the health domain is expanding. In the field of neurodegenerative disorders (ND) such as Alzheimer's disease, SG are currently employed both to support and improve the assessment of different functional and cognitive abilities, and to provide alternative solutions for patients' treatment, stimulation, and rehabilitation. As the field is quite young, recommendations on the use of SG in people with ND are still rare. In 2014 we proposed some initial recommendations (Robert et al., 2014). The aim of the present work was to update them, thanks to opinions gathered by experts in the field during an expert Delphi panel. Results confirmed that SG are adapted to elderly people with mild cognitive impairment (MCI) and dementia, and can be employed for several purposes, including assessment, stimulation, and improving wellbeing, with some differences depending on the population (e.g., physical stimulation may be better suited for people with MCI). SG are more adapted for use with trained caregivers (both at home and in clinical settings), with a frequency ranging from 2 to 4 times a week. Importantly, the target of SG, their frequency of use and the context in which they are played depend on the SG typology (e.g., Exergame, cognitive game), and should be personalized with the help of a clinician.

[Serious game, a link between institution and home]. / Le serious game, un lien entre institution et domicile.

Serious game is a personal innovative technology to facilitate learning and social interaction. It can be used in a patient's home or in an institution. This training tool can also be developed for health professionals, especially accommodation facilities for the elderly. The objective is to integrate knowledge and know-how.

Physical and Cognitive Stimulation Using an Exergame in Subjects with Normal Aging, Mild and Moderate Cognitive Impairment.

BACKGROUND: The use of Serious exerGames (SeG) as enriched environments (EE), which promotes cognitive simulation with physical activity in a positive emotional context, has been proposed to represent a powerful method to slow down the decline due to neurodegenerative diseases (ND), such as Alzheimer's disease (AD). However, so far, no SeG targeting EE has been tested in ND subjects. OBJECTIVE: This study aimed at evaluating the usability and short-term training effects of X-Torp, an action SeG designed for elderly ND subjects with mild cognitive impairment (MCI) and AD. METHODS: X-Torp is a SeG played using the Microsoft® Kinect™. 10 ND subjects and 8 healthy elderly controls (HEC) were enrolled in a 1-month program with three training sessions per week. Usability was evaluated through game time, game performance, the aerobic intensity level reached, perceived emotions, and perceived usability. RESULTS: All participants successfully completed the training program. ND subjects played less and had a lower game performance compared to HEC. During the sessions, ND subjects maintained a light intensity of aerobic activity, while HEC maintained a moderate intensity. Both groups experienced only positive emotions, and reported a 'moderate' to 'high' perceived competence, a 'moderate' game difficulty, and a 'high' interest in the game. CONCLUSION: Usability results suggest that X-Torp represents a usable EE for healthy subjects and persons with MCI and AD. However, in order to reach moderate or high intensity of aerobic activity, X-Torp control modes should be adapted to become more physically stimulating.

A Feasibility Study with Image-Based Rendered Virtual Reality in Patients with Mild Cognitive Impairment and Dementia.

Virtual Reality (VR) has emerged as a promising tool in many domains of therapy and rehabilitation, and has recently attracted the attention of researchers and clinicians working with elderly people with MCI, Alzheimer's disease and related disorders. Here we present a study testing the feasibility of using highly realistic image-based rendered VR with patients with MCI and dementia. We designed an attentional task to train selective and sustained attention, and we tested a VR and a paper version of this task in a single-session within-subjects design. Results showed that participants with MCI and dementia reported to be highly satisfied and interested in the task, and they reported high feelings of security, low discomfort, anxiety and fatigue. In addition, participants reported a preference for the VR condition compared to the paper condition, even if the task was more difficult. Interestingly, apathetic participants showed a preference for the VR condition stronger than that of non-apathetic participants. These findings suggest that VR-based training can be considered as an interesting tool to improve adherence to cognitive training in elderly people with cognitive impairment.

The Multilingual CID-5: A New Tool to Study the Perception of Communicative Interactions in Different Languages.

The investigation of the ability to perceive, recognize, and judge upon social intentions, such as communicative intentions, on the basis of body motion is a growing research area. Cross-cultural differences in ability to perceive and interpret biological motion, however, have been poorly investigated so far. Progress in this domain strongly depends on the availability of suitable stimulus material. In the present method paper, we describe the multilingual CID-5, an extension of the CID-5 database, allowing for the investigation of how non-conventional communicative gestures are classified and identified by speakers of different languages. The CID-5 database contains 14 communicative interactions and 7 non-communicative actions performed by couples of agents and presented as point-light displays. For each action, the database provides movie files with the point-light animation, text files with the 3-D spatial coordinates of the point-lights, and five different response alternatives. In the multilingual CID-5 the alternatives were translated into seven languages (Chinese, Dutch, English, French, German, Italian, and Polish). Preliminary data collected to assess the recognizability of the actions in the different languages suggest that, for most of the action stimuli, information presented in point-light displays is sufficient for the distinctive classification of the action as communicative vs. individual, as well as for identification of the specific communicative gesture performed by the actor in all the available languages.

Costs and benefits of tool-use on the perception of reachable space.

Previous studies have shown that using a tool modifies in a short time-scale both near-body space perception and arm-length representation in the body schema. However, to date no research has specifically investigated the effect of tool-use on an action-related perceptual task. We report here a study assessing the effect of tool-use on the perception of reachable space for perceptual estimates made in reference to either the tool or the hand. Using the tool on distal objects resulted in an extension of perceived reachable space with the tool and reduced the variability of reachability estimates. Tool use also extended perceived reachable space with the hand, but with a concomitant increase of the variability of reachability estimates. These findings suggest that tool incorporation into the represented arm following tool-use improves the anticipation of action possibilities with the tool, while hand representation becomes less accurate.

Embodied perception of reachable space: how do we manage threatening objects?

This study aimed at determining whether the size of reachable space is affected by the level of danger of some everyday manipulable objects. Two possibilities are examined: Dangerous objects affect the size of reachable space because of long-term semantic knowledge of their potential hurtful value or the on-line relation between objects' dangerous attributes and the body. The experimental paradigm combined the danger value (dangerous/not dangerous) and the orientation of objects (e.g. pointing away from/towards the perceiver). Reachability judgments measured the size of peripersonal space, and perception of objects' danger was estimated through questionnaires. Results revealed that, whatever the estimated level of objects' danger, the extent of peripersonal space was reduced when the threatening part of dangerous objects was oriented towards participants, not when oriented away. This suggests that the characteristics of the here and now body-objects interaction are crucial in affecting the boundary of peripersonal space.

Effect of visuomotor calibration and uncertainty on the perception of peripersonal space.

Target selection for action depends not only on the egocentric location of objects estimated from retinal and extraretinal variables, but also on the assessment of current action possibilities. In the present study, we investigated the effect of altering sensorimotor anticipation processes on subsequent perceptual estimates of reachability. To do so, we conducted two experiments in which we changed the relation between visual distance and movement amplitude. Experiment 1 showed that iterative visuomotor adaptation to distorted visual feedback (in steps of ±15 mm, up to a total adaptation of ±75 mm) led to a congruent variation of perceived reachable space, although the first introduction of the shifted visual feedback produced a reduction of perceived reachable space whatever the direction of the feedback shift. Experiment 2 showed that increasing uncertainty about visuomotor performances, by providing a visual feedback randomly shifted in depth (±7.5 mm), produced the same reduction of perceived reachable space in the absence of visuomotor adaptation. Taken together, these data suggest that the visual perception of reachable space depends on a motor-related perceptual system, which is affected by both visuomotor recalibration and reliability of the visuomotor system.