Keywords

1 Introduction

1.1 Background

According to Alzheimer’s Disease International (ADI) data from 2017, it is estimated that on average every 4 s one person will suffer Dementia onset, with Alzheimer’s disease (AD) accounting for the majority of Dementia sufferers (about 60–80%) [1].

Contemporary eating habits combined with long-term sedentary work patterns along with slowed metabolism in the middle-aged and elderly and lack of exercise, lead to increasing prevalence of suffering from Alzheimer’s disease. As cerebral disease is often complicated and considered dangerous by patients, and cannot be easily detected, or when detected there is already irreversible nerve damage; therefore, cerebral health is often ignored. Especially in the senior years, when the body’s metabolism is gradually slowing, the lack of exercise, resulting in poor blood circulation, affecting and resulting in slow cerebral blood flow and vasoactivity, causes the brain to aggregate unnecessary substances, and finally results in pathological cerebral states and disease. The brain is one of the most important human organs, and maintaining cerebral health and an active lifestyle are keys to preventing senescence and enjoying longevity in the aging society [2, 3].

In today’s mainstream allopathic medicine, treatments and prevention methods are divided into pharmacological and non-pharmacological treatment approaches, pharmacological treatment aims to increase Acetylcholinesterase inhibitors to reduce cerebral hypoxia, while for improving patient status through invasive methods, the price of medicine is not only expensive, but patient willingness to take medicine for a long time is also not high [4]. Non-pharmacological preventive treatment includes regular exercise, reminiscence therapy and music therapy, through speech communication or improvement of emotions, and thus slowing progressive degeneration [5, 6]. This reduces senior citizens’ needs for pharmacological treatment, hence, it is extremely important to improve the prevention of neurodegenerative conditions among senior citizens through performing simple activities.

This study aims to promote people’s activities in a simple and convenient way, to explore the etiology of Alzheimer’s disease, to analyze the causes of cognitive impairment, to consider from which point of view we can effectively prevent AD, enhance senior citizens’ willingness for engaging in activities, and promote cerebral vascular circulation, increasing brain-derived neurotrophic factor (BDNF), analyzing how the holistic approach accelerates cerebral vascular circulation and brain activation, and consider human factors designs to develop a suitable human-computer interaction designed device to slow down the increasing rate of the AD population, as well as reduce the future mental, economic and social pressures on primary and secondary caregivers.

1.2 Research Purposes

This study requires senior citizen interaction including the needs of senior citizens and their activities in device development and research. The main purpose of this study is to develop a set of interactive devices with elderly preferences and suitability by understanding the causes of cognitive function and memory degeneration caused by AD.

During the process of the research, this study will accompany senior citizens to deploy several smart games on the market and explore the relevant literature on improving AD. The activities and difficulties can be used as evaluation experiments for future device design. Test results and literature review organization will specifically summarize the useful parameters of the senior citizens in the smart game activities that can be used as a reference for the development of wearable evaluation devices in the future.

The main purposes of this study are summarized in these 3 following points: (1) Analysis of the relationship between puzzle/smart games on the market and prevention of AD. (2) Exploring the etiologies influencing cognitive function and neurodegeneration as the theoretical basis for the design of the evaluation device. (3) Focusing on the design of interactive devices and evaluation devices for promoting cerebral vascularity and non-sedentary activities.

It is hoped that this study will elucidate the differences in the games for reducing memory degeneration and cognitive training, elicit the learnability of the products and needs for improvement, and try to integrate the medical operations of cognitive impairment and memory degeneration as referents in future design.

2 Related Work

2.1 Alzheimer’s Disease

In the initial phase of AD, the temporal lobe’s entorhinal cortex and hippocampus nerve cells are damaged resulting in inability to form new memory. With the aggregation of amyloid beta (Aβ) and it’s slowly spreading throughout the brain, the affected brain areas extend wider from the hippocampus to the temporal lobe to cause dysphasia and further influence the frontal lobe, affecting cognition, logic and judgment for decision-making ability. In the late phase of AD, there will occur cerebral atrophy and neurodegeneration, and brain functions will be affected as the patient loses ability for independent living [7].

Harm of Aβ to nerve cells:

  1. (1)

    Etiology of Brain Aβ:

Aβ will aggregate into a senile plaque, over 10 to 20 years, Tau protein will be coagulated in the nerves, causing neurofibrosis, blocking neuro processes or links, and resulting in neural twisting, causing nerve cell atrophy and death [8, 9].

  1. (2)

    Tau Neurofibrillary Tangles:

Aβ oligomers attached on the nerve cell membrane may activate Phosphorylase kinase, causing Tau proteins excessive phosphorylation and leaving the microtubules, while the microtubules without Tau protein stability contribution leads to disintegration, aggregation into neurofibrillary tangles, with cell body substances unable to be transported to the axon distal end, resulting in Neuronal synapse atrophy and degeneration [10].

  1. (3)

    Generate Reactive Oxygen and Free Radicals:

Aβ binds to the scavenger receptor of cerebrovascular epithelial cells and produces reactive oxygen via NADPH oxidase [11], which reduces brain blood flow, promotes Aβ aggregation, and forms cerebral amyloid angiopathy (CAA). Aβ also reduces the efficiency of mitochondrion to produce ATP, and increases Reactive oxygen generation [12].

  1. (4)

    Causes Cerebrovascular Constriction:

The mechanism eliminating Aβ is the blood-brain barrier (BBB) and if it is blocked, there will be increasing Aβ aggregation in the blood vessels, inducing cerebrovascular constriction and reducing brain blood flow [13] (Fig. 1).

Fig. 1.
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Formation process of Alzheimer’s disease

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2.2 Importance of Cerebral Vascular Blood Circulation to Prevent Alzheimer’s Disease

The brain is the most metabolically active organ in the human body. Because the energy reserves of the brain are scarce, it is extremely important to continuously provide nutrient energy to the brain. The brain must rely on circulation to maintain the supply of nutrients and oxygen to effectively remove dysfunction from metabolic waste. AD is a disease that may cause neurovascular dysfunction and aging to form neurodegeneration [14]. Cerebrovascular injury promotes aggregation of AD Aβ in the brain, and Aβ aggregation leads to BBB blockage in the brain of those with Alzheimer’s disease. AD promotes inflammation and cytotoxicity, so cerebrovascular destruction can cause damage to the blood-brain barrier, causing the neurotoxic cycle to directly trigger neuronal damage [15]. Vascular dysfunction also affects Aβ clearance, leading to elevated Aβ concentration in the brain [16].

In AD patients, the most important way to discharge Aβ is the blood-brain barrier. If the elimination rate is too slow, Aβ concentration will be deposited in the brain micro vascularity, which will cause the cerebral blood vessels to lose elasticity and damage the brain blood flow adjusting its function and forming a vicious neuropathological circle [17, 18]. Therefore, the discharge of Aβ reduces the concentration of the pathological or toxic substances, when the blood circulation is enhanced. The interaction between the aggregation and blood circulation to reduce Aβ is a non-negligible factor in the design of this product [13].

2.3 Prevention of Alzheimer’s Disease

Exercise Helps Improve Cognitive Function

Mild cognitive impairment (MCI) is a transitional phase between normal cognitive function and mild Dementia. Depending on the severity of AD, cognitive impairment will become more and more serious in specific areas of the brain (hippocampus and prefrontal areas). In order to promote the region of cognitive task performance, cognitive degeneration is considered to be an indicator of deterioration of brain tissue and brain’s function. There are many references that demonstrate promoting cardiovascular health and performing aerobic exercise can effectively improve cognitive function [19, 20].

Holistic cognitive function involves memory, language, perception, and executive function (EF), where EF is an important function in working memory, problem solving, and complex reasoning. Therefore, the relationship between executive function and AD is considered. Research indicates that moderate-intensity continuous exercise (MCE), and high-intensity interval exercise (HIIE) can effectively improve EF. In addition to aerobic exercise, resistance exercise also has a positive effect on cognitive function. Scholars also propose that the combination of resistance exercise and aerobic exercise is more than aerobic exercise alone or resistance exercise has a greater influence on cognitive function [21]. Aerobic exercise can improve several aspects of executive function (EF), especially inhibitory control (IC). Inhibitory control, as a cognitive process, involves the prefrontal cortex (PFC), and Caudate nucleus participation control with subthalamic nucleus. Inhibitory control (IC) can improve neural activities in the brain as induced by aerobic exercise and resistance exercise [22].

Exercise Promotes BDNF Secretion

Brain-derived neurotrophic factor (BDNF) acts on the Central Nervous System (CNS) and the Peripheral Nervous System (PNS) in the neuron, helping the neuron to grow and derive new neurons and synapses, particularly focusing on the hippocampus and cerebral cortex, so learning and memory are extremely important [23]. Many surveys show that people with higher education or those who need to work with the brain have lower rates of dementia, and environmental stimulation, learning or exercise require the brain’s neurological action [24]. The aforementioned stimulation can promote nerve health by increasing the secretion and function of BDNF. If nerve cells increase or there are more synapse links between cells, when a synapse is blocked by Aβ aggregation, it can transmit information via other synapses. When the brain’s blood flow is reduced, it will affect BDNF generation, and cause brain damage [25].

Exercise is the most effective method to reduce the risk of AD. The induction of aerobic exercise and resistance exercise can promote improved cognition, and also promote BDNF. The literature repletely demonstrates that physical exercise delays cognitive decline. A non-pharmaceutical intervention to stave off neurodegeneration, neuroprotective factors are not only associated with brain plasticity and neurobehavioral efficacy, but also have a great relationship with angiogenesis [21]. The reason for this is that exercise will increase the activity of neplysin, which decomposes Aβ. In addition to the goal of preventing AD Aβ aggregation, nerve cells can be made into BDNF to achieve neuroprotective effects [25, 26].

Finger Activities Stimulate the Brain

Neurosurgeon Wilder Penfield plotted a homunculus, which shows that the five fingers and the palm account for about one-third of the total neurotopology affected by the exercise area, and the somatosensory cortex constitutes about a quarter of the total. The Motor Cortex area is responsible for performing body movements. The function of the Somatosensory Cortex area is for feeling, so about one-third of the brain’s field is used to control the fingers and hands, especially the fingertips which have many nerve cells connected in series [27]. Some studies have pointed out that finger stimulation specified tasks can increase blood flow in the brain and also find that in the finger touch recognition task, the sympathetic nerve will induce blood vessels constriction, resulting in changes in the fingertip blood flow [28, 29].

The three main functions of the nerve are sensory function, synthesis and command function and exercise function. The peripheral nerve contains sensory nerves and exercise nerves. When we feel an object through the sense of touch, we will receive the message through the sensory nerves and transmit it to the central nervous system (CNS). The exercise nerves complete a series of actions, so the finger is at the end of the peripheral sensory nerve. The starting point for transmitting the message is also the place where the nerve distribution is the mostly dense. In the task of tactile perception, it is equivalent to performing indirect brain nerve activities [30] (Fig. 2).

Fig. 2.
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Homunculus neurotopology

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2.4 Prevention Device Design Guidelines and Principles for Alzheimer’s Disease

Holistically organizing the above-mentioned studies on the causes and prevention of AD allow for discrimination in the following three directions:

  • Exercise can promote brain’s secretion of BDNF, training cognitive function to activate the brain

  • Finger activities and tactile movements combine the operation of sensory nerves, exercise nerves and the brain to increase cerebral blood flow.

  • Increase in cerebral blood flow can promote BDNF production and reduce Aβ aggregation.

This study used observation, literature review and invited experts in various fields to carry out a focus group, as well as considering how to advance cerebral blood circulation, types of senior citizen activities and market trend to discuss the design direction and development.

3 Research Method

The literature points out that brain’s blood circulation is one of the key factors in preventing AD. This study clarifies the problem and establishes the goal of innovative design.

3.1 Participant Observation

This study focuses on the training of senior citizens for preventing AD; therefore, we observe the type of elderly activities in daily life at nursing homes, and learn about the interests of the elderly and their participation willingness for various activities, among which Dementia and people with mobility problems accounted for the majority. By interacting with the elderly to understand their lifestyles and interests, the participants’ wishes and appropriateness were determined by observing the status of the activities, and asking the local caregivers to design activities and objectives of the activities, in order to obtain the most realistic scenarios, by maintaining the most natural context, reducing the interaction effects of the observed person, and reducing the preconceived views of the individual by the researcher. This study incorporates the life style and activities as observed into the future design considerations.

Problems found by observation are divided into five major items: (1) it is impossible to synchronize multiple tasks, such as simultaneous stepping and clapping. (2) When performing exercise, the correctness of the posture is not clear. (3) Trying new things is difficult. (4) High participation rate for things related to familiarity or reminiscence memory. (5) Low participation in difficult and complex activities (Fig. 3).

Fig. 3.
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Observation process

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3.2 Focus Group

After carrying out the observation and literature review, the apparent problems and potential solutions were elicited and discussed by the Focus Group team. In order to facilitate the senior citizens’ ease in getting started, we began by analyzing hand activities in daily life. The most commonly used actions are rotation, pressing and holding. Therefore, these three actions are included in the gestures of the game. As for spatial ability training, the space position training was based on the relative position of the azimuth positioning, distance estimation and mental rotation. Then we designed guidelines to think about the game modes of play.

The key points and principles are as follows: (1) The hand muscles’ activities are promoted to facilitate the brain’s blood circulation, and the gripping gestures are paired with the space training game mode suitable for synergetic participation, and the play pattern updates frequently. Putting an object into the correct matching position activates the memory to train the spatial relationship ability and the spatial sensory ability. (2) According to the research, the activity of the thumb effectively enhances brain blood circulation, and the button is used to make the thumb perform simple activities, such as in the mental arithmetic game mode. (3) Training for spatial positioning ability is most complex since the rotating gesture is the most complicated action, so the psychological rotation of spatial visual ability and the training of spatial organization ability are more suitable.

Features of future design: After discussion by the focus group, the training modes are divided into: the conjunction of spatial relationship ability and the psychological rotation of spatial visual ability to train the space ability game to promote hippocampus activities to promote the circulation of that brain area. The partial exercise mode: Combine the rotation and pressing of the hand to increase the frequency of the whole hand activity to promote brain blood circulation. For the main design goals, this study seeks to indirectly stimulate the brain with directly affected brain and local movements, to maximize the positive effect on brain blood circulation (Fig. 4).

Fig. 4.
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Focus group process

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3.3 Design of Evaluation Device

This study primarily aims to increase the amount of hand activities to promote brain blood circulation as the main design content. Before the game content design, an evaluation device is needed to evaluate the finger activities and blood flow status. This study is designed with the Arduino board design, and a set of wearable gloves as the evaluation device. The device set includes Arduino, a bending sensor, and a pulse sensor module.

Arduino bending sensing is mainly used to detect the number of fingers bending. Through 10 bending sensors, the frequency of 10 fingers used in the game can be evaluated. The main structure can be divided into the information receiving end, and USB is connected to the computer to receive signals. As the computer software data is processed, the bending sensor will increase the resistance due to the bending, and the data will be converted into the number of instances of bending after the data is collected. The pulse sensor is clamped to the earlobe, and the pulse is a non-invasive detector. The Photoplethysmography (PPG) instrument itself is based on the calculation of the relative change of the blood flow using the reflection of light to calculate the pulse rate by Near Infrared Spectroscopy (NIRS). This study mainly uses the change of the blood flow state as the main indicator, so the process of estimating the pulse rate is required, and the blood flow is presented as a relative change waveform (Fig. 5).

Fig. 5.
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Glove evaluation device

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3.4 Pretest Experiment

In this study, the purpose of the pretest experiment is to test and evaluate whether the glove can effectively detect the number of activities of the finger and the blood flow value, and establish the relationship between the amount of activity and the brain’s blood flow.

Experiment mode: (1) Using the current puzzle/smart game products (Tangram and Wisdom Ball) as the test game, use the Study design evaluation glove to calculate the finger activities frequency and blood flow status during the game. (2) For the blood flow part, measure the neck blood flow with a sophisticated Doppler Bi-mode Blood Flow Monitor, compare the measured data of the precision instruments on the market with the sensing ability of this study’s wearable device, and detect it. The measured finger activity and blood flow data were statistically analyzed and explore the relationship between hand activity and blood flow.

Experiment Arrangement

In this experiment, we evaluated the effect of the wearable glove design in an objective way. We evaluate the performance of the device through the game of the puzzle, Wisdom Ball and Tangram. There were 5 testees all of whom are female, in the age range of 24-30 years old with no major illnesses and physical disabilities that may affect the outcome. Participants in the experiment process must not perform any other exercise. Testees wear a designed wearable device. The set up includes a table, a chair, and a laptop. The experiment environment allows participants to stay relaxed and calm during the test (Fig. 6).

Fig. 6.
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Experiment arrangement

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Experiment Procedure

First phase of experiment

  1. (1)

    Before testees undertake the experiment, we will explain the steps and content of the overall experiment. Testees will be taught to wear the design’s wearable device. Then turn on the wearable device and connect the wearable device. Before the experiment starts, they must first measure the neck blood flow with a precise blood flow meter, then follow the steps to test if the device has a problem.

  2. (2)

    After the equipment is prepared and ready, testees will wear the design’s wearable glove and earlobe blood flow sensor. For the tangram test, the Study provides 10 questions for the Tangram, and let testees perform the five-minute Tangram test.

  3. (3)

    After the Tangram test is completed, the neck blood flow is measured by a precision instrument blood flow meter, that is, the first phase of the experiment is completed.

Second phase of the experiment

  1. (1)

    In order to ensure the accuracy of the experiment, since the test of the blood flow data may cause errors and effects just after the completion of the tangram experiment, we let the testees rest until the blood flow returns to the most recent data, and then continue to the next experiment.

  2. (2)

    Before proceeding to the second experiment, we still need to test the device for problems, and briefly explain how to play the Wisdom Ball. After the instrument is ready, testees will wear this study designed wearable glove and earlobe blood flow sensor for the wisdom ball experiment, and the game will take five minutes.

  3. (3)

    After the wisdom ball test is completed, measure the neck blood flow with a precision instrument blood flow meter is used to complete the experiment (Fig. 7).

    Fig. 7.
    figure 7

    (left) Tangram Game, (middle) Wisdom Ball game, (right) Measuring blood flow on the neck area

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4 Discussion

In this section, the objective evaluation results demonstrate the performance of the new wearable device design, which are mainly divided into the performance evaluation of the earlobe-style blood flow sensor data, the data relationship between the finger activities frequency and the blood flow.

4.1 Earlobe Type Blood Flow Sensor Effectiveness Evaluation

Experiment 1: During the experiment, the subject will wear the wearable evaluation device for the tangram. The earlobe blood flow sensor detects the data in waveforms before and after the game as shown in Fig. 8 (left). The higher the wave peak represents a higher blood flow. Figure 8 (left) is the earlobe blood flow waveform presented by testees before and after the tangram game. It can be found that the earlobe blood flow after the tangram game has a slight increase in the wave peak, which indicates the tangram game positively promotes the brain’s blood flow.

Fig. 8.
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The wearable device presents the blood flow waveform before and after the (left) tangram game, the (middle) wisdom ball game and the comparison between the blood flow of (right) tangram and wisdom ball

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Experiment 2: During the experiment, the subject will wear the wearable evaluation device for the wisdom ball game. The earlobe blood flow sensor detects the data in waveforms before and after the game, as shown in Fig. 8 (middle). Before and after the wisdom ball game, the waveform of earlobe blood flow can be found to be slightly higher which indicates the testees are undertaking the wisdom ball game. After the wisdom ball game, the earlobe blood flow waveform has a slight increase, which indicates the wisdom ball game positively promotes the brain’s blood flow.

This experiment also uses a sophisticated ultrasonic (Laser Doppler Spectroscopy (LDS)) blood flow instrument to measure the neck blood flow before and after the game, and evaluate the evaluation performance and accuracy of the wearable evaluation device of this Study design. Compare the subject’s blood flow waveform with tangram and wisdom ball. The relative relationship is shown in Fig. 8 (right), with the data displayed by the precision Ultrasound LDS blood flow meter, indicating that the test brain blood flow increase by using the wisdom ball was higher than that of the tangram, and the same result was also found by the wearable evaluation device designed by this study. The blood flow waveform of the wisdom ball is indeed higher than the relative relationship between the blood flow waveform and the data after using the tangram.

4.2 Statistical Analysis of Glove Activities’ Frequency and Blood Flow

Measurement of the testees’ blood flow after the tangram and wisdom ball respectively through the Doppler Ultrasound LDS blood flow meter indicates that the maximum blood flow and the average blood flow of the neck blood flow are significantly improved after the game (Tables 1 and 2).

Table 1. Descriptive statistics of three-stage experimental maximum blood flow (measured by LDS Ultrasound blood flow meter)
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Table 2. Descriptive statistics of three-stage experimental average blood flow (measured by LDS Ultrasound blood flow meter)
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At the same time, it can be demonstrated that using the wearable device to evaluate the degree of finger bending (Table 3), indicates the instance of finger bending during wisdom ball game is higher than that of the tangram. It can be seen that the average number of left-hand finger bending of testees in the tangram game is 204.4 times, the average number of fingers bending in the right hand is 297.2. The average number of fingers bending in the left-hand finger is 367.4 times in the wisdom ball game, while the average number of fingers bending in the right hand is 357.4 times. Thus, the amount of activities required for the wisdom ball game in the hand is greater than for the tangram. The amount of finger activities and the blood flow data show that the amount of finger activities is directly proportional to the promotion of brain blood flow, which is also consistent with the conclusions of this study’s literature review.

Table 3. Use wearable device to evaluate the narrative statistics of the number of times the glove bends
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According to Table 4, the results of the paired sample t-test demonstrates that the maximum blood flow before and after the tangram is in the first pair of paired samples, maximum blood flow (M = 3.48, SD = 1.31), t(4) = −5.95, p = 0.004, with significant difference; in the second pair of paired samples, for the wisdom ball game (M = 12.94, SD = 2.4), t(4) = −12.07, p = 0.0003, with significant difference, the results indicate a significant difference. In Table 5, the results of the paired sample t-test show that the average blood flow before and after the tangram is in the first pair of paired samples, average blood flow (M = 2.18, SD = 0.98), t(4) = −4.97, p = 0.007, with significant difference; in the second pair of paired samples, for the wisdom ball game (M = 6.86, SD = 2.22), t(4) = −6.92, p = 0.0002, with significant difference, the results are significant, indicating both tangram and wisdom ball games can effectively improve the brain’s maximum blood flow and the brain’s average blood flow.

Table 4. Conduct tangram and wisdom ball maximum blood flow paired sample t-test
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Table 5. Conduct tangram and wisdom ball average blood flow paired sample t-test
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4.3 Summary

The main purpose of the glove evaluation device is to evaluate the number of fingers used and blood flow conditions for users to facilitate future design and integration. After the above experiment, it can be demonstrated that:

  • Glove performance evaluation: The evaluation device designed by this study can effectively detect the number of hand activities of users and the condition of earlobe blood flow.

  • Blood sensor efficacy evaluation: The NIRS earlobe blood flow sensor can successfully display accurate blood flow waveforms, and the relative values are similar to those of precision LDS instruments.

  • Finger activities and blood flow: The higher the number of finger activities, the blood flow or the precision instrument designed by this study, the corresponding blood flow shows a higher value, and the results are consistent with the conclusions of the relevant literature.

5 Conclusion

This study is mainly for the purpose of decelerating the progress of Alzheimer’s disease, and the causes and possible solutions of AD are summarized by literature review and participant observation. The improvement of cerebral blood circulation and the prevention of AD are the main strategies adopted in this study. The circulation method is divided into indirect and direct stimulation, indirect is by systemic exercise or local exercise, directness is to allow the brain to directly cognize activities, this study will eventually combine hand exercise with cognition activities for game design, and currently an evaluation device that can evaluate the number of finger activities and blood flow sensing has been developed. The effectiveness and operability of the evaluation device can be seen from the above experiment. It can also be demonstrated from the experiment that the higher the number of finger activities, the better the effect of the brain stimulation, and the higher the cerebral blood flow.

The conclusions of the study are summarized as follows:

  • As the global population of Dementia patients climbs yearly, there are many product designs related to AD status improvement and prevention, but less discussion of theoretical knowledge as the basis and innovation of design creation. This study informs a theoretical basis and creative ideas to elucidate breakthrough ideas for existing puzzle games.

  • This study combines Arduino with human-computer interaction (HCI) to assess finger activity and blood flow status, and hopes to assess the improvement of cerebral blood circulation during human activities in an objective manner.

  • The evaluation device designed by this study is a wearable device, and in addition to effectively detecting the amount of hand activities and blood status of users, does not hinder the actions of users’ activities.

Follow-Up Discussion and Development

The current study points out that more brain games and exercises are important activities to slow down progression of AD. This study considers the needs of the elderly and the suitability of the device design for future lifestyles. The study aim is to develop a combination of exercise, cognition and cooperation. The wearable evaluation device game can simultaneously assess the condition of the hand activities and the adjustment of the blood flow condition, and also provide users with a large number of activities to train the fingers and cognitive thinking skills, encouraging design of a combination of games for evaluation and representing a suitable game device for improving quality of life and deceleration of neurodegeneration in patients with AD.