BioEd Online

If you're one of the many people who while away hours playing FreeCell, that heinously addictive and complicated version of Solitaire, you may be interested to hear that some researchers think your performance in this computerized card game might reveal early signs of dementia.

As Holly Jimison from the Oregon Center for Aging and Technology explains, scientists are looking for ways to spot mild loss of brain function, termed 'mild cognitive impairment' (MCI), before the full-blown symptoms of Alzheimer's disease emerge. This would allow doctors to plan their treatments earlier.

That's a tricky task. MCI is poorly defined: it is not clear, for example, how much memory impairment should be considered abnormal, nor whether measured MCI will lead to Alzheimer's disease. "Standard memory tests, brain imaging and biological markers are all currently being used. There are a lot of interesting data but no solid answers," says William Jagust, a neuroscientist from the University of California, Berkeley.

The Oregon researchers wanted to develop an unobtrusive continuous monitoring system that might reveal more reliable information than intensive, yearly memory check-ups. "We thought of using a suite of computer games," says Jimison. "So we interviewed elderly people, and FreeCell was by far their favourite. FreeCell requires a lot of mental planning to play, and it's cheap, non-invasive and fun."

Brainy bonanza

Nine senior citizens were chosen for a preliminary 3-week study. "They usually played 30-50 games a week and one subject played 660 games in 3 weeks," says Jimison. A computer algorithm judged the easiest way of completing each game, recalculating it after every card move, so the researchers could calculate the efficiency of each player.

The study results, presented at the 10th International Conference on Alzheimer's Disease and Related Disorders from 15 to 20 July in Madrid, Spain, showed that the three players who had already been diagnosed with MCI were less efficient than healthy players, and also showed less day-to-day consistency¹. However, three weeks was too short to spot any actual decline in game-playing efficiency.

"Amusing as it sounds, the basic idea is not so dissimilar from other kinds of tests that clinicians use to monitor cognitive decline," says Catherine Myers at Rutgers University in Newark, New Jersey. "The only question is: does it work?"

No one, not even the researchers involved, knows yet. Any statistically justifiable conclusions will have to wait until a planned study with 300 volunteers has been completed.

Everyday play

If the test works, it could be a more sensitive approach than current MCI tests. "The standard tests are performed irregularly," says Jimison. "The patients come in, they might be having a bad day, then might not be measured for another year. We look at continuous performance over time, and feel that we can tell the difference between, say, Alzheimer's and apathy."

The Oregon team are planning to test a whole battery of computer games, to see how well they correlate with cognitive function.

The next logical step is to see whether games such as FreeCell can improve brain function. The games company Nintendo already markets console games such as Brain Age and Dr Kawashima's Brain Training, which involve completing a daily series of quickfire puzzles, from arithmetic questions to spot-the-difference games. Each day, the player receives a 'brain age' assessment.

Mental-health researcher Deborah Barnes from the University of California, San Francisco, is well versed in the study of how computer exercises can enhance brain activity. "Computer games probably do improve cognitive function, but this improvement is likely to be very specific to the type of game played," she says. "It's unclear whether it will have any impact on day-to-day brain function or risk of dementia."

As for keeping your brain cells fit, "probably the best thing people can do is go out and get some exercise," recommends Jimison. But if you are stuck at your computer playing cards, it might be helpful to know that some FreeCell card layouts are in fact unsolvable. Trying to play those ones may be enough to drive anyone demented.

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