The limitations and challenges in the assessment of executive dysfunction associated with real-world functioning: The opportunity of serious games

Abstract

Nowadays, there is a broad range of methods for detecting and evaluating executive dysfunction ranging from clinical interview to neuropsychological evaluation. Nevertheless, a critical issue of these assessments is the lack of correspondence of the neuropsychological test’s results with real-world functioning. This paper proposes serious games as a new framework to improve the neuropsychological assessment of real-world functioning. We briefly discuss the contribution and limitations of current methods of evaluation of executive dysfunction (paper-and-pencil tests, naturalistic observation methods, and Information and Communications Technologies) to inform on daily life functioning. Then, we analyze what are the limitations of these methods to predict real-world performance: (1) A lack of appropriate instruments to investigate the complexity of real-world functioning, (2) the vast majority of neuropsychological tests assess well-structured tasks, and (3) measurement of behaviors are based on simplistic data collection and statistical analysis. This work shows how serious games offer an opportunity to develop more efficient tools to detect executive dysfunction in everyday life contexts. Serious games provide meaningful narrative stories and virtual or real environments that immerse the user in natural and social environments with social interactions. In those highly interactive game environments, the player needs to adapt his/her behavioral performance to novel and ill-structured tasks which are suited for collecting user interaction evidence. Serious games offer a novel opportunity to develop better tools to improve diagnosis of the executive dysfunction in everyday life contexts. However, more research is still needed to implement serious games in everyday clinical practice.

Keywords:

• Ecological validity
• executive function
• Information and Communications Technologies
• neuropsychological assessment
• real-world functioning
• serious game

Acknowledgments

We want to thank the reviewers for their valuable comments and suggestions, which helped us improve the manuscript’s quality.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

DM-P is partially supported by ANID/Fondecyt/11190507 & 1231839 and ANID / FONDEF / ID 22I10251 & ID 18I10113. BFM has been partially funded by Regional Government of Madrid (eMadrid S2018/TCS4307, co-funded by the European Structural Funds FSE and FEDER), the Telefonica-Complutense Chair on Serious Games and by the Ministry of Education (PID2020-119620RB-I00). AS is partially funded by ANID / FONDEF / ID 22I10251 & ID 18I10113; ANID/FONDAP/15150012, ANID/Fondecyt/1231839 ; ANID/PIA/Anillos ACT210096 and MULTI-PARTNER CONSORTIUM TO EXPAND DEMENTIA RESEARCH IN LATIN AMERICA [ReDLat, supported by National Institutes of Health, National Institutes of Aging (R01 AG057234), Alzheimer’s Association (SG-20-725707), Tau Consortium, and Global Brain Health Institute], and Alzheimer’s Association GBHI ALZ UK-20- 639295. LO is supported by ANID / FONDEF / ID 22I10251 & ID 18I10113 and ANID/PIA/Anillos ACT210096. AA, VC, SB, SG, JV & FH were partially supported by ANID / FONDEF / ID 18I10113. JV was partially funded by ANID/Fondecyt 1231122 and PIA/PUENTE AFB220003. MC & GF are partially supported by ANID / FONDEF / ID 22I10251. AI is partially supported by grants from CONICET; ANID/FONDECYT Regular (1210195 and 1210176 and 1220995); FONCYT-PICT 2017-1820; ANID/FONDAP/15150012; ANID/PIA/ANILLOS ACT210096; ANID/FONDEF ID 20I10152 and ID 22I10029, Takeda CW2680521; Alzheimer’s Association GBHI ALZ UK-20-639295; and the MULTI-PARTNER CONSORTIUM TO EXPAND DEMENTIA RESEARCH IN LATIN AMERICA [ReDLat, supported by National Institutes of Health, National Institutes of Aging (R01 AG057234), Alzheimer’s Association (SG-20-725707), Rainwater Charitable Foundation-Tau Consortium, and Global Brain Health Institute)]. The contents of this publication are solely the responsibility of the authors and do not represent the official views of these Institutions.