Cognitive decline, or a progressive deterioration of mental (cognitive) abilities, is an increasingly common condition due to the aging population. Mild cognitive decline (MCI) is the preclinical and transitional phase between healthy physiological aging and major neurocognitive disorders, more commonly known as dementia. The impermanence of this intermediate stage represents a crucial opportunity for interventions to restore reversible conditions, often associated with metabolic or endocrine imbalances, or to delay progression to more severe declines that result in a significant impact on the elderly person's quality of life.

The worldwide prevalence of MCI among people aged 50 years or older is more than 15 percent. Challenges related more generally to cognitive decline range from missed diagnosis to insufficient preventive measures, as well as failure or inadequate ongoing monitoring by health professionals; this prevents timely adjustment of treatment plans. However, in recent years it has been shown that lifestyle modifications and mental function stimulation are effective tools for promoting people's neuroplasticity and consequently enhancing their brain capacity. In particular, one tool that has been shown to be particularly effective in this regard is the so-called serious game.

Serious games are games designed with a primary focus on education or skill development and are a promising tool for training and cognitive assessment of older people. These games integrate engaging and interactive elements to stimulate various cognitive functions, including memory, attention and problem-solving. Serious games facilitate repeated and continuous assessment of cognitive function, enabling health care professionals to visualize trends and detect acute changes that are traditionally difficult to identify. Nevertheless, the simultaneous use of a serious game for training and continuous monitoring of cognitive function by healthcare professionals remains to be explored. 

The project "Serious Games for Cognitive Assessment of the Elderly at Home" (SIGMA) aims to develop and implement serious games to stimulate and monitor the cognitive status of elderly patients followed at home, while also analyzing their conditions of acceptability and use by the recipients (patients and nurses).

SIGMA is managed by the Competence Centre for Healthcare Practices and Policies (CPPS) of SUPSI's Department of Business Economics, Health and Social Care, in collaboration with the Institute of Digital Technologies for Personalised Healthcare (MeDiTech), the Institute of Information Systems and Networking (ISIN) and the Institute of Systems and Technologies for Sustainable Production (ISTePS). The involvement of these institutes, which come under SUPSI's Department of Innovative Technologies, has enabled the development of both the first version of the beSerious gaming platform and the web platform, still in the works, which aims to support health care professionals in monitoring the cognitive progress of the elderly on an ongoing basis.


Throughout the development process, a participatory approach was applied, involving a multidisciplinary research team, consisting of the project leader, a researcher in nursing, several engineers, a neuropsychologist, and especially older people and geriatric nurses.
 
Interviews, workshops, and usability tests were conducted with elderly people and nurses to explore accessibility, usability, and preferences at different stages during the design and implementation of both the games and the web platform. So far, both the game framework and the serious games in it have received very favorable feedback from participants and nurses. Finalization of the web application and implementation of the serious games on a larger scale is planned in the coming months.
 
The project has significant relevance to the area and also involves the Associazione assistenza e cura a domicilio del Mendrisiotto e Basso Ceresio. SIGMA proposes an approach of the elderly and health professionals, active in the home care setting, to the use of technologies that can provide support for care planning and implementation, in the perspective of an elderly population that will have increasing access to the Internet and technological devices. In this regard, the project will offer new tools for cognitive training of older people and monitoring of their cognitive status. 

These are particularly interesting goals, not least in light of the paucity of detection of cognitive decline in the elderly still living at home (according to rough estimates, the percentage of Spitex clients with suspected dementia at age 65 and above would be around 9 percent), and the interest shown by Spitex in playful tools that can facilitate this type of activity.