Cognitive Games and Assessments

mindLAMP offers a variety of neurocognitive assessments in the form of games, which are native to the app. These will show up on the Assess page of the app, and performance scores can be displayed on the Prevent page.

Balloon Risk

Balloon Risk, or the Balloon Analog Risk Task (BART) is a computerized risk-reward assessment task (1). The BART has shown to be significantly correlated to self report scores on risk related constructs such as sensation seeking, impulsivity and behavioral constraint, as well as real world risk behaviors such as drug use, gambling, and sexually risky behavior (1, 2, 3). The Users must tap to inflate a balloon to the largest possible size without it bursting. The task has been successfully used as a computerized assessment for risk-taking behavior. Every time the participant taps the balloon their potential points will increase. Every time they hit ‘collect points’, those points are added to the total. However, if the balloon is pumped too much, the balloon will pop. The number of points at which the balloon pops will change with each game.

References

1. Lejuez, C. W., Read, J. P., Kahler, C. W., Richards, J. B., Ramsey, S. E., Stuart, G. L., ... & Brown, R. A. (2002). Evaluation of a behavioral measure of risk taking: the Balloon Analogue Risk Task (BART). Journal of Experimental Psychology: Applied, 8(2), 75. DOI: 10.1037//1076-898X.8.2.75
2. Hunt, M. K., Hopko, D. R., Bare, R., Lejuez, C. W., & Robinson, E. V. (2005). Construct validity of the balloon analog risk task (BART) associations with psychopathy and impulsivity. Assessment, 12(4), 416-428. DOI: 10.1177/1073191105278740
3. Lauriola, M., Panno, A., Levin, I. P., & Lejuez, C. W. (2014). Individual differences in risky decision making: A meta‐analysis of sensation seeking and impulsivity with the balloon analogue risk task. Journal of Behavioral Decision Making, 27(1), 20-36. DOI: 10.1002/bdm.1784

Sample Game Play

Customizations

Balloon Count: This will change the number of balloon trials required to complete the task.

Breakpoint Mean and Standard Deviation: The task can be customized to alter the mean number of taps required to burst the balloon, as well as the standard deviation for the number of taps required. These can be used to adjust the level of risk.

Scoring

Participants are given points based on the number of taps they made before they stopped inflating the balloon, or no points if the balloon burst.

Sample Instructions

Tap the button to 'Pump Up Balloon' to inflate it as large as you can, before the balloon bursts. When you feel like you can't inflate it anymore without it bursting, tap the button to 'Collect Points'. The number of times you pumped up the balloon will be equal to the number of points you get. If the balloon bursts, you get no points!

Cats and Dogs

Cats and Dogs is a digital task, originally developed for the assessment of early stage Parkinson's disease, which tests multiple domains at once: visual and working memory, attention, response control, and set-shifting (1). Users must remember the location of multiple stimuli, remember which stimuli to respond to and which to ignore, reproduce the location of the response stimuli from memory, and switch between which stimuli to pay attention to.

In this task, participants are first shown a pattern of boxes. The boxes temporarily lift, to reveal the image of a dog or a cat behind some of them. Participants are asked to select the boxes which a cat or dog behind them. At higher levels, participants must switch whether to respond to the the cat or the dog.

The cat and dog cues assess response control and set-shifting as go/no-go stimuli: participants must respond to one, but not the other, and then change which to respond to and which to ignore when instructed.

The animal stimuli and the box together assess visual memory, working memory, and attention: each cue is only briefly visible 'behind' the boxes, so participants must attend to the cues, remember the position of each stimulus, and then recall the position to select the correct boxes. They must also remember increasingly more cues at each subsequent trial within a level.

References

1. Weil, R. S., Pappa, K., Schade, R. N., Schrag, A. E., Bahrami, B., Schwarzkopf, D. S., ... & Morris, H. R. (2017). The cats‐and‐dogs test: a tool to identify visuoperceptual deficits in Parkinson's disease. Movement Disorders, 32(12), 1789-1790. DOI: 10.1002/mds.27176.

Sample Game Play

Trial 1

Trial 2

Examples of Rule Changes at Subsequent Levels

Customization

The game automatically progresses as levels are completed. There are no researcher-defined customizations necessary.

Scoring

Scoring is based on the number of correct boxes selected within the timeframe of the game.

Sample Instructions

"In this game, you will see a screen with many boxes. These boxes will 'lift', revealing either a dog, cat, or nothing behind them. Your task is to tap the correct boxes, based on what is behind each box. The instructions for which boxes are correct will change depending on the level, so pay attention to the animals!"

Digit Symbol Substitution Test

The symbol-digit substitution task has been used to evaluate motor speed, attention, associative thinking (1). Initially developed as part of the Wechsler Adult Intelligence Scale and later digitized, the task is one of the most frequently used assessment in neuropsychological testing (1, 2, 3). The measure has shown to be valid and sensitive to change in major depressive disorder, age related cognitive decline, alcoholism and a variety of other conditions (3). Participants are shown a series of symbols (greek letter). They are also shown a grid which maps various symbols to digits (digits shown are 1-9). For each successive symbol, participants are required to press the button containing the corresponding digit. Example: Participant is shown greek letter α. According to the map, α corresponds to "4". The participant then selects the "4" button.

References

1. Wechsler, D. (1955). Wechsler adult intelligence scale--. Archives of Clinical Neuropsychology. DOI: 10.1037/t15169-000
2. McLeod, D. R., Griffiths, R. R., Bigelow, G. E., & Yingling, J. (1982). An automated version of the digit symbol substitution test (DSST). Behavior Research Methods & Instrumentation, 14(5), 463-466. DOI: 10.3758/BF03203313
3. Jaeger, J. (2018). Digit symbol substitution test: the case for sensitivity over specificity in neuropsychological testing. Journal of clinical psychopharmacology, 38(5), 513. DOI: 10.1097/JCP.0000000000000941

Sample Game Play

Game begins with a symbol to map (greek letter). Select the correct mapped digit (1-9) to continue. Participant must keep making attempts until correct symbol is chosen. Example: Participant is shown Ɛ. Ɛ is mapped to "2". Participant must select "2". The symbols will be matched to different numbers in different rounds of the game.

Customizations

Number of symbols: The researcher can choose the number of symbols to appear

Duration: The number of seconds the task will last

Scoring

Participants are scored according to the total number of correct symbols pressed given the timeframe.

Sample Instructions

In this game, you will be shown a symbol in the center of the screen. This symbol will correspond to a number. Check the symbol-mapping shown at the top of the screen and look for your symbol. Identify the symbol which corresponds to your symbol. Once you find the corresponding symbol, select the corresponding number at the bottom of the screen. After you make the correct selection, you will move on to a new symbol, and the process will repeat until time runs out. The faster you move, the more points you will accrue.

Emotion Recognition

The emotion recognition task is designed to allow researchers to upload up to 50 pictures of faces and test whether the user can select the emotion that each image represents from a preset list of emotions (namely, happiness, sadness, fear, anger, and neutral). When a user takes this assessment, they are presented with a random subset of 10 images from the images provided by the researchers. If the researchers provided fewer than 10 images, all images will be displayed in a random order. To progress through this assessment, participants first click on the emotion they feel best applies to the image and then on "Save" to move onto the next question.

Sample game play

The user progresses through a series of up to 10 screens in which they are presented with an image and must select the corresponding emotion from a list of options.

Customizations

Researchers must provide a dataset of up to 50 facial images for the emotion recognition and assign each image with the appropriate emotion. Currently, the emotions that can be assigned to an image are restricted to happiness, sadness, fear, anger, and neutral.

Scoring

Participants are scored by whether they correctly identified the emotion expressed by the image or not.

Sample Instructions

In this task you will be presented with up to 10 facial images and asked to identify the emotion expressed by each one from a list of 5 emotions.

Jewels

Jewels replicates the Trail Making Tests, in which participants are asked to sequentially select numbered jewels in the correct ascending order.

The Trail Making Test, with its two subtypes A and B, typically used to screen for dementia and assess cognition. It evaluates visual and motor abilities, executive functioning, and set shifting (1). Evidence suggests that digital and computerized version of the pen-and-paper Trail Making Test reliably assess the same cognitive domains. (2, 3, 4). Trails A requires a patient to make a 'trail' connecting numbered circles, placed randomly on a single page, in ascending order. Trails B requires a patient to make a similar trail, but alternate between numbered and alphabetized circles.

mindLAMP offers its own digitized version of both version of the Trail Making Test, called Jewels. Here, the numbered circles are replaced by numbered jewels in both Jewels A and B. For Jewels B, instead of having alternating numbers and alphabets, the sets alternate between two differently shaped jewels. participants must select jewels starting from 1 in ascending order, within a given time limit. Participants are indicated which jewel shape they must begin at number 1 with. Here is an example of both Jewels A and B.

References

1. Soo-Yong Park & Nadja Schott (2021) The trail-making-test: Comparison between paper-and-pencil and computerized versions in young and healthy older adults, Applied Neuropsychology: Adult, DOI: 10.1080/23279095.2020.1864374 https://doi.org/10.1080/23279095.2020.1864374
2. Chanda Simfukwe, Young Chul Youn, Sang Yun Kim & Seong Soo An (2021) Digital trail making test-black and white: Normal vs MCI, Applied Neuropsychology: Adult, DOI: 10.1080/23279095.2021.1871615 https://doi.org/10.1080/23279095.2021.1871615
3. Magdalene R. Bracken, Anya Mazur-Mosiewicz & Kuba Glazek (2019) Trail Making Test: Comparison of paper-and-pencil and electronic versions, Applied Neuropsychology: Adult, 26:6, 522-532, DOI: 10.1080/23279095.2018.1460371 https://doi.org/10.1080/23279095.2018.1460371
4. Robert P. Fellows, Jessamyn Dahmen, Diane Cook & Maureen Schmitter-Edgecombe (2017) Multicomponent analysis of a digital Trail Making Test, The Clinical Neuropsychologist, 31:1, 154-167, DOI: 10.1080/13854046.2016.1238510 https://doi.org/10.1080/13854046.2016.1238510

Jewels A and B Sample Game Play

Customization

The digitized version offers the opportunity to customize Jewels, using the Activity settings:

1. Variant: Here, clinicians and researchers can define which Variant, A or B, they would like patients to play.
2. Mode: The game can be played at four different difficulty modes - Beginner, Intermediate, Advanced, or Expert. Clinicians can customize which difficulty mode they would like patients to play, by selecting from the Mode category. a. Each mode varies by the Duration the player has to complete the trail. This can also be changed for each mode, by changing the various Durations, in seconds.
3. Initial Diamond Count: This can be used to determine the number of jewels that appear at the Level 1, the maximum is 25.
4. Initial Shape Count: If so desired, the game can present not 1 or 2 different shapes of jewels, as it would for Trails A and B respectively, but any number of shapes.
5. Bonus points: As an additional gamification strategy, bonus points can be awarded for each level completed.

For more advanced settings, please contact our research team for assistance.

Scoring

Scoring for both Jewels variants are out of a 100, with each incorrect jewel earning -2 point

Sample Instructions

Sample Instructions, Jewels A: "Tap the jewels in chronological order, starting with number 1."

Sample Instructions, Jewels B: "Look at the bottom of the screen to see which jewel to collect first. Tap number of 1 of that shape, and then number 1 of the second shape. Continue alternating the jewel pattern in chronological order until all of the jewels have been collected."

Maze Task

The Maze task can be used to measure motor control, and spatial problem solving. Though there is not a gold standard model, digital maze games have been utilized in the assessment of visual cognition and problem solving in individuals with neurodegenerative disorders, brain injury, and schizophrenia (1, 2, 3). Participants can tilt their phone to move the ball and exit the maze. The first level starts with one ball and two rings, and the difficulty increases with each level (more balls, more intricate puzzle designs).

References

1. Jin, R., Pilozzi, A., & Huang, X. (2020). Current cognition tests, potential virtual reality applications, and serious games in cognitive assessment and non-pharmacological therapy for neurocognitive disorders. Journal of Clinical Medicine, 9(10), 3287. DOI: 10.3390/jcm9103287
2. Livingstone, S. A., & Skelton, R. W. (2007). Virtual environment navigation tasks and the assessment of cognitive deficits in individuals with brain injury. Behavioural brain research, 185(1), 21-31. DOI: 10.1016/j.bbr.2007.07.015
3. Wilkins, L. K., Girard, T. A., Herdman, K. A., Christensen, B. K., King, J., Kiang, M., & Bohbot, V. D. (2017). Hippocampal activation and memory performance in schizophrenia depend on strategy use in a virtual maze. Psychiatry Research: Neuroimaging, 268, 1-8. DOI: 10.1016/j.pscychresns.2017.07.007

Sample Game Play

Customizations

The game automatically progresses as levels are completed. There are no researcher-defined customizations necessary.

Scoring

Participants are scored by the time taken to complete each level as well as the number of levels completed.

Sample Instructions

In this game, you can tilt your phone to control a small ball seen on your screen. Try to navigate the ball out of the center of the maze and into the open space. The faster you escape, the more points you will accrue.

Pop the Bubbles

Pop the Bubbles is a go/no-go task that can measure sustained attention and response control. Go/no-go tasks typically require a response to one stimulus, and response inhibition to another stimulus.

mindLAMP offers a task with multiple stimuli in the form of bubbles, which participants must 'pop' or ignore. Participants must pay attention the rules for each level to know which bubbles to pop and which to ignore. In addition to color-based responses, higher levels also demand pattern-based responses.

Sample Game Play

Examples of Rule Changes at Subsequent Levels

Customization

The task can be customized by the clinician or researcher in the Activity settings, to adjust the speed at which each bubble is presented, the number of bubbles shown for a given level, and the duration between bubbles.

Scoring

Final scores on based on the percentage of bubbles successfully popped, the percentage of incorrectly missed bubbles, the percentage of correctly-ignored bubbles and the percentage of incorrectly popped bubbles, as shown below:

Sample Instructions

"In this game, you will see lots of different colored bubbles, one at a time. Your task is to "pop" the correctly colored bubbles, while ignoring the incorrect ones. Pay attention to the instructions for each level to know which colored bubbles you should tap, and which ones you should ignore. Your score is based on the percentage of balloons shown that you correctly tapped, minus the percentage of balloons shown that you incorrectly tapped, with a perfect score being 100%."

Spatial Span

Spatial Span is a task that assess visuospatial memory, derived from a computerized spatial span test, and iterating upon the commonly used Corsi Block Test and Wechsler Spatial Span tests (1). Spatial span assessments have been used in a variety of populations, including idividuals with autism, psychosis, and depression (2, 3, 4). In this game, white squares are arranged in a grid. Squares will 'light up' or change color to green, and then return to white, one square at a time. Participants are required to recall and reproduce the order in which squares in the grid light up. The task can be customized such that the patterns must be reproduced in the same order as cued, or in reverse of the order cued. At every subsequent level, the number of squares that light up increases.

The recall and reproduce task requires the visuospatial working memory. The backward variation also measures working memory, as some processing must be done before reproducing the pattern. Finally, the increasing number of squares to remember measures memory capacity.

References

1. Woods, D. L., Wyma, J. M., Herron, T. J., & Yund, E. W. (2016). An improved spatial span test of visuospatial memory. Memory, 24(8), 1142-1155. DOI: 10.1080/09658211.2015.1076849
2. Wang, Y., Zhang, Y. B., Liu, L. L., Cui, J. F., Wang, J., Shum, D. H., ... & Chan, R. C. (2017). A meta-analysis of working memory impairments in autism spectrum disorders. Neuropsychology review, 27, 46-61. DOI: 10.1007/s11065-016-9336-y
3. Sheffield, J. M., Karcher, N. R., & Barch, D. M. (2018). Cognitive deficits in psychotic disorders: a lifespan perspective. Neuropsychology review, 28, 509-533. DOI: 10.1007/s11065-018-9388-2
4. Douglas, K. M., Gallagher, P., Robinson, L. J., Carter, J. D., McIntosh, V. V., Frampton, C. M., ... & Porter, R. J. (2018). Prevalence of cognitive impairment in major depression and bipolar disorder. Bipolar disorders, 20(3), 260-274. DOI: 10.1111/bdi.12602

Sample Game Play

Forward Spatial Span

Level 1

Level 2

Backward Spatial Span

Level 1

Level 2

Scoring

Total score is based on how many times participants can correctly complete the task within the time limit at the top of the screen, with six possible levels.

Customization

Each trial allows the user to play 5 levels as a default. Researchers and clinicians can designate whether the game is to be ordered Forward or Backward.

Sample Instructions

Forward Spatial Span: "You will see a grid of boxes. The boxes in a grid will light up in a certain order. Remember that order, and then tap the boxes in the same order in which they lit up. Each level will have more boxes light up in the sequence. See how far you can get!"

Backwards Spatial Span: "You will see a grid of boxes. The boxes in a grid will light up in a certain order. Remember that order, and then tap the boxes in the REVERSE order in which they lit up. Each level will have more boxes light up in the sequence. See how far you can get!"

Spin the Wheel

Spin the Wheel is based on the Iowa Gambling Task that aims to measure decision-making and risk-taking behavior (1). The Iowa Gambling Task has been effectively used in studying clinical conditions such as substance abuse, pathological gambling, and schizophrenia (2). The task has been effectively computerized, with no discernable difference between digital and analogue versions (2, 3). The game presents the user with a wheel that can be spun by selecting one of four buttons at the bottom of the screen. Each spin can result in a win or loss of money, and the total amount remaining is displayed at the top of the screen. Participants start with $2000 and have 20 spins per game by default.

References

1. Bechara, A., Damasio, A. R., Damasio, H., & Anderson, S. W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50(1-3), 7-15. DOI: 10.1016/0010-0277(94)90018-3
2. Bechara A. (2007). Iowa Gambling Task Professional Manual. Version 1, ed Raton B. (Lutz: Psychological Assessment Resources, Inc.).
3. Bowman, C. H., Evans, C. E. Y., & Turnbull, O. H. (2005). Artificial time constraints on the Iowa gambling task: the effects of behavioural performance and subjective experience. Brain and Cognition, 57, 21–25. DOI: 10.1016/j.bandc.2004.08.015

Spin the Wheel Sample Game Play

Customization

The task can be customized by the clinician or researcher in the Activity settings, to adjust the number of spins each game and the probability of the wheels stopping at different amounts to create different risk levels.

Scoring

Player score is represented by the amount of money held at the end of a 20 spin game.

Sample Instructions

"The game presents you with two wheels that can be spun by selecting one of four buttons at the bottom of the screen. The colors of the buttons do not correspond to the colors on the wheel. Each spin can result in a win or loss of money, with the wheel at the top displaying the money you won and the bottom displaying the money lost. The total amount remaining is displayed at the top of the screen. You start with $2000 and have 20 spins per game by default. Points at the end of a session are represented in the amount of money you have."