Visual Search Efficiency in Mild Cognitive Impairment and Alzheimer’s Disease: An Eye Movement Study

Pereira, Marta Luisa Goncalves de Freitas; Camargo, Marina von Zuben de Arruda; Bellan, Ariella Fornachari Ribeiro; Tahira, Ana Carolina; Santos, Bernardo dos; Santos, Jandir C.; Machado‐Lima, Ariane; Nunes, Fátima L. S.; Forlenza, Orestes Vicente

doi:10.3233/jad-190690

Cited by 28 publications

(51 citation statements)

References 54 publications

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“…They ranged from 26 to 30 points, which confirms the inclusion of cognitively nonimpaired participants in the study but is probably too small to find correlations. As mentioned in the introduction, other studies with cognitively impaired patients did find a relationship between cognition and eye movements [37,38,69], moderated by the amount of cognitive impairment [10]. Therefore, we assume that a similar study in patients with a diagnosis of dementia might show a relationship between MoCA scores and eye movements.…”

Section: Renderxmentioning

confidence: 63%

“…Visual exploration studies have shown that saccades are shorter and fixations are longer in patients with AD than in healthy older adults [37]. Also, higher number of fixations are reported in patients with AD during visual search [38], and the extent of saccade abnormalities in dementia is related to the level of cognitive impairment. To use eye movements as digital markers, they must provide replicable results across the short term and be related to disease severity [10].…”

Section: Eye Trackingmentioning

confidence: 99%

“…In Huntington disease, abnormal eye movements are one of the earliest manifestation of the disease [70]. Previous research has shown that patients diagnosed with dementia or mild cognitive impairment show more and longer fixations on distractor items than healthy participants [38]. Moreover, the visual search strategy of patients with dementia focuses more strongly on areas in the periphery, while healthy older participants focus more strongly on the center of the visual field [71].…”

Section: Clinicalmentioning

confidence: 99%

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Application of Eye Tracking in Puzzle Games for Adjunct Cognitive Markers: Pilot Observational Study in Older Adults

Krebs¹,

Falkner²,

Niklaus³

et al. 2021

JMIR Serious Games

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Background Recent studies suggest that computerized puzzle games are enjoyable, easy to play, and engage attentional, visuospatial, and executive functions. They may help mediate impairments seen in cognitive decline in addition to being an assessment tool. Eye tracking provides a quantitative and qualitative analysis of gaze, which is highly useful in understanding visual search behavior. Objective The goal of the research was to test the feasibility of eye tracking during a puzzle game and develop adjunct markers for cognitive performance using eye-tracking metrics. Methods A desktop version of the Match-3 puzzle game with 15 difficulty levels was developed using Unity 3D (Unity Technologies). The goal of the Match-3 puzzle was to find configurations (target patterns) that could be turned into a row of 3 identical game objects (tiles) by swapping 2 adjacent tiles. Difficulty levels were created by manipulating the puzzle board size (all combinations of width and height from 4 to 8) and the number of unique tiles on the puzzle board (from 4 to 8). Each level consisted of 4 boards (ie, target patterns to match) with one target pattern each. In this study, the desktop version was presented on a laptop computer setup with eye tracking. Healthy older subjects were recruited to play a full set of 15 puzzle levels. A paper-pencil–based assessment battery was administered prior to the Match-3 game. The gaze behavior of all participants was recorded during the game. Correlation analyses were performed on eye-tracking data correcting for age to examine if gaze behavior pertains to target patterns and distractor patterns and changes with puzzle board size (set size). Additionally, correlations between cognitive performance and eye movement metrics were calculated. Results A total of 13 healthy older subjects (mean age 70.67 [SD 4.75] years; range 63 to 80 years) participated in this study. In total, 3 training and 12 test levels were played by the participants. Eye tracking recorded 672 fixations in total, 525 fixations on distractor patterns and 99 fixations on target patterns. Significant correlations were found between executive functions (Trail Making Test B) and number of fixations on distractor patterns (P=.01) and average fixations (P=.005). Conclusions Overall, this study shows that eye tracking in puzzle games can act as a supplemental source of data for cognitive performance. The relationship between a paper-pencil test for executive functions and fixations confirms that both are related to the same cognitive processes. Therefore, eye movement metrics might be used as an adjunct marker for cognitive abilities like executive functions. However, further research is needed to evaluate the potential of the various eye movement metrics in combination with puzzle games as visual search and attentional marker.

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Section: Renderxmentioning

confidence: 63%

Section: Eye Trackingmentioning

confidence: 99%

Section: Clinicalmentioning

confidence: 99%

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Application of Eye Tracking in Puzzle Games for Adjunct Cognitive Markers: Pilot Observational Study in Older Adults

Krebs¹,

Falkner²,

Niklaus³

et al. 2021

JMIR Serious Games

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“…Of the 94 records, 40 studies were not diagnostic accuracy studies or unrelated to CI, 5 studies were published in non-English, and 16 studies were reviews or meta-analyses. In the end, the qualitative descriptive analysis included 11 studies [26][27][28][29][30][31][32][33][34][35][36], 9 comparative studies met all criteria and were included in a quantitative meta-analysis. Fig 1 shows our retrieval process and selection process.…”

Section: Results Of the Searchmentioning

confidence: 99%

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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“…Using machine learning methods to process eye tracking signals [10] has shown the potential of an approach under development, illustrated by Figure 2. Some of the psychiatric disorders can limit an individual's ability to recognize facial expressions of emotions.…”

Section: Computer-aided Diagnosis and Therapymentioning

confidence: 99%

Virtual Reality, Augmented Reality and Beyond: Laboratory of Computer Applications for Health Care at University of São Paulo

Nunes¹,

Aranha

Testa

et al. 2020

Revista CI

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The Laboratory of Computer Applications for Health Care at University of São Paulo develop multidisciplinary research involving Computer Science areas and other knowledge fields such as Physiotherapy, Psychiatry, Radiology, and Cardiology. Most studies use concepts besides Computer Science, by aggregating knowledge to solve real problems. In this paper we present the main projects in Virtual Reality and Augmented Reality areas, highlighting serious games, computer-aided diagnosis and therapy, simulation and training. Besides the social and scientific impact inherent to the type of the developed research, some systems are available to health professionals in order to allow technology transfer and consequent technological and economic impact in daily activities of health tasks.

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Visual Search Efficiency in Mild Cognitive Impairment and Alzheimer’s Disease: An Eye Movement Study

Cited by 28 publications

References 54 publications

Application of Eye Tracking in Puzzle Games for Adjunct Cognitive Markers: Pilot Observational Study in Older Adults

Application of Eye Tracking in Puzzle Games for Adjunct Cognitive Markers: Pilot Observational Study in Older Adults

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

Virtual Reality, Augmented Reality and Beyond: Laboratory of Computer Applications for Health Care at University of São Paulo

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