Dissecting Digital Card Games to Yield Digital Biomarkers for the Assessment of Mild Cognitive Impairment

Commercial off-the-shelf digital card games, specifically Klondike Solitaire, serve as a scalable and ecologically valid platform for the longitudinal monitoring of Mild Cognitive Impairment (MCI) in older adults. By leveraging gameplay interactions as digital biomarkers, this approach offers a non-invasive alternative to traditional, resource-intensive neuropsychological assessments. The research establishes a framework for identifying cognitive decline by translating player actions into measurable data points, providing a more accessible method for early detection and continuous cognitive health tracking.

The methodology relies on an expert consensus process that defined 21 distinct player actions mapped to nine core cognitive functions. From this foundation, 23 potential digital biomarkers were developed, categorized by performance, timing, and error metrics. Statistical validation reveals that 12 of these biomarkers demonstrate significant efficacy in distinguishing between healthy older adults and those diagnosed with MCI. Furthermore, these metrics exhibit high reliability, with intraclass correlation coefficients exceeding 0.75, confirming that time-based metrics, such as think time, alongside error rates and overall game performance, are robust indicators of cognitive status.

While these digital biomarkers show significant diagnostic potential, they are intended to function as a supplementary tool rather than a replacement for formal clinical evaluations. The findings underscore the utility of integrating consumer-grade technology into geriatric healthcare to facilitate broader screening efforts. By utilizing familiar, engaging interfaces, this model overcomes common barriers to patient adherence, offering a promising pathway for the early identification of cognitive impairment within aging populations. Future applications of this research could enhance the precision of remote monitoring, allowing for more timely clinical interventions and improved long-term outcomes for patients at risk of dementia.