Neurodegenerative diseases comprise a heterogeneous group of age-related disorders with progressive loss of neuronal structure and function ( Cummings and Pillai, 2016 Kovacs, 2018). Further studies are needed to more comprehensively establish the cognitive validity and test–retest reliability of using Numberlink puzzles as a valid cognitive assessment tool. In particular, game-based movement measures from the maze-like puzzle Numberlink games are promising as a tool to monitor the progression of motor impairment in neurodegenerative diseases. Findings from this study support recent suggestions that data from a maze-like puzzle game provide potential “digital biomarkers” to assess changes in psychomotor, visuoconstructional, and executive function related to aging and neurodegeneration. Furthermore, varying characteristics of the Numberlink puzzle game succeeded in creating graded difficulty levels. Correlational analyses showed significant associations between game-based performance and movement metrics and performance on neuropsychological tests for psychomotor, attentional, visuospatial, and constructional and executive function. However, patients with Parkinson’s disease (PD) did not differ from older adults. Analyses of Numberlink game-based cognitive (solving time and errors) and motor performance metrics revealed statistically significant differences between age groups and between patients with HD and older adults. Fifty-five participants, including young (18–31 years, n = 18), older (64–79 years, n = 14), and oldest adults (86–98 years, n = 14), and patients with Parkinson’s (59–76 years, n = 4) and Huntington’s disease (HD 35–66 years, n = 5) played different difficulty levels of the Numberlink puzzle game and completed usability questionnaires and tests for psychomotor, attentional, visuospatial, and constructional and executive function. This study evaluated the feasibility of a maze-like Numberlink puzzle game in assessing differences in game-based measures of cognition and motor function due to age and neurodegenerative diseases. There is currently a need for engaging, user-friendly, and repeatable tasks for assessment of cognitive and motor function in aging and neurodegenerative diseases. 5Department of Neurology, University Neurorehabilitation, Inselspital, Bern, Switzerland.4Neurozentrum Siloah and Department of Neurology, Swiss Huntington’s Disease Center, University of Bern, Bern, Switzerland. ![]() ![]() 3Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland.2ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.1Gerontechnology & Rehabilitation, University of Bern, Bern, Switzerland.Tobias Nef 1,2, Alvin Chesham 1, Narayan Schütz 1, Angela Amira Botros 1, Tim Vanbellingen 1,3, Jean-Marc Burgunder 4, Julia Müllner 5, René Martin Müri 1,5 and Prabitha Urwyler 1,2,5*
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