Tangram Puzzles in Patients with Neurocognitive Disorders: A Pilot Study

Objective: The tangram puzzle is a serious math puzzle game used to promote mathematic development in children, which improves visuospatial function and creativity. A game to improve cognitive functions is useful for patients with neurocognitive disorders. This pilot study aimed to determine whether this game could improve cognitive function in patients with neurocognitive disorders. Materials: This study recruited patients with mild Alzheimer's disease or mild cognitive impairment who were followed longitudinally by the Department of Psychiatry, Juntendo University Hospital, or Juntendo Tokyo Koto Geriatric Medical Center (Tokyo, Japan). Methods: Participants were asked to solve Tangram puzzles 2-3 times weekly, spending 30-40 min/session at home with or without family members for approximately 90 (Study 1) or 180 (Study 2) days. Mini-Mental State Examination (MMSE) in Study 1 as well as a Japanese version of the Montreal Cognitive Assessment and Trail Making Test in Study 2 were performed on the initial and final days. Results: Study 1 comprised eight participants and Study 2 comprised nine participants. Statistically significant improvement was observed in MMSE total score (p = 0.016) and orientation segment (p = 0.026) in Study 1. No statistically significant difference was noted in MMSE total score, orientation segment, or MoCA-J (Japanese version of Montreal Cognitive Assessment) score between the initial and final days in Study 2 (p = 0.764, p = 0.583, and p = 0.401, respectively). Conclusions: Study 1 revealed that Tangram puzzles may ameliorate the progression of cognitive functions in patients with neurocognitive disorders within a short time (3 months); however, Study 2 did not show a consistent result. Thus, randomized controlled trials are warranted to draw a conclusion.