Measuring cognitive performance in older adults through completion time and accuracy in brain games

INTRODUCTION

Good cognitive ability is essential for older adults for independence in activities of daily living (ADL), social relationships, physical well-being, and overall quality of life. However, a systematic review reported a globally high incidence of cognitive impairment among the older population, ranging from 22 to 76.8/1000 person-years.^[1] As people age, the brain may gradually undergo atrophy, especially in the hippocampus and prefrontal cortex, affecting executive function, memory, and information processing.^[2,3] Even mental disorders such as anxiety and depression have been shown in many studies to affect cognitive performance in older adults.^[4-8] Ultimately, older adults with mental disorders may engage in less physical activity,^[9] disrupting antioxidant defenses and accumulating free radicals, leading to oxidative damage to the brain.^[10,11]

A previous study showed that a high level of participation in leisure activities was linked to a 41% reduction in the risk of cognitive impairment compared to low-level engagement after controlling for age, sex, education, and other confounders.^[12] Leisure activities such as brain games are believed to stimulate brain functions and effectively prevent dementia,^[13] while brain games have potential benefits for sustained attention and mental engagement.^[14] This is further supported by a systematic review and meta-analysis of 15 trials among 759 older adults that were noted to enhance several brain functions such as processing speed, selective attention, and short-term memory.^[15] Jenga, for instance, which is a type of brain game, promotes critical thinking, speed, and accuracy,^[16] while also enhancing decision-making, problem-solving, and multitasking skills.^[17] In addition, brain games may provide a higher satisfaction level and encourage social interaction among players.^[18] However, Murman also argued that the ability to continuously perform unfamiliar, complex, and timed activities tends to decline, particularly in older adults of advanced age.^[17] Hence, exploring the factors associated with time and accuracy in completing brain games can provide insight into the evaluation of cognitive performance in older adults. There have been limited studies on how the cognitive performance of older adults is affected by playing brain games. For example, one study examined how eye-hand coordination and anxiety are linked in nursing professionals.^[19] Another study discovered that brain exercises involving Jenga games improved abilities as measured by the Montreal Cognitive Assessment (MoCA).^[18] A study has also explored the reaction time and accuracy in adults using brain games such as Whack-a-mole and Hit-the-ball.^[20] Hence, investigating time and accuracy with Jenga games could offer insights into the clinical application of brain games such as detecting cognitive changes in older adults.

Understanding the role of brain games in cognitive functions can be explained by the cognitive reserve theory (CRT), which proposes that the ability to maintain cognitive functions relatively well at a given level of pathology can be influenced by early experiences such as the level of education that could protect against cognitive decline.^[21] Accordingly, the CRT advocates that lifestyle factors result in individual differences in the flexibility and adaptability of brain networks that may allow some people to cope better than others with cognitive changes.^[22] The CRT can be used to hypothesize that brain functions can be influenced by several individuals’ characteristics. Cognitive reserve may be essential for the enhancement of executive function by challenging cognitive skills.^[23] A recent study has shown that engaging in novel, active, and productive intellectual tasks could mitigate cognitive decline in older adults’ cognitive reserve.^[24] Therefore, the CRT can be used to guide further studies in elucidating the roles of brain games, such as Jenga, in enhancing the executive function of older people. So far, there are limited studies supporting how characteristics such as sociodemographics, cognitive function, and mental health impact intellectual or challenging tasks at a later age, such as playing Jenga games that demand efficiency.

To fill the gap in the current literature, we proposed the use of the CRT to develop the theoretical model of this study [Figure 1] that explains the interrelationship of study variables influencing brain performance in older adults while playing brain games. We hypothesize that brain performance while playing games that demand accuracy and timely completion can be distinguished and influenced by several factors related to lifestyles or sociodemographic factors, the current level of cognitive and mental functions. In the model, sociodemographic factors (such as education level, age, marital status), mental health, and cognitive function may impact brain performance while performing challenging tasks.

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Figure 1:

The theoretical model of the influence of cognitive reserve (sociodemographic, cognitive function, and mental health) on brain performance.

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Ultimately, this study aimed to compare older adults with varying sociodemographic, cognitive function, and mental health (anxiety and depression levels) regarding the time and accuracy of completing the Jenga games. This study also aimed to determine whether sociodemographic factors, cognitive functions, and mental health (anxiety and depression levels) influence the time and accuracy that represent cognitive functions in completing the Jenga games. Using logistic regression analysis, we hypothesized that cognitive function, mental health, and sociodemographic factors influence game performance among older adults playing Jenga. Participants with higher cognitive function, lower anxiety and depression levels, and greater educational attainment are expected to perform better, while older age may reduce performance due to age-related cognitive decline.

MATERIALS AND METHODS

The Jenga games procedure

In this study, colored Jenga was used to test the time and accuracy in completing the Jenga tower. Jenga consisted of 54 wooden blocks that comprised six colors: red, pink, yellow, green, blue, and purple. Each color is represented by nine wooden blocks [Figure 2]. The following are the procedures for completing the Jenga games:

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Figure 2:

The Jenga.

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1. The participants were briefly explained about the procedure of the Jenga games and demonstrated the steps to play. The participants needed to build a tower of 10 levels, each consisting of three blocks of the same color. A colored dice determines the color for each level of the Jenga Tower. The dice consisted of six colors, with each side having the same color as that of the wooden blocks. The time began when the participants started to grip the first block and stopped when they completed three rows of Jenga blocks to form one level of the Jenga tower. The sum of the time completed in seconds and the accuracy of each level of the challenge were recorded [Table 1].

2. To begin the challenge, the wooden blocks were placed on the table and grouped according to the same color in front of the participants.

3. The participants then threw dice to determine the color to build each level of the Jenga tower. The participants were required to stack in three rows of the same-colored blocks to form one level of the Jenga tower.

4. To form the next level, the participants needed to arrange the block transversely, and this procedure was repeated until a Jenga tower with ten levels was built.

5. The time the participants took to form the Jenga tower was recorded in seconds, and its accuracy was calculated when the participants chose the color of the blocks the same as the dice to form one level of the Jenga tower.

Table 1: Example of documentation of time and accuracy in completing 10 levels of Jenga tower.

Jenga level	1st	2nd	3rd	4th	5th	6th	7th	8th	9th	10th	Total
Time (seconds)	10	8	6	7	8	9	7	8	11	8	82
Accuracy	✔	✔	✘	✔	✔	✔	✔	✔	✘	✔	8/10

✔: Accurate, ✘: Not accurate

RESULTS

DISCUSSION

The current study examined how different sociodemographic factors, cognitive function, and mental health differed in Jenga performance (time and accuracy) and whether these factors can predict Jenga performance. The findings of this study align with previous research, highlighting the importance of cognitive function, mental health, and sociodemographic factors in predicting task performance among older adults. Consistent with the CRT, participants with higher cognitive function scores performed better in terms of task completion time and accuracy, supporting the significance of cognitive reserve with enhanced executive function and problem-solving skills.^[15] In addition, the negative impact of anxiety and depression on performance supports prior research, indicating that emotional distress hinders cognitive processing and decision-making.^[22] Moreover, the observed influence of age and education level corresponds with studies emphasizing the role of lifelong learning and cognitive engagement in maintaining cognitive reserve.^[21] Older participants showed reduced performance, consistent with age-related declines in cognitive flexibility and working memory documented in a prior study.^[24] Similarly, participants with higher educational attainment performed better, supporting evidence that education promotes resilience against cognitive decline through enhanced cognitive reserve.

Specifically, this current study found that older adults aged ≥75 years took more time to complete and were less accurate in the Jenga performance. It has been suggested that as individuals age, their fluid cognitive functions, such as problem-solving capabilities, processing speed, and reasoning skills, tend to decline.^[29] The current finding is also consistent with an earlier study that younger participants exhibited higher accuracy and speed in completing the task, leading to more correct responses.^[30] Playing brain games such as Jenga requires cognitive skills, such as strategic thinking and precision planning, because players must carefully decide which block to remove or place, understand the spatial relationships between blocks, and maintain stability while anticipating each move’s consequences, which requires planning several steps. Older adults may find brain games challenging as they need to control their focus and emotions to play calmly and carefully to prevent errors and make accurate or precise movements to prevent the Jenga Tower from falling.^[31] These results suggest that older adults may be more adept at solving difficulties quickly by applying their critical thinking skills.

The present study also discovered a connection between age, time taken, and accuracy when building the Jenga tower, suggesting that age could impact reaction time and precision outcomes. This finding aligns with a previous report that revealed that older age is linked to diminished performance, including movements, prolonged processing responses, and reduced accuracy.^[30]

Age was also a factor in predicting how well someone performs the Jenga games, supporting the belief that as people age, their cognitive abilities decrease, affecting how quickly and accurately they can complete cognitive tasks.^[2] A previous study also reported that performance in all cognitive domains decreases with age; in particular, tests related to working memory, flexibility, and visuoconstructive abilities were influenced by age.^[32] Accordingly, the association of age with Jenga performance may be attenuated by the effects of education, mainly in the visuoconstructive domain.^[32] This finding enhances the understanding of age-related declines in task performance, highlighting the protective role of cognitive reserve acquired through lifelong education and engagement.^[17] The current finding supports the importance of considering age differences when researching older adult populations. The time required to complete the task and the accuracy of the task performance are critical measures in older adults due to the decline in reaction time and precision, which are parts of the executive function.

The current study found that gender was not significantly different in brain games, though the majority of males performed better in completing the given task. A previous study found that males had significantly better scores than females in cognitive performance, including executive function, but not in memory and psychomotor speed.^[33] Females have a higher risk of cognitive decline because, on average, females have lower education levels and a reduction in reproductive hormones such as estrogen, which serves as a protective factor of cognitive function.^[33]

Regarding education, those with a higher level completed tasks faster and had higher accuracy in completing Jenga games, indicating that education is fundamental to mental function. This finding supports a previous argument that years of education have a significant positive association with cognitive function.^[33,34] Furthermore, education level is vital in cognitive performance and task completion because it involves thinking and problem-solving. The interaction between education and cognitive status in influencing task performance could be due to the complexity of cognitive aging and suggests that interventions aimed at enhancing cognitive function in older adults should consider individual differences in educational background and cognitive baseline.^[20] Moreover, there is a significant interaction between leisure activity and educational level, such that the beneficial effect of leisure activities on cognitive function was more significant in educated individuals than in their uneducated counterparts, and only those educated benefited from cognitive activities.^[12]

In this study, married participants played the Jenga games in a shorter time and had higher accuracy than those who were single, divorced, or widowed, though the difference was not statistically significant. Marital status was screened because, according to one study, older adults who were single, widowed, or divorced had worse cognitive function than those who were married.^[35] Marriage may enhance opportunities for greater cognitive stimulation as married individuals typically engage in more social interactions and committed partnerships, which offer fundamental protection against cognitive decline.^[36]

Older adults who scored 26 or higher on the MoCA performed better in the Jenga games. These findings are consistent with a previous study that suggested individuals with moderate and moderate-to-severe cognitive impairment presented with slower reaction times and were less accurate in task completion than those with normal cognitive function.^[20]

The participants with lower anxiety and depression scores took a shorter time and had higher accuracy in completing the Jenga games, but they were not significantly different. The non-significant findings could be attributed to the lack of symptoms of anxiety and depression among the participants as the majority scored in the lower ranges. Accordingly, older adults who experience anxiety symptoms often experience severe depression, but anxiety may not increase cognitive dysfunction and recognition tasks.^[37] However, late-life depression is often accompanied by cognitive impairment,^[38] which could be due to the interaction between neurobiological changes, neurotransmitter imbalances, and elevated levels of inflammatory markers. Late-life depression can also cause chronic stress and dysregulation of the hypothalamic-pituitary-adrenal axis, leading to increased levels of cortisol, which can damage brain regions, particularly the hippocampus, which is involved in cognitive functioning.^[39] In terms of relationship, there was no significant correlation between the level of anxiety and time and accuracy in completing the Jenga games. The current finding is also consistent with a previous study that did not show a significant correlation in assessing the level of anxiety using Jenga games, which could be due to differences in the background of the study population.^[19] Morimoto et al. found a correlation between depressive episodes and cognitive impairment but did not progress to dementia.^[38] Mental and cognitive function must be evaluated in terms of time and accuracy, as older adults with mental disorders may have challenges in completing tasks efficiently, as the individual focuses more on the threat rather than completing the task.

It is important to note the limitations of this study, in which the participants were recruited from the institutions for older adults who may have psychosocial circumstances. Ultimately, these results cannot be applied to communities or broader populations.

CONCLUSION

The findings of this study reinforce the theoretical background of the study, suggesting that both cognitive and emotional factors, alongside demographic characteristics, play crucial roles in predicting performance on cognitively demanding tasks such as Jenga. In addition, this study has also contributed to a deeper understanding of the cognitive reserve and executive functions in older people in relation to brain games. Methodologically, Jenga may be a feasible tool for cognitive assessment for institutionalized older adults. This study reveals several factors that influence cognitive tasks and can implicate clinical practice to mitigate cognitive decline, creating personalized approaches that focus on an individual’s baseline education and cognitive ability.

It is important to note the limitations of this study, in which the participants were recruited from the institutions for older adults who may have psychosocial circumstances. Ultimately, these results cannot be applied to communities or broader populations. In addition, this study used only Jenga games which may limit generalization to other specific cognitive tasks. Future studies are recommended to adopt a longitudinal approach and consider conducting follow-up assessments to maintain regular contact with participants to track better outcomes, as well as the use of various brain games.