Background: Unsupervised serious video games delivered through the SmartMe&You-TELEMAIA home telemonitoring platform (https://smartme.cloud.garr.it/) may provide a practical approach to track cognitive fluctuations in older adults with or without impairment. This study evaluated their validity in cognitively unimpaired individuals (Healthy) and in patients with mild cognitive impairment and mild-to-moderate Alzheimer’s disease–related dementia (ADCD).

Methods: Clinical, demographic, and resting-state eyes-closed EEG (rsEEG) data were collected from 34 Healthy participants and 62 ADCD patients. Seven unsupervised cognitive tasks, which involved the quick evaluation of visual stimuli in a grid and finger motor responses were administered via a commercial tablet (Figure 1). The rsEEG data were processed using the EEGLAB toolbox. rsEEG cortical source activity in the individual delta, theta, and alpha frequency bands was estimated using eLORETA. Game performance was compared with Mini-Mental State Examination (MMSE) scores and rsEEG activity, that is typically abnormal in patients experiencing this neurodegenerative condition. Statistical analyses were performed using the freeware tool jamovi version 2.3.

Results: Game performance metrics (Table1) discriminated Healthy participants from ADCD patients, , achieving an overall accuracy above 90%. Across the entire cohort, performance showed a strong positive association with MMSE scores (Figure 2). Conversely, it was negatively associated with global and regional rsEEG source activity in the delta and theta bands. (GLMs, p < 0.01; Figure 3).

Conclusions:  Serious games implemented on the SmartMe&You-TELEMAIA platform are feasible and informative in older adults across the cognitive spectrum. They may represent a low-cost, sustainable, and unsupervised tool for assessing cognitive status in home telemonitoring, supporting both primary prevention in at-risk individuals and tertiary prevention aimed at slowing disease progression in ADCD.