Puzzling with online games (BAM-COG): reliability, validity, and feasibility of an online self-monitor for cognitive performance in aging adults

J Med Internet Res. 2013 Dec 3;15(12):e270. doi: 10.2196/jmir.2860.


Background: Online interventions are aiming increasingly at cognitive outcome measures but so far no easy and fast self-monitors for cognition have been validated or proven reliable and feasible.

Objective: This study examines a new instrument called the Brain Aging Monitor-Cognitive Assessment Battery (BAM-COG) for its alternate forms reliability, face and content validity, and convergent and divergent validity. Also, reference values are provided.

Methods: The BAM-COG consists of four easily accessible, short, yet challenging puzzle games that have been developed to measure working memory ("Conveyer Belt"), visuospatial short-term memory ("Sunshine"), episodic recognition memory ("Viewpoint"), and planning ("Papyrinth"). A total of 641 participants were recruited for this study. Of these, 397 adults, 40 years and older (mean 54.9, SD 9.6), were eligible for analysis. Study participants played all games three times with 14 days in between sets. Face and content validity were based on expert opinion. Alternate forms reliability (AFR) was measured by comparing scores on different versions of the BAM-COG and expressed with an intraclass correlation (ICC: two-way mixed; consistency at 95%). Convergent validity (CV) was provided by comparing BAM-COG scores to gold-standard paper-and-pencil and computer-assisted cognitive assessment. Divergent validity (DV) was measured by comparing BAM-COG scores to the National Adult Reading Test IQ (NART-IQ) estimate. Both CV and DV are expressed as Spearman rho correlation coefficients.

Results: Three out of four games showed adequate results on AFR, CV, and DV measures. The games Conveyer Belt, Sunshine, and Papyrinth have AFR ICCs of .420, .426, and .645 respectively. Also, these games had good to very good CV correlations: rho=.577 (P=.001), rho=.669 (P<.001), and rho=.400 (P=.04), respectively. Last, as expected, DV correlations were low: rho=-.029 (P=.44), rho=-.029 (P=.45), and rho=-.134 (P=.28) respectively. The game Viewpoint provided less desirable results with an AFR ICC of .167, CV rho=.202 (P=.15), and DV rho=-.162 (P=.21).

Conclusions: This study provides evidence for the use of the BAM-COG test battery as a feasible, reliable, and valid tool to monitor cognitive performance in healthy adults in an online setting. Three out of four games have good psychometric characteristics to measure working memory, visuospatial short-term memory, and planning capacity.

Keywords: Internet; brain aging; cognitive testing; eHealth; games; reliability; self-monitoring; validity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aging / psychology*
  • Cognition*
  • Cohort Studies
  • Diagnostic Self Evaluation
  • Feasibility Studies
  • Female
  • Humans
  • Internet
  • Male
  • Middle Aged
  • Online Systems*
  • Reference Values
  • Reproducibility of Results
  • Telemedicine
  • Video Games / psychology*