Development of the Training Platform "AD-GAMING" for the Improvement of Quality of Life of People with Dementia through "Serious Games"

Research Article

J Fam Med. 2020; 7(4): 1207.

Development of the Training Platform "AD-GAMING" for the Improvement of Quality of Life of People with Dementia through "Serious Games"

Makri M1*, Tsolaki M1,2 and Zygouris S2

1Greek Association of Alzheimer Disease and Related Disorders, Thessaloniki, Greece

21st Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

*Corresponding author: Makri M, Greek Association of Alzheimer Disease and Related Disorders, 13 P. Sindika Steet, Analipsi, Thessaloniki, P.C. 54643, Greece

Received: February 25, 2020; Accepted: April 21, 2020; Published: April 28, 2020


AD-GAMING is a platform ( which focuses on increasing the technological skills of people with dementia (PwD), their families and caregivers, thus allowing them to use Serious Games (SGs) with the purpose of improving their quality of life. This program promotes the equity and inclusion of PwD, as it allows them to be an active part of their communities through gaming with their families and peers. The development of the platform was based on collaborative design principles and the evaluation through focus groups with PwD, caregivers and health professionals. Although research continues to show SGs may offer benefits for PwD and their families, the uptake of such applications is still low. This has been attributed to a range of barriers. The main product of this project, the training platform, will be a good solution to such issues and difficulties.

Keywords: Dementia; Serious Games; Quality of Life; ICT technology; collaborative design


PwD: People with dementia; PwA: People with Alzheimer; SGs: Serious Games; ICT: Information and Communication Technologies; QOL: Quality of Life


Currently there are approximately 47 million PwD across the globe with 10 million of them located in Europe. Alzheimer disease is affecting 10% of the global population over 65 years old and nearly 50% of those over 85 years old [1]. This disease affects not only the individuals but also their families and caregivers. The cognitive symptoms of Alzheimer's disease, the most often kind of dementia, affect memory, communication, orientation, ability to maintain attention, recognition of stimuli, ability to perform movements with an intention, calculus capacity and body schema [2,3].

The disease progression may be faster or slower depending on the environment of the people with Alzheimer (PwA). Disease accelerators are considered to be family stress, sudden changes in daily routines or change to a new and unfamiliar environment (such as a nursing home). Factors that can delay the disease are considered to be happy family atmosphere, social inclusion, exercise and participation in cognitively stimulating activities [4].

There is strong evidence suggesting that stimulation of cognitive abilities helps slow the decline of functions and abilities, and consistently improves cognitive functioning, and is also associated with benefits in Quality of Life (QoL) and communication. This stimulation consists in exercising those areas still preserved by the patient [5-7].

In the last decades there has been a growing interest in employing Information and Communication Technologies (ICT) to help assess and evaluate patients’ functional impairments, as well as to help and support patients in everyday activities [8,2,9]. This is the underlying idea for the development of SGs. Therapies based on SGs to stimulate cognitive abilities of PwA are exhibiting good results when they are used with people with mild and moderate symptoms [10]. Furthermore, McCallum and Boletsis [11] reviewed SGs for Dementia, and reported mostly positive health effects and successful implementation.

SGs are digital applications or games that can be used for entertainment but also have other important purposes, such as training and educating, communicating, or promoting the use of cognitive, physical and social abilities [12,13]. SGs are often specifically designed and targeted at certain populations such as people with mild and moderate dementia. However, more recent research has suggested that commercially available gaming technology can also be used to benefit the well-being of PwD and their care partners. Some specific games have been developed but there are also traditional games whose use could have a positive impact in PwA [10]. For the purposes of this project, the SGs outlined on the website include games that are both technology-based and not technology-based and that have either been designed for a specific rehabilitation purpose or are more widely available as entertainment tools.

However, the potential of using SGs to improve the QoL of PwA is not fully developed, due to a lack of the selection and prioritization of SGs based on their positive influence on different cognitive symptoms and the lack of guidelines for the use of the most suitable SGs for specific problems of PwA. Also, some other important issues are the lack of caregiver knowledge about the use of SGs according to patients’ particular conditions, the absence of training of PwA in an adapted and accessible way, about the benefits of exploiting SGs as a tool for improving their QoL, and the lack of a family structure that could support participation of PwA in such games with the aim of social inclusion.

Therefore, AD-GAMING website ( has been designed to raise awareness, and encourage the use of SGs amongst PwD, their care partners and practitioners by providing recommendations for overcoming some of the barriers outlined above. Whilst the researches illustrated above cover a broad range of technologies, the aim of this website is to provide more specific information and recommendations on using SGs with PwD and their care partners. The recommendations set-out below are based on that obtained from research within the field.

This training program is unique and innovative because it is based on the development of an adapted e-training platform including ICT solutions addressed to PwA with various levels of disability. Also, AD-GAMING focuses on SGs as innovative therapy and includes the direct involvement and training of PwA. It is a program that aims at the promotion of the inclusion of PwA through the participation of the caregivers of these people and the approach of “playing” with members of the wider community apart from the personnel of medical and therapeutic facilities. AD-GAMING is launched with the main objective of increasing the competences (attitudes, skills, knowledge) of the collective around people with mild and moderate AD (persons, families and caregivers) about how to exploit SGs for increasing their QoL, through an innovative training program. The project has the following specific objectives:


Design and Procedure

The project team was led by Alzheimer’s Valencia and was supported by five European partners: Bournemouth University Ageing and Dementia Research Centre (ADRC), Alzheimer’s Slovenia, Alzheimer’s Romania, Greek Association of Alzheimer Disease and Related Disorders (GAADRD) and the Institute of Biomechanics of Valencia (IBV). Each partner shared the basic information about the existing innovations and best practices. The project began in September 2016 and run for two years. The research consisted of three phases:

Phase 1: Initial feedback from key stakeholders on selected Serious Games

According to their previous background and experience in the field of SGs for PwA, the project team decided which SGs should be included in the Training Program. The evaluation and selection of SGs were according to the impact and applicability to the 8 cognitive symptoms evident in Alzheimer's disease: i) Memory Loss; ii) Loss of ability to communicate; iii) Disorientation; iv) Attention disorders; v) Agnosia; vi) Apraxia; vii) Loss of capacity of calculation; viii) Loss of body schema. Also, attention was paid to the availability of these games and the barriers and supports needed for their use by PwA.

In order to introduce PwD, their care partners and health professionals to a range of SGs selected by the project team and elicit their opinions of engaging with them, interactive workshops were designed. Throughout the workshops, data was elicited through multiple qualitative methods, including:

The selection criteria of PwA to be involved had been to recruit those who are in the early stages of the illness, suffering mild or moderate symptoms, because they are the people who can improve their cognitive situation. People with severe AD had been excluded from the project because they are not able of using SGs and/or they cannot get any positive impact from its use. Additional participant’s characteristics are presented in Table 1.

In these Working Sessions, PwA played some of the final SGs and gave feedback about their experience. Some general and specific questions about the workshops, the platform and the SGs were asked to the participants. There are more details about the focus group discussion and the interview questions in the Box 1.

This data was used to develop the Methodological Guide. This Co-Created Methodological Guide is a document for training PwA and their caregivers on the implementation of inclusive cognitive and physical activities. It is a product created with the direct participation of end users, its main objective being the determination of the key contents, methodologies and tools needed for creating and improving the critical competences of PwA and their caregivers for using SGs with the aim of improving their cognitive functioning.

It is crucial to underline that AD-GAMING was indeed devoted to the study and development of a training methodology to properly involve PwA together with their families and professionals. Training Methodology and supporting tools, including ICT supporting tools were developed from the beginning according to Accessibility and Usability criteria. Therefore specific methodologies, tools and ICT solutions were developed in order to make their participation as easy as possible.