How Video Game Therapy Affects Thinking and Emotions in Older Adults With Cognitive Impairment

Primary outcomes

1. Montreal Cognitive Assessment (MoCA)

   Time frame: General perception of the person's cognitive sphere (not session-specific), used at week 0 (baseline) and week 8 (post-intervention).

   Measures overall cognitive function (memory, attention, language, orientation, etc.). The total score ranges from 0 to 30 points. Higher scores indicate better cognitive performance. The standard administration guidance states that 26/30 or above is generally considered within the normal range, although cut-off points may vary depending on population, education level, age and clinical context.

2. Observed Emotion Rating Scale (OERS)

   Time frame: Pre-intervention and post-intervention (up to 1 week)

   Measures emotional state during the sessions (positive and negative emotions observed).The OERS measures the intensity or duration of these affective states using a 5-point Likert-type scale. Each emotional state is rated separately, usually from 1 to 5.

   A higher score in pleasure is positive. A higher score in general alertness is usually positive or activation-related. Higher scores in anger, anxiety/fear or sadness indicate more negative affect.

3. Menorah Park Engagement Scale (MPES)

   Time frame: Pre-intervention and post-intervention (up to 1 week)

   The adapted MPES assesses participant engagement during the activity using a 5-point duration scale aligned with the OERS. Observation takes place during the central 10 minutes of the session, from minute 15 to minute 25, to avoid start-up or fatigue bias. Each engagement category is scored according to the total accumulated time observed: 1 means the behaviour was never observed; 2 indicates a very brief occurrence; 3 indicates a short occurrence; 4 means the behaviour was observed for 1 to 5 minutes; and 5 means it was observed for more than 5 minutes. The categories assessed are constructive engagement, passive engagement, social engagement, non-engagement and self-engagement. If two behaviours occur at the same time, constructive engagement is prioritised.

4. Quality of Life in Alzheimer's Disease (QoL-AD, proxy version)

   Time frame: General perception of the person's recent overall wellbeing (not session-specific), used at week 0 (baseline) and week 8 (post-intervention).

   The QoL-AD proxy version assesses perceived quality of life in people with cognitive impairment through the judgement of a caregiver, professional or informant who knows the participant well. It includes 13 items, each scored on a 4-point scale: 1 means poor, 2 means fair, 3 means good and 4 means excellent. The total score is obtained by adding the 13 item scores, giving a possible range from 13 to 52 points. Higher scores indicate better perceived quality of life.