Advanced digital platform to monitor, assess and train people with neurocognitive impairments

Advanced digital platform to monitor, assess and train people with neurocognitive impairments 1st Alessandro Provaggi Dibris University of Genoa Genoa, Italy alessandro.prov[email protected] 2nd Cecilia De Vicariis Dibris University of Genoa Genoa, Italy cecilia.de[email protected] 3nd Guido Rodriguez University of Genoa Genoa, Italy 4nd Emauele Micheli Scuola di Robotica Genoa, Italy [email protected] 5rd Maura Casadio Dibris University of Genoa Genoa, Italy [email protected] Abstract—Neurocognitive impairments encompass a spectrum of conditions that lead to deterioration of cognitive functions, with symptoms worsening over time, and impose significant physical, psychological, social, and economic burdens on patients, caregivers, and society. Early cognitive training and continuous monitoring have proven beneficial in slowing decline and supporting daily functioning. This project originates from the need for innovative technological tools to train, monitor, and assess the cognitive abilities of individuals with dementia. It introduces a tablet-based digital platform, designed according to a user-centered design approach, for cognitive training and assessment in individuals experiencing cognitive decline, that delivers gamified exercises across the six cognitive domains defined in the Diagnostic and Statistical Manual of Mental Disorders guidelines. The system integrate adaptive difficulty, performance monitoring, and the potential for multiplayer interaction, to promote engagement and provide longitudinal data for clinicians and caregivers. A preliminary beta version is under evaluation to assess usability, engagement, and clinical relevance. Index Terms—dementia, assessment, cognitive training, digital platform, user centered design I. INTRODUCTION Neurocognitive disorders are a collection of syndromes that lead to the deterioration of cognitive functions (i.e. problemsolving and decision-making), often accompanied by changes in mood, behavior, or motivation [1]. According to the World Health Organization (WHO), more than 55 million people worldwide are affected by dementia, a number that is expected to rise exponentially, mainly due to population ageing, and represent one of the most pressing healthcare challenges of our time. Early detection is essential to enable interventions that delay decline and improve quality of life [2], and assistive and training technologies play a central role in preserving cognitive abilities and slowing symptom progression by enhancing independence, optimizing symptom management, stimulating cognition, and reducing healthcare burden [3]. Traditional clinical assessments (e.g., MMSE, MoCA) remain the standard for diagnosis but are limited by their subjective nature, often detecting impairment only after significant neurodegeneration has occurred [4]. In contrast, digital platforms provide a promising alternative, enabling continuous monitoring, scalable deployment, and adaptive interventions [5]. This project introduces a tablet-based, user-friendly application that serves a dual purpose: as a monitoring and early detection tool for clinicians and caregivers, and as a training system designed to preserve cognitive functions and slow the progression in individuals with mild cognitive impairment or early-stage dementia. Following a User-Centered Design methodology, the platform is iteratively refined through feedback from end users, caregivers, and clinicians. The system aims to deliver longitudinal data for patients and clinicians, and represents a turning point in dementia care, fostering a new era of early-stage detection and preventive medicine. II. MATERIALS AND METHODS A. Platform design Games are played on tablets to maximize accessibility, avoiding the usability issues of PC applications. Users access a main menu displaying interactive icons representing available games, and each activity includes a detailed instruction sheet to support independent use. The user interface is designed to be simple and accessible, allowing individuals with limited digital literacy to easily navigate exercises. Players are allowed to pause the activities at any time and return to the main activity menu, allowing them to stop the current task and select a different game if desired. This feature is intended to reduce potential stress and anxiety. 2025 I-RIM Conference October 17-19, Rome, Italy ISBN: 9788894580570 10.5281/zenodo.17629812 183 B. Platform development The application is developed using Unity 3d and C#, ensuring cross-platform deployment on both Android and iOS tablets. The platform features a diverse set of gamified activities tailored to different levels of cognitive abilities. The games are designed with adjustable difficulty settings, allowing users to select activities that best match their preferences and cognitive capacities, fostering motivation and sustained participation over time. The difficulty levels follow a progressive adaptation model, in which players start from an easy level and advance as they consistently achieve correct responses. C. Game Protocol The developed activities involve all six cognitive domains - complex attention, executive functioning, short-term memory, language, perceptual-motor skills, and social cognition - either individually or in combination. Examples include mathematical recognition tasks (attention), word-image association (language), and emotional state recognition (social cognition). D. Data saving Given the impossibility to ensure that each user has internet access, the application will operate in offline mode, storing data locally in .json files on individual devices. Whenever a network connection is available, data will be automatically uploaded to a private server accessible only to the research team. The recorded data will include the number of logins and the time spent on the platform during each session, enabling evaluation of the platform’s usability. Other parameters will include performance metrics, such as the number of correct and incorrect responses and the average execution time, to monitor user progress and to identify strengths and weaknesses across specific cognitive domains. Given the involvement of a vulnerable population, the study will follow rigorous ethical and privacy standards in compliance with General Data Protection Regulation (GDPR). Data will be anonymized, securely encrypted, and collected with informed consent to ensure participant confidentiality and research integrity. E. Study Design A beta version including approximately 20 games will undergo a 6–8 week pilot study to evaluate usability, engagement, and accessibility. This phase will involve 10-15 participants in the early stages of dementia. If users are unable to complete the tasks autonomously and/or when caregiver assistance is required, such support will be allowed but monitored through specific questionnaires. Following, based on the recorded parameters and the feedback obtained from usability questionnaires, modifications will be implemented to improve and enhance the user experience and accessibility of the application. A subsequent clinical testing phase will begin, during which participants will be monitored in their use of the platform over an approximately 12-month period. Cognitive outcomes, assessed through standardized cognitive tests, will then be compared with those of a control group that will not be provided with a tablet containing the application. This phase will involve 15 control subjects and 15 people in the early stages of dementia. Participants presenting with severe sensory, motor, or psychiatric conditions that could interfere with their ability to perform the proposed tasks will be excluded from the study. III. RESULTS AND CONCLUSIONS The developed platform will collect a set of usability and performance data to evaluate both the effectiveness of the cognitive training platform and its impact on users’ daily functioning. In addition to in-game metrics, two complementary evaluation approaches will be applied: •Questionnaires will be administered to both users and their caregivers at the beginning and end of the testing period to assess the usability of the platform and the overall user experience, including perceived changes, positive or negative, in cognitive abilities, mood, or capacity to perform daily activities. •Standardized cognitive assessments (such as the MoCA and MMSE) will be administered at baseline, mid-point, and at the end of the trial to provide objective reference scores that can be correlated with in-game performance outcomes. By combining subjective feedback, clinical test results, and detailed digital performance metrics, the project aims to evaluate the platform’s usability, its capacity to stimulate specific cognitive domains, and its potential as a long-term tool for cognitive training and early detection of cognitive decline. REFERENCES [1] M. Guerriero Austrom, C. B. Johnson, D. F. Rexroth, and F. W. Unverzagt, “Neurocognitive disorders,” in *APA handbook of clinical psychology: Psychopathology and health*, Vol. 4, Washington, DC, USA: American Psychological Association, 2016, pp. 253–271. [2] C. Henkel, S. Seibert, and C. N. Widmann, “Current advances in computerized cognitive assessment for mild cognitive impairment and dementia in older adults: A systematic review,” *Dementia and Geriatric Cognitive Disorders*, vol. 54, no. 2, pp. 109–119, Sept. 2024. [3] M. L. Fotteler, V. M¨ uhlbauer, S. Brefka, S. Mayer, B. Kohn, F. Holl, W. Swoboda, P. Gaugisch, B. Risch, M. Denkinger, and D. Dallmeier, “The effectiveness of assistive technologies for older adults and the influence of frailty: Systematic literature review of randomized controlled trials,” *JMIR Aging*, vol. 5, no. 2, pp. e31916, Apr. 2022. [4] I. Arevalo-Rodriguez *et al.*, “Mini-Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI),” *Cochrane Database of Systematic Reviews*, vol. 7, pp. CD010783, July 2021. [5] A. M. Staffaroni, E. Tsoy, J. Taylor, A. L. Boxer, and K. L. Possin, “Digital cognitive assessments for dementia: Digital assessments may enhance the efficiency of evaluations in neurology and other clinics,” *Practical Neurology (Fort Washington, Pa.)*, vol. 2020, pp. 24–45, 2020. 184