Eye tracking metrics to screen and assess cognitive impairment in patients with neurological disorders

Tao, Ling; Wang, Quan; Liu, Ding; Wang, Jing; Zhu, Zijue; Feng, Li

doi:10.1007/s10072-020-04310-y

Cited by 87 publications

(73 citation statements)

References 71 publications

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“…ET offers an objective means to assess motor cerebral involvement in ALS [ 44 ]. Impaired ET performance in patients with presenile onset dementia [ 45 ], and ET can measure disease progression in cognitively impaired patients [ 12 ]. With this background, we have conducted this systematic review.…”

Section: Discussionmentioning

confidence: 99%

“…The saccade task also includes the front saccade task, the back saccade task, and the memory saccade task [ 49 ]. The parameters of these saccade tasks mainly reflect impairments in executive function [ 12 ]. In one study, the accuracy of a visual search task was also used to assess whether the executive function was impaired [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, both age and education level affect MMSE scores [ 10 ]. Existing bedside tools MMSE and MOCA are not sensitive to milder impairment [ 11 ], results grading resolution is not high (absent/slight/moderate) [ 12 ], and iterative feedback based on a large database is also absent [ 13 ], the examiner who use them need to be trained to make the results more reliable [ 14 ]. Eye tracking (ET), by contrast, is a new technique that objectively measures eye movement and the location of a subject’s gaze [ 15 ], it is becoming increasingly popular because it can provide better quantitative parameters for big data analysis.…”

Section: Introductionmentioning

confidence: 99%

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The effectiveness of eye tracking in the diagnosis of cognitive disorders: A systematic review and meta-analysis

Liu

et al. 2021

PLoS ONE

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Background Eye tracking (ET) is a viable marker for the recognition of cognitive disorders. We assessed the accuracy and clinical value of ET for the diagnosis of cognitive disorders in patients. Methods We searched the Medline, Embase, Web of Science, Cochrane Library, and Pubmed databases from inception to March 2, 2021, as well as the reference lists of identified primary studies. We included articles written in English that investigated ET for cognitive disorder patients—Mild cognitive impairment (MCI), Alzheimer’s disease (AD), Amyotrophic lateral sclerosis (ALS), and dementia. Two independent researchers extracted the data and the characteristics of each study; We calculated pooled sensitivities and specificities. A hierarchical summary of receiver performance characteristics (HSROC) model was used to test the diagnostic accuracy of ET for cognitive impairment (CI). Findings 11 studies met the inclusion criteria and were included in qualitative comprehensive analysis. Meta-analysis was performed on 9 trials using Neuropsychological Cognitive Testing (NCT) as the reference standard. The comprehensive sensitivity and specificity of ET for detecting cognitive disorders were 0.75 (95% CI 0.72–0.79) and 0.73 (95% CI 0.70 to 0.76), respectively. The combined positive likelihood ratio (LR+) was 2.74 (95%CI 2.32–3.24) and the negative likelihood ratio (LR−) was 0.27 (95%CI 0.18–0.42). Conclusions This review showed that ET technology could be used to detect the decline in CI, clinical use of ET techniques in combination with other tools to assess CI can be encouraged.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effectiveness of eye tracking in the diagnosis of cognitive disorders: A systematic review and meta-analysis

Liu

et al. 2021

PLoS ONE

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“…If this work were to be extended to an older adult or clinical population with cognitive deficits, this eye-tracking metric will remain important to investigate, as eye-tracking has been suggested for assessment of cognitive impairment and diagnosis of neurodegenerative conditions. Patients with dementia and Alzheimer's disease have been shown to demonstrate altered pupillary responses and oculomotor impairments, which can be associated to brain function and neural mechanisms to assess cognitive dysfunction (Pavisic et al, 2017;Marandi and Gazerani, 2019;Tao et al, 2020). Aging has also been associated with an increased latency of saccades and increased blink frequency in addition to neurocognitive decline (Marandi and Gazerani, 2019).…”

Section: Limitationsmentioning

confidence: 99%

Driving With Distraction: Measuring Brain Activity and Oculomotor Behavior Using fMRI and Eye-Tracking

Yuen

Tam

Churchill

et al. 2021

Front. Hum. Neurosci.

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IntroductionDriving motor vehicles is a complex task that depends heavily on how visual stimuli are received and subsequently processed by the brain. The potential impact of distraction on driving performance is well known and poses a safety concern – especially for individuals with cognitive impairments who may be clinically unfit to drive. The present study is the first to combine functional magnetic resonance imaging (fMRI) and eye-tracking during simulated driving with distraction, providing oculomotor metrics to enhance scientific understanding of the brain activity that supports driving performance.Materials and MethodsAs initial work, twelve healthy young, right-handed participants performed turns ranging in complexity, including simple right and left turns without oncoming traffic, and left turns with oncoming traffic. Distraction was introduced as an auditory task during straight driving, and during left turns with oncoming traffic. Eye-tracking data were recorded during fMRI to characterize fixations, saccades, pupil diameter and blink rate.ResultsBrain activation maps for right turns, left turns without oncoming traffic, left turns with oncoming traffic, and the distraction conditions were largely consistent with previous literature reporting the neural correlates of simulated driving. When the effects of distraction were evaluated for left turns with oncoming traffic, increased activation was observed in areas involved in executive function (e.g., middle and inferior frontal gyri) as well as decreased activation in the posterior brain (e.g., middle and superior occipital gyri). Whereas driving performance remained mostly unchanged (e.g., turn speed, time to turn, collisions), the oculomotor measures showed that distraction resulted in more consistent gaze at oncoming traffic in a small area of the visual scene; less time spent gazing at off-road targets (e.g., speedometer, rear-view mirror); more time spent performing saccadic eye movements; and decreased blink rate.ConclusionOculomotor behavior modulated with driving task complexity and distraction in a manner consistent with the brain activation features revealed by fMRI. The results suggest that eye-tracking technology should be included in future fMRI studies of simulated driving behavior in targeted populations, such as the elderly and individuals with cognitive complaints – ultimately toward developing better technology to assess and enhance fitness to drive.

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“…In contrast, eye tracking technology has become a more widely available and potential technology that can facilitate the traditional memory assessment of cognitive screening in neurological diseases thanks to its millisecond-level sampling rate, quantified measurements, and reliability during the monitoring process ( Tao et al, 2020 ). Moreover, this technology can capture people’s ocular motor information ( Pihl-Jensen et al, 2017 ), reflect complex cognitive processes during tasks ( Heuer et al, 2013 ), help eliminate possible attentional confounding in visual behavior ( Chau et al, 2015 ), and assist in clarifying the underlying mechanism of cognitive impairment disease ( Nagasawa et al, 2011 ; Bastin et al, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

Memory Deficit in Patients With Temporal Lobe Epilepsy: Evidence From Eye Tracking Technology

et al. 2021

Self Cite

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Objective: To explore quantitative measurements of the visual attention and neuroelectrophysiological relevance of memory deficits in temporal lobe epilepsy (TLE) by eye tracking and electroencephalography (EEG).Methods: Thirty-four TLE patients and twenty-eight healthy controls were invited to complete neurobehavioral assessments, cognitive oculomotor tasks, and 24-h video EEG (VEEG) recordings using an automated computer-based memory assessment platform with an eye tracker. Visit counts, visit time, and time of first fixation on areas of interest (AOIs) were recorded and analyzed in combination with interictal epileptic discharge (IED) characteristics from the bilateral temporal lobes.Results: The TLE patients had significantly worse Wechsler Digit Span scores [F(1, 58) = 7.49, p = 0.008]. In the Short-Term Memory Game with eye tracking, TLE patients took a longer time to find the memorized items [F(1, 57) = 17.30, p < 0.001]. They had longer first fixation [F(1, 57) = 4.06, p = 0.049] and more visit counts [F(1, 57) = 7.58, p = 0.008] on the target during the recall. Furthermore, the performance of the patients in the Digit Span task was negatively correlated with the total number of IEDs [r(28) = −0.463, p = 0.013] and the number of spikes per sleep cycle [r(28) = −0.420, p = 0.026].Conclusion: Eye tracking appears to be a quantitative, objective measure of memory evaluation, demonstrating memory retrieval deficits but preserved visual attention in TLE patients. Nocturnal temporal lobe IEDs are closely associated with memory performance, which might be the electrophysiological mechanism for memory impairment in TLE.

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Eye tracking metrics to screen and assess cognitive impairment in patients with neurological disorders

Cited by 87 publications

References 71 publications

The effectiveness of eye tracking in the diagnosis of cognitive disorders: A systematic review and meta-analysis

The effectiveness of eye tracking in the diagnosis of cognitive disorders: A systematic review and meta-analysis

Driving With Distraction: Measuring Brain Activity and Oculomotor Behavior Using fMRI and Eye-Tracking

Memory Deficit in Patients With Temporal Lobe Epilepsy: Evidence From Eye Tracking Technology

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