Uncovering the Effectiveness of Chess!
Did you know that playing chess can also have a positive impact on cognitive function, mood, and overall quality of life?
In recent years, there has been growing interest in the potential benefits of chess as a training program for improving these aspects of mental health.
In this article, we will explore the effectiveness of a chess-training program in enhancing cognition, mood, and quality of life.
I am going to show you the research that has been conducted on this topic, looking at studies that have investigated the impact of regular chess practice on various cognitive functions such as memory, problem-solving skills, and executive function. Furthermore, we will examine how playing chess can also have a positive effect on mood, with studies suggesting that the game can help reduce stress and anxiety, increase feelings of happiness and satisfaction, and even improve self-confidence and self-esteem.
| Introduction |
"The global impact of dementia"
The World Alzheimer Report 2018 highlighted dementia as a significant health issue affecting 50 million people globally. Recent research has focused on understanding modifiable lifestyle factors that could play a role in preventing mild cognitive impairment (MCI) or dementia. Engaging in mentally stimulating leisure activities has been linked to a reduced risk of cognitive decline and dementia in later life. These activities can contribute to cognitive reserve, which is thought to protect against age-related cognitive decline and the development of MCI or dementia.
Factors influencing cognitive reserve include education, occupation, intelligence, social interactions, physical activity, and engagement in mentally stimulating activities throughout life.
Regular participation in mentally stimulating activities, such as playing chess, has been shown to delay cognitive decline and offer social and psychological benefits. Chess requires strategic thinking and problem-solving skills, which can enhance working memory, logical reasoning, executive functions, and processing speed. Some studies have suggested a link between challenging mental activities like chess and a lower risk of developing dementia, but more research is needed to establish causality.
The current study aimed to assess the impact of a chess training program on cognitive function, mood, and quality of life in older adults living in care institutions. The hypothesis was that regular practice of intellectually stimulating activities like chess could help protect against cognitive impairment and dementia, while also improving social interactions and emotional well-being. The study sought to explore the potential benefits of chess as a non-pharmacological intervention for older adults in care.
"Normal brain vs Alzheimer Brain"
| The Study |
The study was a controlled pilot study with repeated measures (pre- and post-intervention), without randomization. Therefore, the outcomes of interest were evaluated before and after implementing the program in both the experimental and control groups.
The research protocol (code 2019/582) was approved by the Autonomic Research Ethics Committee of Galicia (Spain) and conducted in adherence to the ethical principles outlined in the Declaration of Helsinki. All participants or their proxies provided written informed consent, especially in cases of cognitive impairment.
"Autonomic Research Ethics Committee of Galicia (Spain)"
| Participants |
The participants in the study were taken from users of a gerontological complex in A Coruña, Spain, consisting of a daycare center and a nursing home. Participants were classified as institutionalized (residents of the nursing home) or semi-institutionalized (users of the daycare center).
Inclusion criteria included being ≥60 years old, having intact or corrected visual and auditory function, and agreeing to participate. Eligibility was verified by physicians and clinicians based on the Global Deterioration Scale to ensure legal decisional capacity. Individuals with advanced dementia or disorders preventing participation in the chess training program were excluded from the study.
At the end of the recruitment process, 32 subjects met the inclusion and exclusion criteria described above, although only 22 participants completed the entire study.
"Flowchart of study participants. Recruitment, sampling, and dropouts throughout the study."
| Procedure |
An informative presentation was organized at the gerontological complex to inform potential study participants about the study's nature and goals. After obtaining informed consent, the sample was chosen based on specific criteria, and the participants were divided into groups.
The assignment to each group was done conveniently, taking into account their interest in receiving chess training. The participants underwent a baseline neuropsychological assessment lasting 45–60 minutes, tailored to their cognitive abilities. Both groups were evaluated again after completing the chess program, with the evaluation process mirroring the initial one.
The chess training sessions were conducted in groups under the guidance of two expert chess instructors and supervision from a researcher and a center therapist. The sessions took place in a specially designated room in the gerontological complex, accommodating both institutionalized and semi-institutionalized participants.
The experimental group received 12 weeks of training, with two sessions per week lasting 1 hour each. The program comprised 24 sessions, requiring participants to attend at least 80% of them to ensure meaningful results.
Meanwhile, the control and experimental groups continued with their usual daily activities at the complex. The classes covered a range of topics, from basic chessboard and piece introductions to advanced tactics, ensuring participants acquired essential knowledge and skills for playing chess. Each session followed a consistent format: a theoretical explanation followed by practical exercises.
Practice and repetition were emphasized, allowing participants to progress at their own pace while considering their cognitive abilities. The difficulty level of the exercises was adjusted accordingly, with a focus on reviewing previous lessons until participants could independently play basic games.
| Instruments and outcomes measures |
As mentioned earlier, both groups' participants were evaluated twice - before and after the intervention program. The assessments were conducted by two gerontologists experienced in neuropsychological evaluations.
The main focus was on measuring cognition, mood, and quality of life. Additionally, the experimental group's post-intervention assessment included two extra questions: one on a five-point Likert scale regarding satisfaction with the chess program, and the other as a yes/no question on their interest in participating again if given the opportunity.
| Cognition |
"The human brain"
The neuropsychological evaluation of cognition was conducted through a comprehensive assessment that included measures of general cognitive status and specific assessments of particular cognitive domains. One of the instruments used was the Montreal Cognitive Assessment test (MoCA), which evaluates 8 domains of cognition such as attention, memory, language, and executive functions.
The MoCA was standardized for the Spanish population to account for age and years of education. In addition to the MoCA, specific cognitive domains were assessed using the Trail Making Test (TMT) and the Visual Benton Retention Test (VBRT).
The TMT evaluated attention, processing speed, and executive functions through two parts involving connecting numbers and letters in a sequential pattern. The VBRT included three sets of geometric figures and different assessment methods, with Method C assessing visuoperceptual and visuospatial abilities, and Method A assessing visual memory through immediate recall of designs shown for 10 seconds.
This detailed evaluation allowed for a comprehensive understanding of the participant's cognitive functioning across different domains and provided valuable insights into their cognitive strengths and weaknesses.
| Montreal Cognitive Assessment test (MoCA) |
The Montreal Cognitive Assessment (MoCA) is a screening test designed to assess cognitive function, particularly when mild cognitive impairment or dementia is suspected. The test consists of various tasks that test various cognitive functions such as memory, attention, language, orientation and visual-spatial abilities. Tasks include, for example, remembering words, drawing a clock, imitating a certain string of characters, and performing certain tasks that require logical thinking.
The maximum number of points that can be achieved at MoCA is 30 points. A score of 26 or more points is usually considered normal, while a score below 25 points may indicate cognitive impairment. The MoCA test can be carried out by medical professionals and is used to obtain an initial assessment of a person's cognitive status.
However, it is important to note that a good result on the MoCA test alone does not constitute a definitive diagnosis of dementia or other cognitive impairment, but should only serve as an indication of possible problems that require further investigation.
| Trail Making Test (TMT) |
The Trail Making Test (TMT) is a standardized cognitive test used to evaluate a person's visual search ability, speed of processing, motor coordination, and cognitive flexibility.
The test consists of two parts: in part A the person has to connect scattered numbers in ascending order, while in part B he has to alternately connect numbers and letters in ascending order. Test time and accuracy are measured to evaluate the person's cognitive abilities.
The TMT is often used in neurological diseases such as dementia, stroke, trauma or schizophrenia to identify changes in cognitive status. It is a useful tool to quantify cognitive deficits and monitor treatment and rehabilitation.
| Mood |
The researchers evaluated the emotional state of participants by using the Geriatric Depression Scale Short Form (GDS-SF)24 in order to identify any signs of depression.
This scale consists of 15 items where individuals indicate whether they have been feeling certain emotions in the past two weeks with a simple yes or no response.
The Geriatric Depression Scale Short Form (GDS-SF)24
The Geriatric Depression Scale Short Form (GDS-SF) is a screening tool for measuring depressive symptoms in older people. The short form of the questionnaire consists of 15 questions aimed at finding out whether a person suffers from depressive symptoms.
The questions relate to various aspects of daily life and mood. Depending on the question, the answers are rated as either “yes” or “no”.
The total score ranges from 0 (no depressive symptoms) to 15 (severe depressive symptoms). A higher score indicates a higher risk of depression.
The GDS-SF is an effective tool for diagnosing depression in older adults and can help ensure those affected receive the support and treatment they need.
| Quality of life |
The quality of life of the participants was assessed using the WHOQOL-OLD, an additional module of the WHOQOL scale specifically designed for older adults to evaluate their subjective perception of their quality of life.
The WHOQOL-OLD module consists of 24 five-point Likert-scale items grouped into six facets, which cover key aspects of quality of life in older age: sensory abilities, autonomy, past, present, and future activities, social participation, death and dying, and intimacy.
Participants were asked to reflect on their thoughts and feelings regarding these aspects of their quality of life in the past two weeks. Each facet contains four items, with possible scores ranging from 4 to 20. The total score is calculated by summing all 24 items in the module, with higher scores indicating a higher quality of life.
WHOQOL scale ; WHOQOL-OLD
The WHOQOL-OLD is an additional module of the World Health Organization Quality of Life (WHOQOL) instrument designed specifically for older adults.
It is aimed at assessing and improving the quality of life of older people. The WHOQOL-OLD includes various domains such as health and life satisfaction, social support, environment, autonomy and participation, and spiritual dimensions. It takes into account the special needs and challenges that older people face, such as age-related health restrictions, social isolation or loss of autonomy.
By using the WHOQOL-OLD, healthcare providers, researchers and policymakers can gain information about the quality of life of older people and develop targeted interventions to improve their well-being. The tool helps to take a holistic look at the lives of older people and to better understand their individual needs.
| Statistical analysis |
Prior to conducting any analyses, the normality of the variables' distribution was assessed using the Shapiro-Wilk test. Due to the lack of normality and small sample size (n < 30), nonparametric tests were utilized for subsequent analyses.
Descriptive statistics and frequency distributions were used to analyze the baseline characteristics of the sample.
Shapiro-Wilk test.
The Shapiro-Wilk test is a statistical test used to check whether a sample comes from a normally distributed population. It is based on the assumption that the data is normally distributed and compares the observed data with the expected data from a normal distribution.
The test calculates a W value, which is a measure of the deviation of the data from a normal distribution. If the p-value of the Shapiro-Wilk test is small (typically less than 0.05), then the null hypothesis is rejected and one can conclude that the data is not normally distributed.
The Shapiro-Wilk test is particularly useful for small samples because it is robust to deviations from normality. It is often used in statistics and research to verify the normality of data before applying parametric tests.
|
Total sample (n = 22) |
Control group (n = 11) |
Chess group (n = 11) |
p-value | |
|---|---|---|---|---|
| Gender, n (%) | 0.006⁎⁎ | |||
| Female | 15 (68.2) | 11 (100) | 4 (36.4) | |
| Male | 7 (31.8) | 0 (0.0) | 7 (63.6) | |
| Age | 0.263 | |||
| Mean age ± SD | 83.05 ± 8.19 | 85.73 ± 5.61 | 80.36 ± 9.68 | |
| Age range | 64 – 94 | 76 – 94 | 64 – 93 | |
| Setting, n (%) | 0.669 | |||
| Daycare center | 10 (45.5) | 4 (36.4) | 6 (54.5) | |
| Nursing home | 12 (54.5) | 7 (63.6) | 5 (45.5) | |
| Marital status, n (%) | 0.133 | |||
| Single | 1 (4.5) | 0 (0.0) | 1 (9.1) | |
| Married | 6 (27.3) | 1 (9.1) | 5 (45.4) | |
| Widower | 13 (59.1) | 9 (81.8) | 4 (36.4) | |
| Divorced/Separated | 2 (9.1) | 1 (9.1) | 1 (9.1) | |
| Years of formal education | 0.484 | |||
| Mean ± SD | 8.86 ± 3.63 | 8.91 ± 3.45 | 8.82 ± 3.97 | |
| Range of years | 0 – 17 | 0 – 13 | 3 – 17 | |
| Level of cognitive impairment, n (%) | 0.801 | |||
| Severe | 12 (54.6) | 7 (63.6) | 5 (45.4) | |
| Moderate | 3 (13.6) | 1 (9.1) | 2 (18.2) | |
| Mild | 4 (18.2) | 2 (18.2) | 2 (18.2) | |
| No impairment | 3 (13.6) | 1 (9.1) | 2 (18.2) |
"Sociodemographic characteristics of the study population."
In this study, the researchers utilized a Brunner-Langer mixed nonparametric ANOVA27 analysis with an F1-LD-F1 design to examine the effects of an intervention (chess program vs. control) and its interaction with time on various cognitive and quality of life measures.
The whole-plot factor was the group (intervention vs. control), while the subplot factor was time. The cognitive and quality of life measures included in the analysis were MoCA, VBRT, TMT, GDS-SF, and WHOQOL-OLD scores. Pairwise comparisons were conducted using the Wilcoxon signed-rank and Mann-Whitney U tests. Wilcoxon signed-rank tests were used to compare test scores before and after the intervention within each group, while Mann-Whitney U tests were used to compare scores between the control and intervention groups at each time point.
A significance level of p < 0.05 was set for defining statistical significance. All statistical analyses were conducted using IBM SPSS Statistics v.25.0 and R v.3.6.1 software, with additional R packages Rcmdr, MASS, and nparLD utilized for specific analyses.
Brunner-Langer mixed nonparametric ANOVA27 analysis with an F1-LD-F1
Brunner-Langer mixed nonparametric ANOVA27 analysis with an F1-LD-F1 refers to a statistical analysis method used to examine differences between groups with respect to independent variables without making specific assumptions about the shape of the data distribution.
In this particular case, the F1-LD-F1 refers to the specific type of mixed model structure used for the analysis. The term “mixed” refers to the analysis taking into account both fixed and random effects. Nonparametric means that no assumptions are made about the distribution of the data. ANOVA stands for analysis of variance, a statistical technique for analyzing differences between groups. The value "27" in ANOVA27 indicates that this particular analysis compares 27 different groups.
In summary, Brunner-Langer mixed non-parametric ANOVA27 analysis with an F1-LD-F1 is a specific statistical analysis method used to examine differences between groups while accounting for various group effects.
Wilcoxon signed-rank tests
The Wilcoxon signed-rank test is a non-parametric test used to examine whether there is a significant difference between paired samples. This test is often used when the data is not normally distributed or the variance is homogeneous.
The test compares the ranks of the differences between the paired observations and determines whether they are significantly different from zero. The paired data is assumed to be pairwise independent and symmetrically distributed.
The test provides a p-value indicating whether the observed difference between the paired samples is due to chance or due to an actual difference between the groups.
A low p-value indicates that there is likely a significant difference between groups. Overall, the Wilcoxon signed-rank test is a useful tool to examine whether there is a difference between two related groups and is suitable when the assumptions of parametric tests are not met.
Mann-Whitney U tests
The Mann-Whitney U test is a statistical procedure used to determine whether there is a significant difference between the rankings of two independent groups. It is often used when data is not normally distributed or sample sizes are small.
The test is based on the assumption that the two samples are independent and continuous. The null hypothesis of the Mann-Whitney U test states that there is no significant difference between the rankings of the two groups.
The test is based on calculating the rank sum for each group and comparing them with each other. The test statistic is then calculated and compared to a specified significance level to determine whether the difference between the groups is significant.
The Mann-Whitney U test is widely used in various fields such as medicine, social sciences and economics to examine the difference between two groups.
| Results |
Sample characteristics
The final sample consisted of 22 subjects, with 11 individuals per group. The mean age of the participants was 83.05 ± 8.19 years, and 68.2% of the sample were women. The marital status of most of the participants was widowhood (59.1%). Regarding educational level, the average number of years of formal education completed was 8.86 ± 3.63, ranging from 0 to 17 years.
Finally, concerning the level of cognitive impairment, slightly more than half of the sample (54.6%) presented severe cognitive impairment at the beginning of the study based on the MoCA cutoff points adjusted for age and education.
At baseline, there were no significant differences between chess and control groups for these characteristics, with the exception of gender since the control group was entirely composed of women.
Effects of the chess training program on cognition
The mixed nonparametric ANOVA showed significant effects of the group × time interaction, but only in the context of the MoCA scores. Pairwise comparisons revealed significant improvements in MoCA scores in the chess group after the intervention program compared to baseline, as well as significant differences between groups, with post-intervention scores being higher in the chess group.
For TMT Part A, execution time decreased for both groups after the intervention program compared to the baseline assessment, but without significant differences between groups or over time.
In TMT-Part B, 15 participants were unable to complete the task due to difficulties in understanding. Only seven participants, two from the control group and five from the chess group, completed TMT Part B in both assessments.
The participants in the chess group who completed TMT-Part B showed improved performance with significantly shorter execution time after the intervention program.
Regarding the VBRT, there were hardly any changes in the scores over time in both groups. The VBRT revealed no significant differences between groups or over time.
Effects of the chess training program on mood
Depressive symptomatology measured by GDS-SF was significantly lower in the patients in the chess group at both evaluation time points (before: p = 0.048; after: p = 0.023) than in the control group participants.
No significant effects were observed within each group over time.
"Depressive symptomatology"
Depressive symptomatology refers to the various signs and symptoms that can occur with depression. The most common symptoms include persistent sadness, loss of interest, lack of energy, sleep problems, weight changes, concentration problems, self-esteem doubts, suicidal thoughts and physical complaints.
Depressive symptoms can occur in varying degrees and can significantly impair the affected person's daily life and ability to function. It is important to seek professional help if you experience these symptoms in yourself or someone else to receive appropriate treatment and support.
Effects of the chess training program on quality of life
The Wilcoxon signed-rank test showed significant differences (p = 0.021) in the WHOQOL-OLD scores from before to after the intervention program in the participants who received the chess sessions.
The WHOQOL-OLD scores remained stable in the comparison of pre- and post-intervention evaluations, and no significant differences were found between the groups.
Acceptability, feasibility and perceived satisfaction with the chess training program
The results show the preliminary acceptability and feasibility of the chess training program with positive effects on general cognition and quality of life.
Participants demonstrated reasonable commitment to the program, with missed classes always due to medical reasons. In a final test it was found that the majority of participants had correctly learned the positions of the chess pieces and also understood basic moves and tactics.
Overall satisfaction with the program was high, and all participants expressed a desire to continue playing chess. The program has been successfully implemented as a non-drug treatment for dementia in the gerontological complex.
Conclusion
The World Alzheimer Report 2018 emphasized the global impact of dementia, affecting 50 million people. Recent research has identified lifestyle factors like engaging in mentally stimulating activities, such as chess, that may help prevent cognitive decline and dementia.
A study was conducted on older adults in care institutions to assess the effects of a chess training program on cognitive function, mood, and quality of life. The results showed improvements in cognition, reduced depressive symptoms, and enhanced quality of life in participants who underwent the chess training.
The program was well-received and deemed feasible for implementation as a non-pharmacological intervention for dementia. The study highlighted the potential benefits of mentally stimulating activities like chess in promoting cognitive health and overall well-being in older adults.
