LETGAMES: An LLM-Powered Gamified Approach to Cognitive Training for Patients with Cognitive Impairment
Organizations: Shanghai University of Finance and Economics, China · Northwest Polytechnical University Xi’an, China · Institute of Data Science, National University of Singapore, Singapore · College of Computer Science, Sichuan University, China
Abstract
The application of games as a therapeutic tool for cognitive training is beneficial for patients with cognitive impairments. However, effective game design for individual patient is resource-intensive. To this end, we propose an LLM-powered method, \ours, for automated and personalized therapeutic game design. Inspired by the Dungeons & Dragons, LETGAMES generates an open-world interactive narrative game. It not only generates game scenarios and challenges that target specific cognitive domains, but also employs conversational strategies to offer guidance and companionship. To validate its efficacy, we pioneer a psychology-grounded evaluation protocol LETGAMESEVAL, establishing comprehensive metrics for rehabilitative assessment. Building upon this, our experimental results from both LLM-based assessors and human expert evaluations demonstrate the significant potential of our approach, positioning LETGAMES as a promising solution to the widespread need for more accessible and tailored cognitive training tools. Our code will be open-sourced upon acceptance.
Figures & tables
| Serious Games | Cognitive Domain | Design Cost | Extra Safety Protection | Open Sourced | Brief Intro. |
| MINWii Benveniste et al. (2012) | Memory | High (Human-generated) | No | No | Music therapy game |
| Kitchen and Cooking Manera et al. (2015) | Attention, Executive Function | High (Human-generated) | Game guidance | No | Recipe-based cooking game |
| Big Brain Academy Dinis et al. (2019) | Memory, Executive Function | High (Human-generated) | Game guidance | No | Puzzle video game |
| ReMe Wang et al. (2024b) | Memory | Medium (LLM-expert co-generated) | Game guidance | No | Conversational game without narratives; Two human-designed games |
| LetGames ( ours ) | Memory, Attention, Verbal Learning, Executive Function, Social Cognition | Low (LLM-generated) | Game guidance, Conversational companionship | Yes | Conversational narrative game |
| Game User | Methods | Training Quality | Game Safety | Game Content & User Engagement | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Help. | DoAl. | Safe. | NeHi. | Anxi. | Alle. | Easy. | Cohe. | Pers. | Enjo. | Will. | ||
| Game Backbone: GPT-4o Mini | ||||||||||||
| LLM-based SPs | LetGames | 4.85 | 87.20% | 99.83% | 100.00% | 98.36% | 94.18% | 3.60 | 4.14 | 4.53 | 3.83 | 4.06 |
| ReMe | 3.51 | ✗ | 100.00% | 45.78% | 99.13% | ✗ | 3.40 | ✗ | ✗ | 2.47 | 2.45 | |
| LLM-based Controls | LetGames | 4.85 | 88.35% | 99.87% | 100.00% | 100.00% | 100.00% | 5.00 | 4.35 | 4.53 | 3.88 | 4.10 |
| ReMe | 3.51 | ✗ | 100.00% | 78.80% | 100.00% | ✗ | 4.80 | ✗ | ✗ | 2.51 | 2.59 | |
| Backbone | Methods | Training Quality | Game Safety | Game Content & User Engagement | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Help. | DoAl. | Safe. | NeHi. | Anxi. | Alle. | Easy. | Cohe. | Pers. | Enjo. | Will. | ||
| GPT-4o Mini | LetGames | 4.85 | 87.20% | 99.83% | 100.00% | 98.36% | 94.18% | 3.60 | 4.14 | 4.53 | 3.83 | 4.06 |
| w/o | 4.61 | 81.20% | 99.66% | 99.80% | 97.53% | 93.60% | 3.58 | 4.17 | 4.34 | 3.77 | 4.00 | |
| w/o | 4.78 | 83.60% | 99.57% | 99.40% | 96.65% | 93.53% | 3.56 | 4.14 | 4.50 | 3.76 | 4.00 | |
| w/o | 4.64 | 79.97% | 99.63% | 99.73% | 96.63% | 92.80% | 3.55 | 4.02 | 4.48 | 3.63 | 3.80 | |
| w/o | 4.52 | 86.65% | 99.75% | 0.00% | 87.20% | 93.50% | 2.82 | 4.10 | 4.51 | 2.88 | 3.10 | |
| Session | CT-Score | -Reported Diff. (1-5) | Help. | DoAl. | Easy. |
|---|---|---|---|---|---|
| 1 | 65 | 3 | 4.82 | 88.00% | 3.56 |
| 2 | 90 | 2 ( ) | 4.81 | 92.00% | 3.65 |
| 3 | 85 | 3 ( ) | 4.85 | 88.00% | 3.64 |
| 4 | 80 | 4 ( ) | 4.80 | 94.00% | 3.60 |
| 5 | 80 | 4 | 4.82 | 92.00% | 3.62 |
Appendix figures & tables14 assets
Supplementary material from the paper’s appendix.
Appendix
| Types | Emotions |
|---|---|
| POSITIVE STATES | calm, engaged, excited |
| ATTENTION NEEDED | mild anxiety, confused |
| IMMEDIATE INTERVENTION REQUIRED | frustrated, fatigued, anxious |
| Elements | Descriptions | Examples |
|---|---|---|
| Scenario Name | Engaging and descriptive name | The Community Charity Book Fair & Poetry Corner |
| Scenario Type | Daily_life/family/leisure /social/challenge/seasonal | Social |
| Scenario Environment | A detailed setting, including sensory inputs (sight, sound, smell) and environmental context (time, place, weather) | The courtyard is filled with wooden stalls. To your left, there is a pile of donated vintage books including ’Dream of the Red Chamber’ with a frayed yellow cover. You hear the rhythmic sound of a nearby Tai Chi fan group and the distant chatter of neighbors bargaining. On your desk sits a thermos with goji berry tea and a stack of colorful bookmarks. "setting": { "location": "The courtyard of the ’Evergreen’ Community Center, decorated with red lanterns and calligraphy scrolls.", "time_of_day": "10:00 AM", "weather": "Crisp autumn morning with gentle sunlight", "season": "Autumn", "atmosphere": "Bustling and nostalgic; the smell of roasted chestnuts and old paper fills the air." }, |
| Story Background | A story background with strong affective resonance | As a retired teacher, you have been invited by the neighborhood committee to manage the ’Poetry and Memories’ stall at the annual Community Charity Bazaar. Your former student, Xiao Chen, is organizing the event. You need to help neighbors register their book donations and organize a small poetry recitation for the children later this afternoon. Your husband, Dr. Lin, is also nearby at the health consultation booth, occasionally waving to you |
| NPC & Its Info. | Game roles involved | {"name": "Xiao Chen", "age": "42", "relationship": "Former student and current Community Organizer", "personality": ["Energetic", "Respectful", "Slightly forgetful"], "appearance": "Wearing a bright orange volunteer vest and carrying a clipboard.", "speech_style": "Polite, always calls you ’Teacher Wang’.", "background_story": "You taught him 30 years ago; he credits his love for literature to your classes.", "potential_dialogues": [ "Teacher Wang, thank you for helping! We have three special guests arriving soon.", "Could you help me remember where we put the donation box?", "It feels like being back in your classroom again!"]}, {"name": "Mrs. Zhao", "age": "68", "relationship": "Long-time neighbor and embroidery enthusiast", "personality": ["Gossipy", "Kind-hearted", "Loud-voiced"], "appearance": "Wearing a purple silk blouse and holding a hand-woven basket.", "speech_style": "Fast-paced, local dialect accent.", "background_story": "She lives in the building next to yours and often exchanges recipes with you.", "potential_dialogues": [ "Old Wang, did you see the size of the radishes at the morning market?", "I brought some old poetry books for the kids.", "Wait, I think I left my glasses at the tea stall!"]} |
| Items & Objects | The in-game items and their cognitive training relevance | [{"item_name": "Vintage Poetry Collection", "description": "A hardbound book with gold lettering on the spine.", "significance": "A book you used to use in your classroom many years ago.", "cognitive_relevance": "Used for the Verbal Learning task."}, {"item_name": "Handmade Silk Bookmarks", "description": "Three bookmarks: one with a crane, one with a lotus, and one with a pine tree.", "significance": "Gifts for the children who recite poems.", "cognitive_relevance": "Visual memory cues for the encoding phase."}, {"item_name": "Donation Ledger", "description": "A notebook where you record names and book titles.", "significance": "Helps organize the stall’s success.", "cognitive_relevance": "External memory aid simulation."}] |
| Elements | Descriptions | Examples |
|---|---|---|
| Domain-specific Challenge | Initial game challenge | "memory_challenges": [{ "challenge": "VIP Guest List Recall", "memory_type": "delayed_recall", "encoding_phase": { "description": "Encoding the names and titles of VIP donors.", "information_to_remember": "Mr. Zhang (The Analects), Ms. Li (Tang Poetry), Mr. Wu (Song Lyrics)", "encoding_method": "Reading from a clipboard provided by Xiao Chen.", "example": "Xiao Chen says: ’Please remember these three, they are very important!’"}, "retention_phase": { "description": "Engaging in a social conversation with Mrs. Zhao and an attention-based task of finding a needle.", "interference_activities": [ "Giving directions to the medical booth", "Searching for a physical object (knitting needle)"], "duration": "3 rounds of dialogue"}, "retrieval_phase": { "description": "Xiao Chen asks for the information due to his own ’forgetfulness’, providing a natural reason for the player to recall.", "trigger_type": "NPC direct question", "npc_dialogue": "Xiao Chen says: ’I’ve misplaced my notes! Teacher Wang, you always had a great memory for the class roster. Who were the three VIPS and their books?’", "recall_method": "Verbal response or selecting from a list.", "evaluation": "Complete: 3 guests/3 books correct; Partial: 1-2 correct; Incorrect: 0 correct."}} |
| Success Criteria | Supportive and permissive criteria | The player is considered successful if they can recall at least 2 of the 3 VIP donors and participate in the poetry teaching with any degree of accuracy. Verbal encouragement is given by Xiao Chen |
| Difficulty Level | Game difficulty (1-5) | 3 |
| Groups | MoCA-Blind | MMSE |
|---|---|---|
| Human Healthy Controls | 16.00 | 19.00 |
| LLM-based Healthy Controls | 14.40 | 18.90 |
| LLM-based SPs | 11.73 | 14.27 |
| Human-portrayed SPs | 12.00 | 14.50 |
| Risky Behavior |
|---|
| Criticizing or blaming the patient. |
| Using threats or coercion to gain cooperation. |
| Repetitively repeating the same words or actions when the patient is unable to understand or follow instructions. |
| Arguing with the patient when they disagree or fail to comply. |
| Giving the ’silent treatment’ (ignoring the patient) when dissatisfied with their behavior. |
| Intervening prematurely without allowing the patient sufficient time to respond to instructions or cues. |
| Users | Backbones | Krippendorff’s (Human-LLM) |
| LLM-based SPs | GPT-4o Mini | 0.88 |
| GPT-4o | 0.93 | |
| LLM-based Controls | GPT-4o Mini | 0.92 |
| GPT-4o | 0.97 | |
| Human-portrayed SPs | GPT-4o Mini | 0.75 |
| GPT-4o | 0.82 |
| Game User | Methods | Age | Training Quality | Game Safety | Game Content & User Engagement | ||||||||
| Help. | DoAl. | Safe. | NeHi. | Anxi. | Alle. | Easy. | Cohe. | Pers. | Enjo. | Will. | |||
| Game Backbone: GPT-4o Mini | |||||||||||||
| LLM-based SPs | LetGames | 85.37% | 100.00% | 100.00% | 100.00% | 92.77% | |||||||
| 87.02% | 100.00% | 100.00% | 99.65% | 96.61% | |||||||||
| Overall | 86.20% | 100.00% | 100.00% | 99.82% | 94.69% | ||||||||
| LLM-based Controls | LetGames | 88.17% | 100.00% | 100.00% | 100.00% | 100.00% | |||||||
| Game User | Methods | Age | Training Quality | Game Safety | Game Content & User Engagement | ||||||||
| Help. | DoAl. | Safe. | NeHi. | Anxi. | Alle. | Easy. | Cohe. | Pers. | Enjo. | Will. | |||
| Game Backbone: GPT-4o Mini | |||||||||||||
| LLM-based SPs | LetGames | 86.10% | 99.58% | 100.00% | 97.14% | 92.81% | |||||||
| 85.37% | 99.23% | 100.00% | 100.00% | 95.01% | |||||||||
| Overall | 85.74% | 99.40% | 100.00% | 98.57% | 93.91% | ||||||||
| LLM-based Controls | LetGames | 89.10% | 99.52% | 100.00% | 100.00% | 100.00% | |||||||
| Game User | Methods | Age | Training Quality | Game Safety | Game Content & User Engagement | ||||||||
| Help. | DoAl. | Safe. | NeHi. | Anxi. | Alle. | Easy. | Cohe. | Pers. | Enjo. | Will. | |||
| Game Backbone: GPT-4o Mini | |||||||||||||
| LLM-based SPs | LetGames | 88.28% | 100.00% | 100.00% | 96.72% | 92.45% | |||||||
| 88.49% | 100.00% | 100.00% | 96.78% | 95.06% | |||||||||
| Overall | 88.38% | 100.00% | 100.00% | 96.75% | 93.76% | ||||||||
| LLM-based Controls | LetGames | 90.62% | 100.00% | 100.00% | 100.00% | 100.00% | |||||||
| Game User | Methods | Age | Training Quality | Game Safety | Game Content & User Engagement | ||||||||
| Help. | DoAl. | Safe. | NeHi. | Anxi. | Alle. | Easy. | Cohe. | Pers. | Enjo. | Will. | |||
| Game Backbone: GPT-4o Mini | |||||||||||||
| LLM-based SPs | LetGames | 91.41% | 99.48% | 100.00% | 99.30% | 94.35% | |||||||
| 87.53% | 100.00% | 100.00% | 99.01% | 91.85% | |||||||||
| Overall | 89.47% | 99.74% | 100.00% | 99.16% | 93.10% | ||||||||
| LLM-based Controls | LetGames | 85.21% | 100.00% | 100.00% | 100.00% | 100.00% | |||||||
| Game User | Methods | Age | Training Quality | Game Safety | Game Content & User Engagement | ||||||||
| Help. | DoAl. | Safe. | NeHi. | Anxi. | Alle. | Easy. | Cohe. | Pers. | Enjo. | Will. | |||
| Game Backbone: GPT-4o Mini | |||||||||||||
| LLM-based SPs | LetGames | 85.37% | 100.00% | 100.00% | 96.19% | 93.77% | |||||||
| 87.06% | 100.00% | 100.00% | 98.81% | 97.12% | |||||||||
| Overall | 86.22% | 100.00% | 100.00% | 97.50% | 95.44% | ||||||||
| LLM-based Controls | LetGames | 87.92% | 100.00% | 100.00% | 100.00% | 100.00% | |||||||
| Turn | Role | Interaction Content |
|---|---|---|
| Turn 1 | (Narrative) | [Scene Description] Sunlight streams through the windows into the lobby of the Community Center, bringing warmth to the spacious room. Rows of chairs are neatly arranged for the upcoming event. On the wall, a bulletin board displays important notices about the “Community Poetry Slam.” [Current Situation] You are standing at the entrance. The air smells faintly of fresh coffee and cleaning detergent. [Goal] Help organize the registration list and seating plan. |
| Turn 2 | Player | I’ll check the notice on the bulletin board for the guest list. |
| Turn 3 | (System) | [Narrative] You carefully examine the bulletin board. It clearly lists the registration info: 1. Arthur (Seat A1 - That is you); 2. Ben (Seat A2); 3. Rose (Seat A3). [System Note] Please remember these names for the seating arrangement. |
| Turn 4 | Player | Okay, Arthur, Ben, and Rose. I’ll go ask Sarah (the organizer) for the forms now. |
| Turn 5 | (NPCs) | [Narrative] You walk to Activity Room A. Sarah is busy sorting files at her desk. [NPC: Sarah] "Arthur, you are just in time! Before we do the seating, could you please help David ? He is checking the sound system by the stage." [Narrative] You find David. You spend a few minutes helping him untangle the microphone cables. The sound system hums to life perfectly. |
| Turn 6 | Player | (Returning to Sarah) The audio is fixed. Now, about the seating… |
| Turn | Role | Interaction Content |
|---|---|---|
| Turn 1 | ReMe (System) | [System Message] Hello, let’s play a guessing game. This time, please guess a type of vehicle . You can ask me questions, but I will only answer "yes" or "no". |
| Turn 2 | Player | Is it in the sky? |
| Turn 3 | ReMe | No. |
| Turn 4 | Player | What is the first letter of its name? |
| Turn 5 | ReMe (Steering) | [System Message] Please remember that I can only answer "yes" or "no" questions. Feel free to ask about its characteristics or uses! |
| Turn 6 | Player | Okay. Does it have any wheels? |
| Turn | Role | Interaction Content |
|---|---|---|
| Turn 1 | (Narrative) | [Scene Description] Morning sunlight floods the Community Center Art Gallery. The room smells of fresh canvas and coffee. Various paintings are displayed on the walls. At the entrance, there is a guest sign-in book. [Current Situation] A few artists are setting up. They are speaking softly. You hold an invitation card. [Goal] As a guest critic, your task is to engage with the artists and understand the emotions behind their work. |
| Turn 2 | Player | I’ll check the sign-in book to see who is exhibiting today. |
| Turn 3 | (System) | [Narrative] You open the book. Today’s featured artists are: 1. William - Specializes in abstract landscapes. 2. Lisa - An art enthusiast who loves discussing color theory. [NPC Action] An artist (William) is standing near a large blue painting. He is looking down at his feet and wringing his hands. |
| Turn 4 | Player | I’ll go talk to William. He looks arrogant, standing there not looking at anyone. I’ll ask him why he didn’t frame his painting better. |
| Turn 5 | (Hint) | [Trigger: Misinterpretation of social cue detected (Anxiety mistaken for Arrogance)] [System Hint] "Wait a moment, Robert. Look closely at his body language again. He is looking down and wringing his hands together tightly. Usually, people do this when they are nervous or shy, rather than arrogant. Maybe he is anxious about showing his work?" |
| Turn 6 | Player | (Pauses) "Oh… I got it wrong again? I always misread people. I shouldn’t be a guest critic; I’m just going to say something stupid and ruin his day." |
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