An eye-tracker controlled cognitive battery: overcoming verbal-motor limitations in ALS

Abstract

We assessed language, attention, executive, and social cognition abilities in a sample of patients with Amyotrophic Lateral Sclerosis (ALS) by means of a recently developed cognitive battery based on oculomotor control with eye-tracking (ET) technology. Twenty-one ALS patients and 21 age- and education-matched healthy subjects underwent the ET-based cognitive assessment, together with the standard cognitive screening tools [Frontal Assessment Battery (FAB); Montreal Cognitive Assessment (MoCA); and Digit Sequencing Task]. Psychological measures of anxiety (State-Trait Anxiety Inventory-Y) and depression (Beck Depression Inventory) were also collected, and an ET usability questionnaire was administered. For patients, clinical and respiratory examinations were also performed, together with behavioural assessment (Frontal Behavioural Inventory). The developed battery discriminated among patients and controls with regard to measures of verbal fluency, frontal abilities, and social cognition. Measures of diagnostic utility confirmed a higher diagnostic accuracy of such ET-based tests with respect to FAB; similar diagnostic accuracy emerged when comparing them to the other standard cognitive tools (MoCA, WM). Usability ratings about the ET tests were comparable among the two groups. The ET-based neuropsychological battery demonstrated good levels of diagnostic accuracy and usability in a clinical population of non-demented ALS patients, compared to matched healthy controls. Future studies will be aimed at further investigate validity and usability components by recruiting larger sample of patients, both in moderate-to-severe stages of the disease and affected by more severe cognitive impairment.

The Complex Interplay Between Depression/Anxiety and Executive Functioning: Insights From the ECAS in a Large ALS Population

“…With regard to available literature in this field, our data are globally in accordance with two previous studies ( Jelsone-Swain et al, 2012 ; Wei et al, 2016 ), highlighting an effect of depressive symptoms on cognitive performance at both global and specific neuropsychological measures in ALS. Conversely, contrasting results have been observed in other previous studies employing both traditional and motor-verbal free cognitive testing, showing the absence of a relationship between cognitive impairment and depression levels ( Poletti et al, 2016a , b ; Rabkin et al, 2016 ). The novelty of such topic in ALS, in association with the variety of measures for depression and cognition employed and the different modes of administration of neuropsychological tests (both ‘paper and pencil’ and motor-verbal free based measures), makes a comparison with previous findings not feasible.…”

“…According to recent literature, experimentally induced anxiety seems to impair performance only under low-load, i.e., simple cognitive tasks, while its effect is reduced when subjects engage in more difficult tasks that involve high attentional and executive resources ( Vytal et al, 2012 , 2013 ). Previous results obtained in ALS underlined an effect of anxiety on reasoning times, with higher levels of anxiety corresponding to lower execution times at some cognitive tests ( Poletti et al, 2016a , b ). In our sample, the limited proportion of patients presenting with clinically relevant state and trait anxiety levels, with global mean scores considerably lower than cut off, could explain the absence of clear effects of such psychological component over the observed performances.…”

“…When considering more innovative cognitive tools, two recent studies about feasibility of Eye-Tracking (ET) and Brain Computer Interface (BCI) technologies for cognitive testing in ALS highlighted a negative correlation between anxiety levels and reasoning time at some neuropsychological tests for executive functions. Such results were interpreted according to an increase in the rate of impulsivity, possibly depending both on the reduced amount of cognitive and inhibitory resources in pALS and on the supplementary influence of anxiety on such cognitive profile ( Poletti et al, 2016a , b ). In both studies, no significant correlations were observed between ET tests and depression level, as measured by Beck Depression Inventory ( Beck et al, 1961 ).…”

Communication Matters—Pitfalls and Promise of Hightech Communication Devices in Palliative Care of Severely Physically Disabled Patients With Amyotrophic Lateral Sclerosis

“…It is known that cognitive deficits affect a great proportion of all-ALS-patients ( 54 ) and can compromise their ability to judge and decide over their medical care and life-prolonging measures (see chapter Cognitive and behavioral impairment and its consequences for HT-AAC-use). Promising attempts have been made to develop ETCS-based test procedures of cognitive functioning ( 55 , 56 ).…”

The Arrows and Colors Cognitive Test (ACCT): A new verbal-motor free cognitive measure for executive functions in ALS

“…Eye Tracking (ET), a well-known and consistently validated Alternative and Augmentative Communication system, has been used with the aim of administering neuropsychological tests in a motor-verbal free manner [ 23 – 26 ]. We recently presented preliminary results showing an extensive neuropsychological battery developed for ET control, covering language, attentional and executive functions, and social cognition domains [ 27 – 29 ]. The current study describes clinical data on a newly developed measure of cognitive flexibility, the Arrows and Colors Cognitive Test (ACCT), administered by means of ET technology.…”