“We are nothing more than the sum of our memories and experiences” ― Michael Scott, The Sorceress
Dementia is a broad range of neurodegenerative diseases, the most common sub type known as Alzheimer’s disease, which effects people’s ability to think and remember as their brains shrink. As the disease progresses, confusion sets in, memories are no longer accessible, and loved ones look no different than strangers. The morbid consolation to this tormenting world of uncertainty is death often soon follows. Alzheimer’s is now the 6th leading cause of death in US, and growing. Furthermore, 1/3 of all seniors die from another cause but with some form of dementia. The risk of dementia is relatively low before the age of 60, however, every 5 years after the age of 65, the risk of dementia doubles. On top of the massive toll it takes on the person suffering from dementia, the entire family is often deeply affected too. Children move their senile parents into their homes to take care of them, spending on average $5,000 a year and countless emotionally draining hours looking after their parents. As a country, dementia care costs in the United States are $238 Billion per year. As a planet, dementia will soon cost our species $1 Trillion per year.
The elusive cause of Dementia
And yet, we are still quite lost on what exactly is causing the majority of dementia cases. Frankly, we have essentially no idea what the precise cause of Alzheimer’s disease is. We do have many hypothesis all with evidence backing them. Is itamyloid plaques not being cleared from the spaces between brain cells? Is it tau proteins tangling up and “choking” brain cells? A combination of both? Is it genetic? If so, how much? Is it a problem with the blood brain barrier getting leaky? Could it be a metabolic disease akin to diabetes? From not getting enough sleep? There is even evidence it may have to do with which position you sleep in at night! Scientists have been investigating all of these hypothesis but a concrete cause remains elusive. Indeed there may be no single cause as each case could be different. However, there is still so much for us to learn about this devastating disease.
It is important to note, some less prevalent but equally serious sub types of dementia, like Vascular Dementia, Lewy Body dementia, and familial early-onset (<65 y/o) Alzheimer’s do have well understood causes.
A new way to fight Dementia
At present, there are few treatments for dementia’s symptoms and there are no cures. Some cognitive tests can be administered to diagnose Alzheimer’s if those afflicted see a physician. Catching dementia early may be beneficial in the course of the disease. With early on lifestyle intervention, such as exercise, healthy eating, and proper sleep, the prognosis may be improved and a better quality of life may be sustained for longer.
Currently, we have very few ways to accurately determine if a person is likely to develop dementia later on in life. If we were able to predict whether or not a person was going to develop dementia, life style interventions could be recommended to at least delay the onset of dementia and possibly ease the severity of symptoms.
One of the early signs of dementia is an impairment in spatial navigation. A brain region called the hippocampus plays a large role in spatial navigation and is one of the most afflicted brain regions in Alzheimer’s. It may be possible to predict the likelihood of someone developing dementia by how they navigate. Studies investigating dementia and spatial navigation have been conducted in labs for years and show promising results. However, these experiments are very costly to run and getting a large number of participants is difficult.
Cue citizen science!
Citizen Science is the methodology of getting everyday citizen to participate in scientific advances with the least amount of effort required on the part of the citizens. For example, amateur astronomers have made tremendous contributions to astronomy and astrophysics by looking at the night sky through their hobby telescopes. Recent advances in computing have led to the development of experiments disguised as games. As people play the game, they help scientists investigate the mysteries of the world. For example, FoldIt is a game where people fold proteins to help scientists understand how proteins function and fail to function.
Just this week, a group of researchers from University College London and University of East Anglia have partnered with an app development company, Glitchers, along with Alzheimer’s Research UK and Deutsche Telekom (T-mobile in the US) to make a game to tackle dementia and #gameforgood. Sea Hero Quest is like any other game in the app store; players solve puzzles to advance through the game, scoring points based on how well they do in a given puzzle and using those points to upgrade the look of their boat. However, Sea Hero Quest is unique! All the data from the puzzles, after being anonymized, are sent to the researchers for analysis to fight dementia!
Sea Hero Quest
In Sea Hero Quest, your dad is aging and succumbing to dementia. You had both explored the far reaches of the world collecting memories of epic lands and mysterious sea creatures. However, your father’s memories of these creatures is failing. By revisiting these lands and searching for the forgotten monsters, you can help restore his memories by documenting the beasts you encounter and finding pages of his old ship’s log book.
In order to find these creatures you must navigate through the treacherous seas. Most levels are a puzzle you must solve in order to collect lost pages. The puzzles are specifically designed to test your spatial navigation skills. With the data of how you and everyone else around the world navigates these puzzles, researchers at the participating universities will be able to uncover how people normally navigate in the game. Using gaming data from a hundred of thousand people playing the game, researchers will save hundreds of years of lab work! At the time of writing this, 220 years of lab work have already been collected.
Researchers will use the gaming data to create a benchmark of how people normally navigate in the world. Then, using this benchmark, they may be able to predict if someone is susceptible to developing dementia if they performance differs from the normal benchmark navigation strategies. As outlined earlier, being able to predict if someone is going to develop dementia could have a large impact on their lives if proper lifestyle intervention is started early.
How does Sea Hero Quest test navigation skills?
Sea Hero Quest will be testing five main navigation skills: basic navigational way-finding; recognizing landmarks; navigating complex situations involving several options; sense of direction; and response and rote learning. Let’s break these down to see how the game does this.
First, a bit on navigational strategies
Often times we don’t think about how we navigate, we often just do it. You don’t have to think very much about how to get home. However, people, and animals, use many different strategies to find their way around the world especially in unfamiliar environments.
People may use landmarks to find their way around. Even this strategy has some nuances; people may use a single landmark, like a tall building or mountain, to orient themselves then use smaller landmarks, like a park or street corner, to get a more granular sense of where they are and where they need to go. This is an example of way-finding navigation.
Other way-finding navigational strategies include using your goal location, if known, to plan your route. For example, if a hungry monkey is on top of a hill and sees a tasty fruit tree in the dense forest. Once in the forest, he may not be able to see the fruit tree very well or at all. To overcome this, he may follow a straight line to the fruit tree from the hill. More generally, such as in the case of migrating species, animals may just roughly travel following a compass rather than planning a specific route to a goal location.
If you know you’re hungry but don’t know where to go, you may employ a search strategy. For example, if you’re in a new city, you may just walk up and down the streets around your apartment until you smell something appetizing. Many insects, like bees, use a similar strategy to find flowers. The strategies insects use to look for food can be quite complex!
Another strategy, referred to as path integration or dead reckoning, is a strategy for navigation that relies on your previous actions to determine where you are. Driving directions, before GPS at least, were often given like this. And example of dead reckoning directions would be, “Drive 10 miles North, then turn East and travel 7 miles, then go North for another 3 miles.”
As an area is learned, a detailed cognitive map, which the hippocampus plays a large role in forming, of the environment likely develops which can be recalled for navigation. Rather than relying on landmarks or path integration, you can simply recall the entire area and the spatial relationship of streets and routes to get from where you are to your goal. Further, you may rely on your memory in tandem with cues from the world to figure out where you are going. “Oh yeah last time I came this way I passed this Starbucks, I must be going the right way.”
As you can see, there are many ways of navigating the world. By investigating which strategies people use in Sea Hero, researchers may find differences in the strategies employed by people with dementia than those without. So how does Sea Hero Quest test these strategies?
Sea Hero Quest navigational test
A majority of levels in Sea Hero quest follow a similar paradigm. Before the start of a level, a map is presented which lays out what the level looks like and the locations of the numbered buoys which you have to travel to in sequential order. At first the maps and levels are very basic, they may even just be straight channel. However, as the game progresses the levels get more difficult. More and more buoys are added and the maps may be water damaged and hard to read.
The map portion of the level is vital to getting a good score which is based on how quickly you reach each buoy. However, you can choose any strategy you want. If you have an exceptionally good memory, you may just memorize the layout of the level and where the buoys are. I found this quite difficult to do, especially as levels got more complex. Also, this strategy would not work when you get a water damaged map. Another strategy, using path integration, may be to form a route in your mind irrespective of the map. “First go right, then straight for a while until I hit buoy 1, then go left for a short distance than up till I find buoy 2.” A third strategy based on goal locations could just be learning the relative layout of the buoys to each other. “Buoy 1 is in the top left while buoy 2 is in the middle and bottom portion while buoy 3 is back on the left side.”
For more general strategies, you may just get a rough idea of the map and buoy layout then use landmarks throughout the level, such as castles, crabs, and mushrooms, to find your way around. You could use your original bearing direction and find a distant landmark, like a mountain, to orient with to point you in the direction of the current buoy. Or you may simply ignore the map and randomly travel around till you find each buoy, though this won’t get you many points!
The game seems quite simple then, in theory. Find a strategy that works and stick with it. However, through clever game design, researchers coerce you into using different strategies on different levels. For example, some levels have a very heavy fog which obscures all landmarks and even makes it hard to find the shore line. Other levels may have a very prominent landmark, like a castle, which is hard to ignore when developing a strategy. Other levels have lots of side paths that lead no where, making dead reckoning quite difficult. Buoys may be laid out in a complex manner, such as buoy 1 and 3 being close together but 2 being on the complete other side of the map which makes it difficult to hold in mind the specific relationships between them and your own orientation relative to them.
By using data from a hundred thousand Sea Heroes, researchers can develop a model for how people navigate different levels in order to test these strategies against those of people with dementia. A member of the team at University College London, Professor Hugo Spiers, is planning a study where participants will have their brain’s scanned while the play the game. This will help elucidate which regions of the brain are recruited during game play and navigation. By seeing which brain regions are recruited in normal navigators, these brain regions could be compared to those with dementia playing the game. As the brains of those with dementia deteriorate, different brain regions may be recruited to compensate different from normal navigators. This may then tell us which brain regions to keep an eye out early on. It is just my speculation, but longitudinal studies may also be planned to see how people who go on to develop dementia had navigated the game before being diagnosed.
Origin orienting test
Keeping in mind where you started a journey requires quite a bit of brain power. You need to keep in mind the turns and twists you’ve taken from where you started to where you began. Interspersed with the map levels there are some flare gun levels. On these levels, you start from one point of the level, with no map, and have to navigate around until you find a flare gun. Once you find the gun, you’re tasked with shooting the flare back to where you started. For people with dementia, it is often hard to keep in mind where they have been and where they are going which leads to them getting lost. These levels could help shed light on early signs of this symptom.
The main object of the game is to recapture memories of the fantastical creatures you had first seen with your father in his youth. For each stage of the game there are three different creatures. Every 5th level is a boss battle. These levels test your reaction time as you dodge boulders and waves at high speeds to track down the creatures as they flee. Once your boat is close enough, the monster will jump out of the water and you must take a picture of it for the log book. However, there is only a small time window where the entire monster is visible. If you snap a picture here, you get full points. However, if you snap too early or too late, you will be left with a bad picture and a sub-optimal score. Though reaction times may not be the best measure for predicting if someone will go on to develop dementia, together with the navigational data it may aid in the game’s predictive power.
Just by itself Sea Hero Quest is fun to play! However, playing it and knowing you are helping fight dementia is a great feeling and makes spending time gaming feel a bit more productive. Every month, 126 million people in the US alone play a mobile game. On average, players spend around 30 minutes every day playing mobile games. Using mobile gaming for scientific research could save hundreds of years of lab work and provide larger, more robust findings from hundreds of thousands, rather than a few dozen, participants. Hopefully Sea Hero starts a trend with app companies teaming up with researchers to tackle mysteries which still remain.
You can get Sea Hero Quest here:
Cathleen M. Connell, Mary R. Janevic, and Mary P. Gallant. The Costs of Caring: Impact of Dementia on Family Caregivers. 2001. J Geriatr Psychiatry Neurol December, 14 ,(4): 179-187. doi: 10.1177/089198870101400403
Hebert LE, Weuve J, Scherr PA, Evans DA. Alzheimer disease in the United States (2010–2050) estimated using the 2010 Census. 2013 Neurology 80(19):1778–83.
Hedok Lee, Lulu Xie5, Mei Yu, Hongyi Kang, Tian Feng, Rashid Deane, Jean Logan, Maiken Nedergaard, and Helene Benveniste. The Effect of Body Posture on Brain Glymphatic Transport. 2015. The Journal of Neuroscience, 35(31): 11034-11044; doi: 10.1523/JNEUROSCI.1625-15.2015
Jae-Eun Kang, Miranda M. Lim, Randall J. Bateman, James J. Lee, Liam P. Smyth, John R. Cirrito, Nobuhiro Fujiki, Seiji Nishino, and David M. Holtzman. Amyloid-β Dynamics are Regulated by Orexin and the Sleep-Wake Cycle. 2009. Science.; 326(5955): 1005–1007. doi: 10.1126/science.1180962
Suzanne M. de la Monte and Jack R. Wands.Alzheimer’s Disease Is Type 3 Diabetes–Evidence Reviewed. 2008. J Diabetes Sci Technol. 2(6): 1101–1113.
Marques F, Sousa JC and Sousa N, Palha JA. Blood-brain-barriers in aging and in Alzheimer’s disease. 2013. Mol Neurodegener. 8 (38). doi: 10.1186/1750-1326-8-38.
Jennifer H Barnett, Lily Lewis, Andrew D Blackwell, and Matthew Taylor. Early intervention in Alzheimer’s disease: a health economic study of the effects of diagnostic timing. 2014. BMC Neurol 14 (101). doi: 10.1186/1471-2377-14-101
Kamil Vlček and Jan Laczó. Neural correlates of spatial navigation changes in mild cognitive impairment and Alzheimer’s disease. Front. Behav. Neurosci., 17 March 2014 | http://dx.doi.org/10.3389/fnbeh.2014.00089
Henrik Mouritsena, Rachael Derbyshire, Julia Stalleicken, Ole Ø. Mouritsen, Barrie J. Frost, and D. Ryan Norris. An experimental displacement and over 50 years of tag-recoveries show that monarch butterflies are not true navigators. 2013. PNAS 110 (18): 7348–7353, doi: 10.1073/pnas.1221701110
Michele Lanan. Spatiotemporal resource distribution and foraging strategies of ants (Hymenoptera: Formicidae) 2014. Myrmecological News, 20: 53-70.
Maya Geva-Sagiv, Liora Las, Yossi Yovel & Nachum Ulanovsky. Spatial cognition in bats and rats: from sensory acquisition to multiscale maps and navigation. 2015. Nature Reviews Neuroscience 16: 94–108 doi:10.1038/nrn3888
This work by Blake Porter is licensed under a Creative Commons Attribution-Non Commercial-ShareAlike 4.0 International License
If you enjoyed this article and found it informative, consider donating! Funds first go to keeping the website running (domain name/hosting) and secondly go to me. Donations are secure and handled by PayPal.