Usability and Concurrent Validity of the Gamified Brain Aging Monitor of Cognition (BAMCOG) for the Self-Monitoring of Perioperative Cognitive Function: A Pilot Study

Objectives: An increasing number of older adults, including those with mild cognitive impairment, are undergoing cardiac surgery. Despite strong recommendations for preoperative cognitive screening and peri-operative monitoring, routine implementation faces challenges, such as limited time in busy outpatient clinics and lack of patient motivation. To address this issue, gamification and self-administration of cognitive screening using BAMCOG were explored in patients undergoing transcatheter aortic valve replacement (TAVR). Methods: A multi-methods prospective repeated-measures within-subject cohort study was conducted between January 2021 and December 2022 to assess usability and concurrent validity. The initial part after game development focused on qualitatively examining the usability of BAMCOG in eight patients, using the System Usability Scale (SUS). The second part, with 40 patients, evaluated concurrent validity by comparing BAMCOG with the widely used Montreal Cognitive Assessment (MoCA). Results: The average SUS score was 79.7, indicating good usability. In the preoperative period, the correlation between BAMCOG and MoCA scores was r = 0.33 (p < 0.05), which increased to r = 0.59 (p < 0.001) on the first postoperative day. Conclusions: In conclusion, peri-operative self-monitoring of cognition around a TAVR procedure is feasible, but the concurrent validity of the BAMCOG and the MoCA scores is moderate to low. This warrants further research on gamified cognitive screeners to optimize their use in perioperative cognitive monitoring.