title: Eye-tracking controlled cognitive function tests in patients with amyotrophic lateral sclerosis: a controlled proof-of-principle study.
abstract: Amyotrophic lateral sclerosis (ALS) primarily affects motor and speech abilities. In addition, cognitive functions are impaired in a subset of patients. There is a need to establish an eye movement-based method of neuropsychological assessment suitable for severely physically impaired patients with ALS. Forty-eight ALS patients and thirty-two healthy controls matched for age, sex and education performed a hand and speech motor-free version of the Raven's coloured progressive matrices (CPM) and the D2-test which had been especially adapted for eye-tracking control. Data were compared to a classical motor-dependent paper-pencil version. The association of parameters of the eye-tracking and the paper-pencil version of the tests and the differences between and within groups were studied. Subjects presented similar results in the eye-tracking and the corresponding paper-pencil versions of the CPM and D2-test: a correlation between performance accuracy for the CPM was observed for ALS patients (p < 0.001) and controls (p < 0.001) and in the D2-test for controls (p = 0.048), whereas this correlation did not reach statistical significance for ALS patients (p = 0.096). ALS patients performed worse in the CPM than controls in the eye-tracking (p = 0.053) and the paper-pencil version (p = 0.042). Most importantly, eye-tracking versions of the CPM (p < 0.001) and the D2-test (p = 0.024) reliably distinguished between more and less cognitively impaired patients. Eye-tracking-based neuropsychological testing is a promising approach for assessing cognitive deficits in patients who are unable to speak or write such as patients with severe ALS.
authors.affiliation: Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Keller
authors.forename: Martin
authors.initials: M
authors.lastname: Gorges
authors.forename: Hannah T
authors.initials: HT
authors.lastname: Horn
authors.forename: Helena E A
authors.initials: HE
authors.lastname: Aho-Özhan
authors.forename: Elmar H
authors.initials: EH
authors.lastname: Pinkhardt
authors.forename: Ingo
authors.initials: I
authors.lastname: Uttner
authors.forename: Jan
authors.initials: J
authors.lastname: Kassubek
authors.forename: Albert C
authors.initials: AC
authors.lastname: Ludolph
authors.forename: Dorothée
authors.initials: D
authors.lastname: Lulé
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000175:diagnosis*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D056344:Executive Function / Q000502:physiology*; D053483:Eye Movement Measurements / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity