Classic Tower of Hanoi, Planning Skills, and the Indian Elderly

Elderly populations are vulnerable to age-related cognitive decline. Planning, a frontal lobe function, is reported to be affected in the elderly population. There is a paucity of studies which assessed planning skills in the elderly Indian population. The present study aimed to examine the utility of the classic Tower of Hanoi in the assessment of planning skills of elderly Indian subjects.

A total of 215 (60 of whom were females, all aged 55-80 years) cognitively normal elders and 24 patients with mild Alzheimer's disease were recruited. All subjects provided informed consent and their planning skills were assessed using the classic Tower of Hanoi. Performance at each level was measured by the total time taken to solve, number of moves to solve, and the number of rule violations. Receiver operating characteristic curve analysis was exploratively performed to test the utility of the Tower of Hanoi in differentiating patients with mild Alzheimer's disease from those who were cognitively normal.

Performance measures of cognitively normal group steeply worsened with increasing complexity. With receiver operating characteristic curve analysis, patients with mild Alzheimer's disease were poorly differentiated from cognitively normal group according to their Tower of Hanoi performance.

The Tower of Hanoi test is of limited value for the assessment of planning skills in the Indian elderly population. There is a need to modify and develop a suitable neuropsychology tool to assess the planning skills of elderly Indian subjects and further validate it.