Sailboats, icebergs and old maps may not immediately spring to mind when you think of dementia research, but they’re being used by scientists at UCL in the form of a game, to better understand human navigational skills and in turn, the onset of dementia.
Sea Hero Quest (SHQ) is a mobile gaming app that records users’ sense of direction to determine how navigational skills decline with age. Researchers from UCL and the University of East Anglia will use this data to create the world’s largest benchmark of how humans navigate, which will then go on to become a critical diagnostic tool for dementia in the future.
This benchmark is important as no cure exists for dementia, so quicker diagnoses are vital for effective medical interventions and maximising quality of life.
The game has so far been downloaded 2.7 million times, has been played in every country in the world and is the biggest dementia study in history. Through its innovative approach, it has collected a huge amount of data that would have taken more than 9,000 years to acquire in a traditional lab setting.
What is dementia and why do we need a benchmark?
Dementia is an umbrella term— there are many different diseases within it. Alzheimer’s is the most common, affecting 60–70% of those diagnosed.
What all these diseases have in common is that they involve proteins ‘clumping’ together and becoming toxic to the brain’s nerve cells, causing them to die off and triggering a loss of brain function.
One of dementia’s first noticeable manifestations is that those affected begin to lose the ability to find their way around.
47 million people are currently living with dementia and it is a rapidly growing health threat. Improving healthcare increases life expectancy, contributing to a growing population of older adults that dementia mainly affects. The number of those living with dementia is projected to almost triple to 135 million by 2050.
Dementia is one of the main causes of disability in later life, ahead of cancer, cardiovascular disease and strokes. Despite these figures, the UK spends significantly less on dementia than these other diseases.
Up until now, memory loss has been the gold standard of dementia detection. The problem with using this symptom as a diagnostic is that it is a normal part of ageing — many people complain about their memory as they get older.
This can lead those experiencing these symptoms to ignore them. A decline in spatial navigational abilities, however, is much rarer in the general ageing population but very common in people with dementia.
“What clinicians currently lack is a tool that tells them does someone or does someone not have problems finding their way around,” explains Dr Hugo Spiers, Reader in Cognitive Neuroscience at UCL and co-creator of the game. “So, you can test memory, you can test lots of other abilities but actually having a sophisticated clinical test of spatial orientation navigation doesn’t yet exist.”
Seascapes and sea creatures
Sea Hero Quest is a scientific experiment and a video game in one, with a thoughtful narrative that may be the reason for its popularity. The story is about a young boy and father who travelled the high seas looking for incredible creatures to capture, “not with a hook, but with a pen”. The father chronicled each monster in his journal, and the two adventured together until the boy’s father grew old and died.
In the game, the player takes on the role of the boy, who has now become a man. As the man, the player sets out once again to recover his father’s memories and journal pages, scattered over the different levels, while capturing photographs of the sea creatures.
The game is divided into different levels in which the three main tasks are navigating mazes, shooting flares and chasing sea creatures to capture photos of them.
Players are first asked to memorise a map with a number of flag ‘checkpoints’ on it. They are then transported into a small sailboat, which they can navigate around various seascapes — accelerating around obstacles and bends to find these checkpoints, then locating flares and shooting them back to specific buoys, to test their sense of direction.
When successful, players can take photos of sea creatures emerging from the sea (the game developers thought this less aggressive than capturing the creatures) for their journal, which they can share with others on social media.
As players move around in the game, their positional data is relayed back to the researchers, creating a heat map of their movements. This heat map is used to try to understand how users navigate through these mazes, and it is this data, en masse, that will make up the benchmark.
Stepping out of the lab
How did the game come to be? “I attended a workshop at the Wellcome Trust, which was all about how games can help science, and it occurred to me that, as navigation is such a big part of so many games, we should create a game that can actually measure navigation and trial it with loads of people,” says Michael Hornberger, Professor of Applied Dementia Research at the University of East Anglia.
“I contacted Hugo pretty much straight away because, while I’m a dementia expert, Hugo is a navigation expert and I realised I needed a navigation expert on my side really to help the game.”
It began from there, but the researchers had no idea that the game would be so popular. “We came up with this number, by December we wanted to get to 100,000 people-but at first, we thought this was really crazy. Of course, the data we have now collected has by far exceeded what we could have ever anticipated,” says Professor Hornberger.
The game’s success has surpassed everyone’s expectations. It has won nine Cannes Lions at the International Festival of Creativity and been played at the UN General Assembly.
What is integral to the structure of the game is that at certain intervals, players are asked questions about themselves. They are asked their age, country of residence, whether they are left or right-handed, female or male, if they live in an urban or rural area and how many hours of sleep they get each night.
Using this demographic information, which is held anonymously, the researchers were able to harvest a magnitude of very specific, previously unknown data. This provides the potential for a sophisticated and nuanced diagnostic.
“Imagine we didn’t ask anything — there was no game — we just got 2.7 million people to tell us how many hours’ sleep they got and you can plot that for 193 countries. That’s a breakthrough-that’s amazing,” says Dr Spiers.
“So we can find out where are the most left-handers are in the world and whether they sleep more than right-handers. There’s a lot we can do with those basic demographics before we even add in the game.
“Ultimately, though, we want to build a really sophisticated diagnostic that accounts for the fact that someone might be 49, live in the UK, is left-handed, grew up in the countryside and gets six hours sleep a night and has a degree — here’s how we would predict their navigational skill level.”
Nordic masters and early decline
The first set of results has now been published and has revealed three major findings. The first is that where you grow up affects your navigation. Nordic countries performed particularly well, with Finland topping the league for spatial navigation capabilities.
“We don’t know why,” says Dr Spiers. “It isn’t something we set out to predict, that the Nordic countries would do well, what we’ll now need to do is start analysing data that helps us correctly pin that down.
“It could be healthcare, it could be quite a number of factors that might help provide a better, more detailed understanding of why some countries do well, but we don’t yet know.”
So far the analysis has explored the ‘flare task’, which tests sense of direction. Further analysis will explore the ability to remember where you’ve been and to use a map to navigate to checkpoints. It may be that other countries top the league table for using a map.
The second finding is that there are fundamental differences in spatial navigation strategies between men and women.
‘’Men tend to perform a little bit strategically better and that’s something we really need to do a lot of work on to understand,” Dr Spiers explains.
This was true for every country in which the game was played, with the exception of Madagascar and Cuba, interestingly both island nations, where females outperformed males.
Lastly, and most surprising to the researchers, was the steady decline from early adulthood that was found when plotting age against navigational abilities.
“I can now tell you that, from the age of 19 to 75, navigational ability declines with age. It doesn’t simply wait until we are about 40 and then go down, the effect of decline is from early adulthood,” says Dr Spiers.
The researchers had previously thought that there would be a plateau up until a certain age, and then a decline, as previous studies had suggested, but this was strikingly not the case. They pointed out that the decline was not simply reflective of ‘video games playing ability’, as their results were adjusted to account for such trends.
“It was a big surprise to us because we thought that navigational ability would be pretty stable until later in life,” explains Professor Hornberger.
“It’s very important for us if we want to diagnose somebody, if we know that it’s a gradual healthy decline, or if it is something much more related to dementia.”
The game was a collaborative effort from the start. The researchers paired up with game developers, Glitchers, who built the game around the scientific requirements, while Saatchi and Saatchi developed the narrative. Deutsche Telekom provided funding and marketing for the project and Alzheimer’s Research UK provided support, guidance and advice throughout the process.
All involved had the difficult task of making the game fun to play while maintaining the scientific validity that would produce accurate findings. This inevitably entailed compromise from all parties.
“It was exciting and challenging at the same time. With any collaboration, even between scientists, it can be very difficult,” says Professor Hornberger.
Glitchers, the game developers, had a similar experience. Glitchers is a small company set up three years ago that makes games that deliver some kind of technological impact.
The game and the science were very much ‘baked together’ from the start. Glitchers refer to this as ‘game thinking’.
In his previous lab-based navigational research, Dr Spiers had used lava simulations. Molten lava is a natural obstacle that humans know that they should avoid. Glitchers wanted to adapt this innate human understanding of where you can and can’t move for a wider audience.
“I was thinking, how can we do that in a less oppressive setting? The idea of having a boat on the sea to me really feels quite relaxing and very accessible, something that everyone can play,” explains Maxwell Scott-Slade, co-founder of Glitchers.
However, the researchers didn’t want players to benefit from any directional cues that would help them to orientate themselves, thus invalidating the data.
“You can’t use shadows that are directional because it indicates a direction. You can’t have a sun in the sky because it acts as an indication of where you are. You can’t have unique cloud formations. You can’t have so much stuff that you would lean on to make a game look really pretty,” says Scott-Slade.
“For me, the biggest accomplishment in SHQ is having a game that is fun to play, gets people interacting with the subject matter, and makes them aware that there is research going on and that there is progress being made that they can be a part of. That way, they are empowered as players, as if they were citizen scientists,” he adds.
The future of dementia research
Sea Hero Quest illustrates the potentially fruitful relationship between gaming and science.
The game will now be adapted for a clinical setting to help predict the early onset of dementia and inform the treatment of those who have already been diagnosed with the disease. These patients will be tested using selected levels of the game and matched against the global benchmark.
The researchers believe that similar games could be developed to benchmark other symptoms of dementia, such as language and vision problems.
Sea Hero Quest has contributed a huge amount of data and public awareness to the surge of progress dementia research has seen in the past few years.
“The rate of that progress is increasing,” says Timothy Parry, Director of Communications at Alzheimer’s Research UK. “But we’re still conscious of the fact we’re somewhere behind the research understanding that exists in other disease areas-particularly cancer and heart disease.
“So we’re trying to catch up with them, and our solution to closing the gap on other disease areas is to use innovations to do things differently. And I think that’s what this project represents — a completely different and interesting way of doing research, which has driven an enormous response.”