Augmented Reality Cubes for Cognitive Gaming: Preliminary Usability and Game Experience Testing


  • Costas Boletsis Gjøvik University College
  • Simon McCallum Gjøvik University College



Augmented Reality, cognitive screening, cognitive training, dementia


Early detection is important in dementia care; however, cognitive impairment is still under-recognised and under-diagnosed. Cognitive screening and training are two important preventative treatments, which can lead to early detection of cognitive decline. In this work, the “Cognitive Augmented Reality Cubes” (CogARC) system is presented, i.e. a serious game for cognitive training and screening, utilising an interaction technique based on Augmented Reality and the manipulation of tangible, physical objects (cubes). The game is a collection of cognitive mini-games of preventative nature and is, primarily, targeting elderly players (?60 years old). A preliminary testing was conducted focusing on the game experience that CogARC offers (utilising the In-Game Experience Questionnaire), the usability of the system (using the System Usability Scale), and the specific user observations and remarks, as documented by open, semi-structured interviews.  Overall, CogARC demonstrated satisfying positive responses, however, the negative reactions indicated that there are specific problems with aspects of the interaction technique and a number of mini-games. The open interview shed more light on the specific issues of each mini-game and further interpretation of user interactions. The current study managed to provide interesting insights into the game design elements, integration of Augmented Reality, tangible interaction of the system, and on how elderly players perceive and use those interaction components. 


[1] Persson, J., Nyberg, L., Lind, J., Larsson, A., Nilsson, L., Ingvar, M., Buckner, R. "Structure–Function Correlates of Cognitive Decline in Aging." Cerebral Cortex 16, no. 7 (2006): 907-915.
[2] Boletsis, C. , McCallum, S. "Connecting the Player to the Doctor: Utilising Serious Games for Cognitive Training & Screening." DAIMI PB 597 (2015): 5-8.
[3] Prince, M., Bryce, R., Ferri, C. World Alzheimer Report 2011: The Benefits of Early Diagnosis and Intervention. London (UK): Alzheimer's Disease International (ADI), 2011.
[4] Waldemar, G., Phung, K., Burns, A., Georges, J., Hansen, F., Iliffe, S., Marking, C., Rikkert, M., Selmes, J., Stoppe, G., Sartorius, N. "Access to Diagnostic Evaluation and Treatment for Dementia in Europe." International Journal of Geriatric Psychiatry 22, no. 1 (2007): 47-54.
[5] Connolly, A., Gaehl, E., Martin, H., Morris, J., Purandare, N. "Underdiagnosis of Dementia in Primary Care: Variations in the Observed Prevalence and Comparisons to the Expected Prevalence." Aging & Mental Health 15, no. 8 (2011): 978-984.
[6] Scanlon, L., O'Shea, E., O'Caoimh, R., Timmons, S. "Usability and Validity of a Battery of Computerised Cognitive Screening Tests for Detecting Cognitive Impairment." Gerontology [Epub ahead of print] (Jun 24 2015).
[7] Lopponen, M., Raiha, I., Isoaho, R., Vahlberg, T., Kivela, S. L. "Diagnosing Cognitive Impairment and Dementia in Primary Health Care -- a More Active Approach Is Needed." Age Ageing 32, no. 6 (2003): 606-612.
[8] Boustani, M., Callahan, C., Unverzagt, F., Austrom, M., Perkins, A., Fultz, B., Hui, S., Hendrie, H. "Implementing a Screening and Diagnosis Program for Dementia in Primary Care." Journal of General Internal Medicine 20, no. 7 (2005): 572-577.
[9] Ismail, Z., Rajji, T., Shulman, K. "Brief Cognitive Screening Instruments: An Update." International Journal of Geriatric Psychiatry 25, no. 2 (2010): 111-120.
[10] Clionsky, M., Clionsky, E. "Dementia Screening: Saying No to the Uspstf and Yes to Brief Cognitive Evaluation." Journal of Alzheimers Disease & Parkinsonism 4 (2014): e132.
[11] Workman, B., Dickson, F., Green, S. "Early Dementia--Optimal Management in General Practice." Australian Family Physician 39, no. 10 (2010): 722-726.
[12] Williams, K., Kemper, S. "Exploring Interventions to Reduce Cognitive Decline in Aging." Journal of psychosocial nursing and mental health services 48, no. 5 (2010): 42-51.
[13] Fernández-Ballesteros, R., Botella, J., Zamarrón, M., Molina, M., Cabras, E., Schettini, R., Tárraga, L. "Cognitive Plasticity in Normal and Pathological Aging." Clinical Interventions in Aging 7 (2012): 15-25.
[14] Bouchard, B., Imbeault, F., Bouzouane, A., Menelas, B. "Developing Serious Games Specifically Adapted to People Suffering from Alzheimer." Chap. 21 In Serious Games Development and Applications. Lecture Notes in Computer Science, 243-254: Springer Berlin Heidelberg, 2012.
[15] Robert, P., König, A., Amieva, H., Andrieu, S., Bremond, F., Bullock, R., Ceccaldi, M., Dubois, B., Gauthier, S., Kenigsberg, P., Nave, S., Orgogozo, J., Piano, J., Benoit, M., Touchon, J., Vellas, B., Yesavage, J., Manera, V. "Recommendations for the Use of Serious Games in People with Alzheimer's Disease, Related Disorders and Frailty." Frontiers in Aging Neuroscience 6 (2014): 54.
[16] McCallum, S. "Gamification and Serious Games for Personalized Health." Studies in Health Technology and Informatics 177 (2012): 85-96.
[17] Kato, P. "Video Games in Health Care: Closing the Gap." Review of General Psychology 14, no. 2 (2010): 113-121.
[18] Ninaus, M., Pereira, G., Stefitz, R., Prada, R., Paiva, A., Neuper, C., Wood, G. "Game Elements Improve Performance in a Working Memory Training Task." International Journal of Serious Games 2, no. 1 (2015): 3-16.
[19] Boletsis, C. , McCallum, S. "Augmented Reality Cube Game for Cognitive Training: An Interaction Study." Studies in Health Technology and Informatics 200 (2014): 81-87.
[20] Kato, P. "Evaluating Efficacy and Validating Games for Health." Games for Health Journal 1, no. 1 (2012): 74-76.
[21] Gold, S., Wolfe, J. "The Validity and Effectiveness of a Business Game Beta Test." Simulation & Gaming 43, no. 4 (2012): 481-505.
[22] Baranowski, T., Buday, R., Thompson, D., Lyons, E., Lu, A., Baranowski, J. "Developing Games for Health Behavior Change: Getting Started." Games For Health Journal 2, no. 4 (2013): 183-190.
[23] Farage, M., Miller, K., Ajayi, F., Hutchins, D. "Design Principles to Accommodate Older Adults." Global journal of health science 4, no. 2 (2012): p2.
[24] Ijsselsteijn, W., Nap, H., Kort, Y. de, Poels, K. "Digital Game Design for Elderly Users." In Proceedings of the 2007 conference on Future Play, 17-22, 2007.
[25] Gerling, K., Schulte, F., Masuch, M. "Designing and Evaluating Digital Games for Frail Elderly Persons." In Proceedings of the 8th International Conference on Advances in Computer Entertainment Technology, 1-8, 2011.
[26] Gregor, P., A.Newell. "Designing for Dynamic Diversity: Making Accessible Interfaces for Older People." In Proceedings of the 2001 EC/NSF workshop on Universal accessibility of ubiquitous computing: providing for the elderly, 90-92, 2001.
[27] McCallum, S., Boletsis, C. "Augmented Reality & Gesture-Based Architecture in Games for the Elderly." Studies in Health Technology and Informatics 189 (2013): 139-144.
[28] Nasreddine, Z., Phillips, N., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J., Chertkow, H. "The Montreal Cognitive Assessment, Moca: A Brief Screening Tool for Mild Cognitive Impairment." Journal of the American Geriatrics Society 53, no. 4 (2005): 695-699.
[29] Folstein, M., Folstein, S., McHugh, P. "“Mini-Mental State”: A Practical Method for Grading the Cognitive State of Patients for the Clinician." Journal of Psychiatric Research 12, no. 3 (1975): 189-198.
[30] Kluger, A., Gianutsos, J., Golomb, J., Ferris, S., George, A., Franssen, E., Reisberg, B. "Patterns of Motor Impairment in Normal Aging, Mild Cognitive Decline, and Early Alzheimer's Disease." The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 52, no. 1 (1997): P28-P39.
[31] Flores, E., Tobon, G., Cavallaro, E., Cavallaro, F. I., Perry, J. C., Keller, T. "Improving Patient Motivation in Game Development for Motor Deficit Rehabilitation." In Proceedings of the 2008 International Conference on Advances in Computer Entertainment Technology, 381-384, 2008.
[32] Gerling, K., Schild, J., Masuch, M. "Exergame Design for Elderly Users: The Case Study of Silverbalance." In Proceedings of the 7th International Conference on Advances in Computer Entertainment Technology, 66-69, 2010.
[33] Sharlin, E., Itoh, Y., Watson, B., Kitamura, Y., Sutphen, S., Liu, L. "Cognitive Cubes: A Tangible User Interface for Cognitive Assessment." In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, 347-354, 2002.
[34] Neistadt, M. "A Critical Analysis of Occupational Therapy Approaches for Perceptual Deficits in Adults with Brain Injury." The American Journal of Occupational Therapy 44, no. 4 (1990): 299-304.
[35] Gamberini, L., Fabregat, M., Spagnolli, A., Prontu, L., Seraglia, B., Alcaniz, M., Zimmerman, A., Rontti, T., Grant, J., Jensen, R., Gonzales, A. "Eldergames: Videogames for Empowering, Training and Monitoring Elderly Cognitive Capabilities." Gerontechnology 7, no. 2 (2008).
[36] Correa, A., De Assis, G., Nascimento, M., Ficheman, I., Lopes, R. "Genvirtual: An Augmented Reality Musical Game for Cognitive and Motor Rehabilitation." In Proceedings of Virtual Rehabilitation '07, 1-6, 2007.
[37] Anderson, J., Hinojosa, J., Strauch, C. "Integrating Play in Neurodevelopmental Treatment." The American Journal of Occupational Therapy 41, no. 7 (1987): 421-426.
[38] Zhou, Z., Cheok, A., Pan, J. "3d Story Cube: An Interactive Tangible User Interface for Storytelling with 3d Graphics and Audio." Personal and Ubiquitous Computing 8, no. 5 (2004): 374-376.
[39] Barakova, E., van Wanrooij, G., van Limpt, R., Menting, M. "Using an Emergent System Concept in Designing Interactive Games for Autistic Children." In Proceedings of the 6th international conference on Interaction design and children, 73-76, 2007.
[40] Anagnostou, K., Vlamos, P. "Square Ar: Using Augmented Reality for Urban Planning." In Third International Conference on Games and Virtual Worlds for Serious Applications (VS-GAMES), 128-131, 2011.
[41] Fernandez, A., Goldberg, E., Michelon, P. The Sharpbrains Guide to Brain Fitness: How to Optimize Brain Health and Performance at Any Age. SharpBrains, 2013.
[42] Stroop, J. "Studies of Interference in Serial Verbal Reactions." Journal of experimental psychology 18, no. 6 (1935): 643-662.
[43] Ijsselsteijn, W., de Kort, Y., Poels, K. "The Game Experience Questionnaire:Development of a Self-Report Measure to Assess the Psychological Impact of Digital Games. Manuscript in Preparation." FUGA technical report, Deliverable 3.3, Technical University Eindhoven. (2008).
[44] Herrewijn, L., Poels, K. "Putting Brands into Play." International Journal of Advertising 32, no. 1 (2013): 17-44.
[45] Drachen, A., Nacke, L., Yannakakis, G., Pedersen, A. "Correlation between Heart Rate, Electrodermal Activity and Player Experience in First-Person Shooter Games." In Proceedings of the 5th ACM SIGGRAPH Symposium on Video Games, 49-54: ACM, 2010.
[46] Drachen, A., Nacke, L., Yannakakis, G., Pedersen, A. "Psychophysiological Correlations with Gameplay Experience Dimensions." In Workshop Proceedings of Brain, Body and Bytes at CHI 2010, 2010.
[47] Gajadhar, B., de Kort, Y., Ijsselsteijn, W. "Rules of Engagement: Influence of Co-Player Presence on Player Involvement in Digital Games." International Journal of Gaming and Computer-Mediated Simulations (IJGCMS) 1, no. 3 (2009): 14-27.
[48] Nacke, L., Grimshaw, M., Lindley, C. "More Than a Feeling: Measurement of Sonic User Experience and Psychophysiology in a First-Person Shooter Game." Interacting with Computers 22, no. 5 (2010): 336-343.
[49] van den Hoogen, W., IJsselsteijn, W., de Kort, Y. "Exploring Behavioral Expressions of Player Experience in Digital Games." In Proceedings of the workshop on Facial and Bodily Expression for Control and Adaptation of Games ECAG 2008, 11-19, 2008.
[50] Brooke, J. "Sus: A Quick and Dirty Usability Scale." In Usability Evaluation in Industry, 189-194: Taylor and Francis, 1996.
[51] Kortum, P., Acemyan, C. "How Low Can You Go?: Is the System Usability Scale Range Restricted?". Journal of Usability Studies 9, no. 1 (2013): 14-24.
[52] Bangor, A., Kortum, P., Miller, J. "An Empirical Evaluation of the System Usability Scale." International Journal of Human-Computer Interaction 24, no. 6 (2008): 574-594.
[53] Kirakowski, J. "The Use of Questionnaire Methods for Usability Assessment." University College Cork, (accessed: 25 Oct 2015).
[54] Tullis, T., Stetson, J. "A Comparison of Questionnaires for Assessing Website Usability." In Usability Professional Association Conference, 1-12, 2004.
[55] Brooke, J. "Sus: A Retrospective." Journal of Usability Studies 8, no. 2 (2013): 29-40.
[56] Tullis, T., Albert, W. Measuring the User Experience: Collecting, Analyzing, and Presenting Usability Metrics. Morgan Kaufmann Publishers Inc., 2008.
[57] Sauro, J. A Practical Guide to the System Usability Scale: Background, Benchmarks & Best Practices. CreateSpace Independent Publishing Platform, 2011.
[58] Schnabel, M., Xiangyu, W., Hartmut, S., Kvan, T. "From Virtuality to Reality and Back." In Digitization and Globalization: Proceedings of the 12th International Conference on Computer-Aided Architectural Design Research in Asia.
[59] Milgram, P., Kishino, F. "A Taxonomy of Mixed Reality Visual Displays." IEICE TRANSACTIONS on Information and Systems 77, no. 12 (1994): 1321-1329.
[60] Tang, A., Owen, C., Biocca, F., Mou, W. "Comparative Effectiveness of Augmented Reality in Object Assembly." In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems '03, 73-80, 2003.




How to Cite

Boletsis, C., & McCallum, S. (2016). Augmented Reality Cubes for Cognitive Gaming: Preliminary Usability and Game Experience Testing. International Journal of Serious Games, 3(1).