Cognitive assessment of executive functions using brain computer interface and eye-tracking

Abstract

New technologies to enable augmentative and alternative communication in Amyotrophic Lateral Sclerosis (ALS) have been recently used in several studies. However, a comprehensive battery for cognitive assessment has not been implemented yet. Brain computer interfaces are innovative systems able to generate a control signal from brain responses conveying messages directly to a computer. Another available technology for communication purposes is the Eye-tracker system, that conveys messages from eye-movement to a computer. In this study we explored the use of these two technologies for the cognitive assessment of executive functions in a healthy population and in a ALS patient, also verifying usability, pleasantness, fatigue, and emotional aspects related to the setting. Our preliminary results may have interesting implications for both clinical practice (the availability of an effective tool for neuropsychological evaluation of ALS patients) and ethical issues.

Eye-tracking controlled cognitive function tests in patients with amyotrophic lateral sclerosis: a controlled proof-of-principle study

“…Yet, as Mioshi et al have already described, neuropsychological abnormalities also occur in a very early stage of the disease and may even precede physical impairments [35]. Moreover, for completely locked-in state of ALS, the current study lacks the proof of applicability as correct eye movement control and the ability to blink in this state is not given by definition [14]. Then, additional Brain-Computer Interface technology is needed, which has recently been shown to be an effective means of communication in completely locked-in ALS patients [36].…”

“…By comparing classical paper-pencil and hand and speech motor-free oculomotor methods of neuropsychological tests, executive functions were determined using eye-tracking devices in ALS patients. Previous studies have shown the potential of oculomotor-based neuropsychological testing in healthy subjects [13,14]. We successfully demonstrated the usability of such approaches in a clinical context.…”

“…Although some aspects of oculomotor control might be impaired in patients with ALS [12], eye tracking is still a very promising way to study executive functioning in ALS, which has already been used in healthy subjects: One study has implemented an oculomotor version of the trail-making test and found a strong correlation between the paper-pencil and the eye-trackingbased performance of healthy subjects in one subtest [13] whereas another has demonstrated the usability of an eyetracking-based verbal fluency task [14].…”

Brain-Computer Interface for Clinical Purposes: Cognitive Assessment and Rehabilitation

“…Even if the described protocol satisfies the need for a comprehensive evaluation of cognitive abilities, some issues arise from performing several tests with BCI; in particular, prolonged time for administration and cognitive effort could involve fatigue effects and reduce the reliability of the assessment. This study was included within an extended project, evaluating P300-BCI use for neuropsychological assessment with a particular attention to usability, pleasantness, fatigue, and emotional aspects [ 28 , 29 ]. Within such project, preliminary attempts to adapt another widely used traditional neuropsychological test, that is, Verbal Fluency, have been performed as a proof of concept which needs further investigations.…”

“…With regard to cognitive assessment, the studies presented mainly employed ad hoc designed cognitive tasks, realized according to the characteristics and restrictions of the BCI paradigm adopted [ 21 , 22 , 25 , 30 ]. Cipresso et al [ 28 , 29 ] used a widely known cognitive test, that is, Verbal Fluency, even if with relevant modifications in administration and scoring methods with respect to the traditional “paper and pencil” version, in order to adapt to the BCI system. Differently, a few authors [ 23 , 24 , 27 ] realized a BCI-based version of a validated and standardized neuropsychological measure of fluid intelligence, that is, the RCPM, with particular attention at maintaining a reasonable adherence to the original test.…”