Eye-tracking paradigms for the assessment of mild cognitive impairment: a systematic review - PubMed Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jul 20:14:1197567.
doi: 10.3389/fpsyg.2023.1197567. eCollection 2023.

Eye-tracking paradigms for the assessment of mild cognitive impairment: a systematic review

Alexandra Wolf  1   2 , Kornkanok Tripanpitak  1 , Satoshi Umeda  3 , Mihoko Otake-Matsuura  1
Affiliations
Review

Eye-tracking paradigms for the assessment of mild cognitive impairment: a systematic review

Alexandra Wolf et al. Front Psychol. .

Abstract

Mild cognitive impairment (MCI), representing the 'transitional zone' between normal cognition and dementia, has become a novel topic in clinical research. Although early detection is crucial, it remains logistically challenging at the same time. While traditional pen-and-paper tests require in-depth training to ensure standardized administration and accurate interpretation of findings, significant technological advancements are leading to the development of procedures for the early detection of Alzheimer's disease (AD) and facilitating the diagnostic process. Some of the diagnostic protocols, however, show significant limitations that hamper their widespread adoption. Concerns about the social and economic implications of the increasing incidence of AD underline the need for reliable, non-invasive, cost-effective, and timely cognitive scoring methodologies. For instance, modern clinical studies report significant oculomotor impairments among patients with MCI, who perform poorly in visual paired-comparison tasks by ascribing less attentional resources to novel stimuli. To accelerate the Global Action Plan on the Public Health Response to Dementia 2017-2025, this work provides an overview of research on saccadic and exploratory eye-movement deficits among older adults with MCI. The review protocol was drafted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases were systematically searched to identify peer-reviewed articles published between 2017 and 2022 that examined visual processing in older adults with MCI and reported gaze parameters as potential biomarkers. Moreover, following the contemporary trend for remote healthcare technologies, we reviewed studies that implemented non-commercial eye-tracking instrumentation in order to detect information processing impairments among the MCI population. Based on the gathered literature, eye-tracking-based paradigms may ameliorate the screening limitations of traditional cognitive assessments and contribute to early AD detection. However, in order to translate the findings pertaining to abnormal gaze behavior into clinical applications, it is imperative to conduct longitudinal investigations in both laboratory-based and ecologically valid settings.

Keywords: Alzheimer’s disease; biomarker; cognitive assessment; dementia; eye-tracking; information processing; mild cognitive impairment; screening.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Schematic progression from normal aging to dementia, adapted with modifications in color from Forlenza et al., 2010 (available via license: CC BY 2.0). Relationship between the progression of cognitive and functional symptoms and the neuropathological events in the transition from the pre-clinical (silent) phase to mild cognitive impairment (MCI) due to AD and clinically manifest AD.
Figure 2
Figure 2
The full output plot from the PRISMA flow diagram, generated via the https://estech.shinyapps.io/prisma_flowdiagram/ (Haddaway et al., 2022).
Figure 3
Figure 3
Various conditions of the prosaccade and antisaccade tasks, adapted from Si et al., 2022. Each trial begins with a presentation of a fixation cross at the center of the screen. Participants are required to fixate on it and to make a prosaccade or antisaccade (depending on the task’s instruction). Immediate prosaccade: A-D; Immediate antisaccade: A-E; Gap prosaccade: A-F-D; Gap antisaccade: A-F-E; Overlap prosaccade: A-B; Overlap antisaccade: A-C.
Figure 4
Figure 4
Take-home messages for the section dedicated to the Visual Paired-Comparison test (own elaboration based on reports from Bott et al., 2017; Gills et al., 2019, 2021; Nie et al., 2020).
Figure 5
Figure 5
Schematic of the visuospatial memory eye-tracking task with a brief explanation (figure of the paradigm taken from Haque et al., 2019). Participants are asked to view a set of images for 5 s (with a 1 s interstimulus interval during the encoding phase). During the recognition phase, participants view the same set of realistic images with either one item removed (removed condition) or one item added (added condition). The manipulated regions (indicated by the yellow box just for an explanatory reason) are used to quantify memory performance. The final test consists of the presentation of two sets of 10 original and manipulated pairs (seven with removed condition and three with added condition) with a delay of 1 min between the original and manipulated presentations. The entire task takes 4 min.
Figure 6
Figure 6
Schematic view of the King Devick test with a brief explanation (figure obtained from Leong et al., 2015). Each test card displays 40 digits in five rows, with the spacing between each number varying between rows and across rows. Notably, the visual demands of the test cards increase as the test progresses. The first test card has straight lines connecting the numbers that aid visual scanning. In the second test card, the lines connecting the numbers are missing. The final test card is made up of numbers with no connecting lines and with the spacing between the rows truncated.
Figure 7
Figure 7
Take-home-messages for the section dedicated to the King Devick test (own elaboration based on scientific works by Galetta et al., 2017; Hannonen et al., 2022).
Figure 8
Figure 8
Schematic view of the Rapid Assessment of Cognitive Impairment Test, obtained with permission from Oyama et al. (2019). (A) Rapid cognitive assessment using an eye-tracking technology and ten task movies. (B) The subject views a series of tasks and pictures (for a total of 178 s), which assess smooth pursuit eye movement, deductive reasoning, visuospatial function, and working memory. (C) An example (Task 4) of the visual working memory task (pattern matching). The participant is asked to look at target image (here: a combination of a circle and a triangle) for 10 s (encoding) in order to correctly recall the object later on. The fixation duration within the region of interest (ROI) of the target object is used to calculate the cognitive score. For full details of the procedure kindly refer to the supplementary information in Oyama et al. (2019).
Figure 9
Figure 9
Eye tracking test for the early detection of cognitive decline in mild cognitive impairment and Alzheimer’s disease, obtained with permission from Tadokoro et al. (2021). Representative images of all 10 tasks with English instructions, which were initially given in Japanese. For full details of the instructions, see Tadokoro et al. (2021).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Ahmed T., Hoyle R., Connelly K., Crandall D., Kapadia A. (2015). “Privacy concerns and behaviors of people with visual impairments” in Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems (Seoul Republic of Korea: ACM; ), 3523–3532.
    1. Alber J., Goldfarb D., Thompson L. I., Arthur E., Hernandez K., Cheng D., et al. . (2020). Developing retinal biomarkers for the earliest stages of Alzheimer’s disease: what we know, what we don’t, and how to move forward. Alzheimers Dement. 16, 229–243. doi: 10.1002/alz.12006 - DOI - PubMed
    1. Albert M., Moss M. B., Blacker D., Tanzi R., McArdle J. J. (2007). Longitudinal change in cognitive performance among individuals with mild cognitive impairment. Neuropsychology 21, 158–169. doi: 10.1037/0894-4105.21.2.158 - DOI - PubMed
    1. Albert M. S., DeKosky S. T., Dickson D., Dubois B., Feldman H. H., Fox N. C., et al. . (2011). The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 7, 270–279. doi: 10.1016/j.jalz.2011.03.008 - DOI - PMC - PubMed
    1. Alzheimer’s Association (2019). 2019 Alzheimer’s disease facts and figures. Alzheimers Dement. 15, 321–387. doi: 10.1016/j.jalz.2019.01.010 - DOI

LinkOut - more resources