How Video Game Therapy Affects Thinking and Emotions in Older Adults With Cognitive Impairment

• Videogames masterclass (Procedure), also known as Golden Gamers Methodology: This masterclass sessions are carried out in small groups. It talks about the use of certain videogames and VR devices for improving the health of the participants. Each session begins with a simple introduction, and end with a short group reflection, and professionals record participation and responses to guide future sessions. The vidoegames that will be described and shown for the users experience are some that have a high degree of accesibility from the Golden Gamers Methodology perspective.
• Therapy with videogames (Procedure): Therapy sessions are carried out in small groups using adapted comercial videogames. Each session begins with a simple introduction, followed by gameplay with continuous support. Participants can engage in different ways (playing, assisting, or observing), depending on their needs. Sessions end with a short group reflection, and professionals record participation and responses to guide future sessions. There a lot of unique aspects for this approach. First, the use of comercial videogames for therapy, instead of serious games. Therefore, the whole process is guided by the Golden Gamers Methodology, specialiced in cognitive accesibility. The combination of this kind of videogames, with this adaptations in a senior population with cognitive impairment is totally different from other studies.

Primary outcomes

• Montreal Cognitive Assessment (MoCA) [General perception of the person's cognitive sphere (not session-specific), used at week 0 (baseline) and week 8 (post-intervention).]: Measures overall cognitive function (memory, attention, language, orientation, etc.). The total score ranges from 0 to 30 points. Higher scores indicate better cognitive performance. The standard administration guidance states that 26/30 or above is generally considered within the normal range, although cut-off points may vary depending on population, education level, age and clinical context.
• Observed Emotion Rating Scale (OERS) [Pre-intervention and post-intervention (up to 1 week)]: Measures emotional state during the sessions (positive and negative emotions observed).The OERS measures the intensity or duration of these affective states using a 5-point Likert-type scale. Each emotional state is rated separately, usually from 1 to 5. A higher score in pleasure is positive. A higher score in general alertness is usually positive or activation-related. Higher scores in anger, anxiety/fear or sadness indicate more negative affect.
• Menorah Park Engagement Scale (MPES) [Pre-intervention and post-intervention (up to 1 week)]: The adapted MPES assesses participant engagement during the activity using a 5-point duration scale aligned with the OERS. Observation takes place during the central 10 minutes of the session, from minute 15 to minute 25, to avoid start-up or fatigue bias. Each engagement category is scored according to the total accumulated time observed: 1 means the behaviour was never observed; 2 indicates a very brief occurrence; 3 indicates a short occurrence; 4 means the behaviour was observed for 1 to 5 minutes; and 5 means it was observed for more than 5 minutes. The categories assessed are constructive engagement, passive engagement, social engagement, non-engagement and self-engagement. If two behaviours occur at the same time, constructive engagement is prioritised.
• Quality of Life in Alzheimer's Disease (QoL-AD, proxy version) [General perception of the person's recent overall wellbeing (not session-specific), used at week 0 (baseline) and week 8 (post-intervention).]: The QoL-AD proxy version assesses perceived quality of life in people with cognitive impairment through the judgement of a caregiver, professional or informant who knows the participant well. It includes 13 items, each scored on a 4-point scale: 1 means poor, 2 means fair, 3 means good and 4 means excellent. The total score is obtained by adding the 13 item scores, giving a possible range from 13 to 52 points. Higher scores indicate better perceived quality of life.

Sex: All, ages: 65 Years to any

Inclusion Criteria:

* Older adults with mild to moderate cognitive impairment, able to connect with their environment and participate in group or individual activities, and who agree to take part in the study.

Exclusion Criteria:

* Severe cognitive impairment with lack of environmental awareness, serious visual limitations that prevent interaction, or any condition causing distress or making participation unsafe.

• Cristina García Bravo, PhD, Study chair, Universidad Rey Juan Carlos