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Riva N, Domi T, Pozzi L, Lunetta C, Schito P, Spinelli EG, Cabras S, Matteoni E, Consonni M, Bella ED, Agosta F, Filippi M, Calvo A, Quattrini A. Update on recent advances in amyotrophic lateral sclerosis. J Neurol 2024; 271:4693-4723. [PMID: 38802624 PMCID: PMC11233360 DOI: 10.1007/s00415-024-12435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
In the last few years, our understanding of disease molecular mechanisms underpinning ALS has advanced greatly, allowing the first steps in translating into clinical practice novel research findings, including gene therapy approaches. Similarly, the recent advent of assistive technologies has greatly improved the possibility of a more personalized approach to supportive and symptomatic care, in the context of an increasingly complex multidisciplinary line of actions, which remains the cornerstone of ALS management. Against this rapidly growing background, here we provide an comprehensive update on the most recent studies that have contributed towards our understanding of ALS pathogenesis, the latest results from clinical trials as well as the future directions for improving the clinical management of ALS patients.
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Affiliation(s)
- Nilo Riva
- 3Rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS "Carlo Besta" Neurological Insitute, Milan, Italy.
| | - Teuta Domi
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Pozzi
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Christian Lunetta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Milan Institute, 20138, Milan, Italy
| | - Paride Schito
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Edoardo Gioele Spinelli
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Cabras
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin; SC Neurologia 1U, AOU città della Salute e della Scienza di Torino, Turin, Italy
| | - Enrico Matteoni
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin; SC Neurologia 1U, AOU città della Salute e della Scienza di Torino, Turin, Italy
| | - Monica Consonni
- 3Rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS "Carlo Besta" Neurological Insitute, Milan, Italy
| | - Eleonora Dalla Bella
- 3Rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS "Carlo Besta" Neurological Insitute, Milan, Italy
| | - Federica Agosta
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute Huniversity, Milan, Italy
| | - Massimo Filippi
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute Huniversity, Milan, Italy
| | - Andrea Calvo
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin; SC Neurologia 1U, AOU città della Salute e della Scienza di Torino, Turin, Italy
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Chandrasekharan J, Joseph A, Ram A, Nollo G. ETMT: A Tool for Eye-Tracking-Based Trail-Making Test to Detect Cognitive Impairment. SENSORS (BASEL, SWITZERLAND) 2023; 23:6848. [PMID: 37571630 PMCID: PMC10422410 DOI: 10.3390/s23156848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
The growing number of people with cognitive impairment will significantly increase healthcare demand. Screening tools are crucial for detecting cognitive impairment due to a shortage of mental health experts aiming to improve the quality of life for those living with this condition. Eye tracking is a powerful tool that can provide deeper insights into human behavior and inner cognitive processes. The proposed Eye-Tracking-Based Trail-Making Test, ETMT, is a screening tool for monitoring a person's cognitive function. The proposed system utilizes a fuzzy-inference system as an integral part of its framework to calculate comprehensive scores assessing visual search speed and focused attention. By employing an adaptive neuro-fuzzy-inference system, the tool provides an overall cognitive-impairment score, allowing psychologists to assess and quantify the extent of cognitive decline or impairment in their patients. The ETMT model offers a comprehensive understanding of cognitive abilities and identifies potential deficits in various domains. The results indicate that the ETMT model is a potential tool for evaluating cognitive impairment and can capture significant changes in eye movement behavior associated with cognitive impairment. It provides a convenient and affordable diagnosis, prioritizing healthcare resources for severe conditions while enhancing feedback to practitioners.
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Affiliation(s)
- Jyotsna Chandrasekharan
- Department of Computer Science and Engineering, Amrita School of Computing, Amrita Vishwa Vidyapeetham, Bengaluru 560035, India;
- Department of Industrial Engineering, University of Trento, 38123 Trento, Italy;
| | - Amudha Joseph
- Department of Computer Science and Engineering, Amrita School of Computing, Amrita Vishwa Vidyapeetham, Bengaluru 560035, India;
| | | | - Giandomenico Nollo
- Department of Industrial Engineering, University of Trento, 38123 Trento, Italy;
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Poletti B, Solca F, Carelli L, Diena A, Colombo E, Torre S, Maranzano A, Greco L, Cozza F, Lizio A, Ferrucci R, Girotti F, Verde F, Morelli C, Lunetta C, Silani V, Ticozzi N. Association of Clinically Evident Eye Movement Abnormalities With Motor and Cognitive Features in Patients With Motor Neuron Disorders. Neurology 2021; 97:e1835-e1846. [PMID: 34504031 DOI: 10.1212/wnl.0000000000012774] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although oculomotor abnormalities (OMAs) are not usually considered prominent features of amyotrophic lateral sclerosis (ALS), they may represent potential clinical markers of neurodegeneration, especially when investigated together with cognitive and behavioral alterations. The aim of our study was to identify patterns of clinically evident OMAs in patients with ALS and to correlate such findings with cognitive-behavioral data. METHODS Three consecutive inpatient cohorts of Italian patients with ALS and controls were retrospectively evaluated to assess the frequency of OMAs and cognitive-behavioral alterations. The ALS population was divided into a discovery cohort and a replication cohort. Controls included a cohort of cognitively impaired individuals and patients with Alzheimer disease (AD). Participants underwent bedside eye movement evaluation to determine the presence and pattern of OMAs. Cognitive assessment was performed with a standard neuropsychological battery (discovery ALS cohort and AD cohort) and the Italian Edinburgh Cognitive and Behavioural ALS Screen (ECAS) (replication ALS cohort). RESULTS We recruited 864 individuals with ALS (635 discovery, 229 replication), 798 who were cognitively unimpaired and 171 with AD. OMAs were detected in 10.5% of our ALS cohort vs 1.6% of cognitively unimpaired controls (p = 1.2 × 10-14) and 11.4% of patients with AD (p = NS). The most frequent deficits were smooth pursuit and saccadic abnormalities. OMA frequency was higher in patients with bulbar onset, prominent upper motor neuron signs, and advanced disease stages. Cognitive dysfunction was significantly more frequent in patients with OMAs in both ALS cohorts (p = 1.1 × 10-25). Furthermore, OMAs significantly correlated with the severity of cognitive impairment and with pathologic scores at the ECAS ALS-specific domains. Last, OMAs could be observed in 35.0% of cognitively impaired patients with ALS vs 11.4% of patients with AD (p = 6.4 × 10-7), suggesting a possible involvement of frontal oculomotor areas in ALS. CONCLUSION Patients with ALS showed a range of clinically evident OMAs, and these alterations were significantly correlated with cognitive, but not behavioral, changes. OMAs may be a marker of neurodegeneration, and bedside assessment represents a rapid, highly specific tool for detecting cognitive impairment in ALS.
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Affiliation(s)
- Barbara Poletti
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Federica Solca
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Laura Carelli
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Alberto Diena
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Eleonora Colombo
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Silvia Torre
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Alessio Maranzano
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Lucia Greco
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Federica Cozza
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Andrea Lizio
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Roberta Ferrucci
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Floriano Girotti
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Federico Verde
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Claudia Morelli
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Christian Lunetta
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Vincenzo Silani
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Nicola Ticozzi
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy.
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Liu Z, Yang Z, Gu Y, Liu H, Wang P. The effectiveness of eye tracking in the diagnosis of cognitive disorders: A systematic review and meta-analysis. PLoS One 2021; 16:e0254059. [PMID: 34252113 PMCID: PMC8274929 DOI: 10.1371/journal.pone.0254059] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/18/2021] [Indexed: 02/05/2023] Open
Abstract
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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Affiliation(s)
- Zicai Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
| | - Zhen Yang
- Histology and Imaging platform, Core Facilities of West China Hospital, Sichuan University, China
| | - Yueming Gu
- Rehabilitation College of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Huiyu Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The 7th Affiliated Hospital of Sun Yat-Sen University (Shenzhen), Shenzhen, Guangdong, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Guangzhou, China
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Pinto S, Quintarelli S, Silani V. New technologies and Amyotrophic Lateral Sclerosis - Which step forward rushed by the COVID-19 pandemic? J Neurol Sci 2020; 418:117081. [PMID: 32882437 PMCID: PMC7403097 DOI: 10.1016/j.jns.2020.117081] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/09/2020] [Accepted: 08/01/2020] [Indexed: 12/11/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a fast-progressive neurodegenerative disease leading to progressive physical immobility with usually normal or mild cognitive and/or behavioural involvement. Many patients are relatively young, instructed, sensitive to new technologies, and professionally active when developing the first symptoms. Older patients usually require more time, encouragement, reinforcement and a closer support but, nevertheless, selecting user-friendly devices, provided earlier in the course of the disease, and engaging motivated carers may overcome many technological barriers. ALS may be considered a model for neurodegenerative diseases to further develop and test new technologies. From multidisciplinary teleconsults to telemonitoring of the respiratory function, telemedicine has the potentiality to embrace other fields, including nutrition, physical mobility, and the interaction with the environment. Brain-computer interfaces and eye tracking expanded the field of augmentative and alternative communication in ALS but their potentialities go beyond communication, to cognition and robotics. Virtual reality and different forms of artificial intelligence present further interesting possibilities that deserve to be investigated. COVID-19 pandemic is an unprecedented opportunity to speed up the development and implementation of new technologies in clinical practice, improving the daily living of both ALS patients and carers. The present work reviews the current technologies for ALS patients already in place or being under evaluation with published publications, prompted by the COVID-19 pandemic.
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Affiliation(s)
- Susana Pinto
- Translational and Clinical Physiology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
| | - Stefano Quintarelli
- AgID - Italian digital agency and Clusit - Italian Computer Security Association, Italy
| | - Vincenzo Silani
- Department of Neurology-Stroke Unit and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS - Department of Pathophysiology and Transplantation, “Dino Ferrari” Center and Center for Neurotechnology and Brain Therapeutics, Università degli Studi di Milano, Milan, Italy
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Tao L, Wang Q, Liu D, Wang J, Zhu Z, Feng L. Eye tracking metrics to screen and assess cognitive impairment in patients with neurological disorders. Neurol Sci 2020; 41:1697-1704. [PMID: 32125540 DOI: 10.1007/s10072-020-04310-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/20/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Eye tracking is a powerful method to investigate the relationship between behavior and neural mechanisms. In recent years, eye movement analysis has been used in patients with neurological disorders to assess cognitive function. In this review, we explore the latest eye tracking researches in neurological disorders that are commonly associated with cognitive deficits, specifically, amyotrophic lateral sclerosis (ALS), Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), and epilepsy. We focus on the application of ocular measures in these disorders, with the goal of understanding how eye tracking technology can be used in the clinical setting. FINDINGS Eye tracking tasks (especially saccadic tasks) are often used as an adjunct to traditional scales for cognitive assessment. Eye tracking data confirmed that executive dysfunction is common in PD and ALS, whereas AD and MS are characterized by attention deficits. Research in evaluating cognitive function in epilepsy using eye tracking is still in its early stages, but this approach has shown advantages as a sensitive quantitative method with high temporal and spatial resolution. Eye tracking technology can facilitate the assessment of cognitive impairment with higher temporal resolution and finer granularity than traditional cognitive assessment. Oculomotor data collected during cognitive tasks can provide insight into biological processes. Eye tracking provides a nonverbal and less cognitively demanding method of measuring disease progression in cognitively impaired patients.
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Affiliation(s)
- Ling Tao
- XiangYa School of Medicine, Central South University, Changsha, Hunan, China
| | - Quan Wang
- Key Laboratory of Biomedical Spectroscopy of Xi' An, Key Laboratory of Spectral Imaging technology, Xi'an, Institute of Optics and Precision Mechanics (XIOPM), Chinese Academy of Sciences, Xi' An, China
| | - Ding Liu
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jing Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ziqing Zhu
- XiangYa School of Medicine, Central South University, Changsha, Hunan, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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7
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Bueno APA, Sato JR, Hornberger M. Eye tracking - The overlooked method to measure cognition in neurodegeneration? Neuropsychologia 2019; 133:107191. [PMID: 31521634 DOI: 10.1016/j.neuropsychologia.2019.107191] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/26/2019] [Accepted: 09/08/2019] [Indexed: 12/11/2022]
Abstract
Eye tracking (ET) studies are becoming increasingly popular due to rapid methodological and technological advances as well as the development of cost efficient and portable eye trackers. Although historically ET has been mostly employed in psychophysics or developmental cognition studies, there is also promising scope to use ET for movement disorders and measuring cognitive processes in neurodegeneration. Particularly, ET can be a powerful tool for cognitive and neuropsychological assessments of patients with pathologies affecting motor and verbal abilities, as tasks can be adapted without requiring motor (except eye movements) or verbal responses. In this review, we will examine the existing evidence of ET methods in neurodegenerative conditions and its potential clinical impact for cognitive assessment. We highlight that current evidence for ET is mostly focused on diagnostics of cognitive impairments in neurodegenerative disorders, where it is debatable whether it has any more sensitivity or specificity than existing cognitive assessments. By contrast, there is currently a lack of ET studies in more advanced disease stages, when patients' motor and verbal functions can be significantly affected, and standard cognitive assessments are challenging or often not possible. We conclude that ET is a promising method not only for cognitive diagnostics but more importantly, for potential cognitive disease tracking in progressive neurodegenerative conditions.
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Affiliation(s)
- A P A Bueno
- - Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André, Brazil; - Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK.
| | - J R Sato
- - Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André, Brazil
| | - M Hornberger
- - Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK; - Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
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8
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An ERP-based BCI with peripheral stimuli: validation with ALS patients. Cogn Neurodyn 2019; 14:21-33. [PMID: 32015765 DOI: 10.1007/s11571-019-09541-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/05/2019] [Accepted: 06/03/2019] [Indexed: 12/13/2022] Open
Abstract
Many studies reported that ERP-based BCIs can provide communication for some people with amyotrophic lateral sclerosis (ALS). ERP-based BCIs often present characters within a matrix that occupies the center of the visual field. However, several studies have identified some concerns with the matrix-based approach. This approach may lead to fatigue and errors resulting from flashing adjacent stimuli, and is impractical for users who might want to use the BCI in tandem with other software or feedback in the center of the monitor. In this paper, we introduce and validate an alternate ERP-based BCI display approach. By presenting stimuli near the periphery of the display, we reduce the adjacency problem and leave the center of the display available for feedback or other applications. Two ERP-based display approaches were tested on 18 ALS patients to: (1) compare performance between a conventional matrix speller paradigm (Matrix-P, mean visual angle 6°) and a new speller paradigm with peripherally distributed stimuli (Peripheral-P, mean visual angle 8.8°); and (2) assess performance while spelling 42 characters online continuously, without a break. In the Peripheral-P condition, 12 subjects attained higher than 80% feedback accuracy during online performance, and 7 of these subjects obtained higher than 90% accuracy. The experimental results showed that the Peripheral-P condition yielded performance comparable to the conventional Matrix-P condition (p > 0.05) in accuracy and information transfer rate. This paper introduces a new display approach that leaves the center of the monitor open for feedback and/or other display elements, such as movies, games, art, or displays from other AAC software or conventional software tools.
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9
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Lulé D, Kübler A, Ludolph AC. Ethical Principles in Patient-Centered Medical Care to Support Quality of Life in Amyotrophic Lateral Sclerosis. Front Neurol 2019; 10:259. [PMID: 30967833 PMCID: PMC6439311 DOI: 10.3389/fneur.2019.00259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/26/2019] [Indexed: 12/12/2022] Open
Abstract
It is one of the primary goals of medical care to secure good quality of life (QoL) while prolonging survival. This is a major challenge in severe medical conditions with a prognosis such as amyotrophic lateral sclerosis (ALS). Further, the definition of QoL and the question whether survival in this severe condition is compatible with a good QoL is a matter of subjective and culture-specific debate. Some people without neurodegenerative conditions believe that physical decline is incompatible with satisfactory QoL. Current data provide extensive evidence that psychosocial adaptation in ALS is possible, indicated by a satisfactory QoL. Thus, there is no fatalistic link of loss of QoL when physical health declines. There are intrinsic and extrinsic factors that have been shown to successfully facilitate and secure QoL in ALS which will be reviewed in the following article following the four ethical principles (1) Beneficence, (2) Non-maleficence, (3) Autonomy and (4) Justice, which are regarded as key elements of patient centered medical care according to Beauchamp and Childress. This is a JPND-funded work to summarize findings of the project NEEDSinALS (www.NEEDSinALS.com) which highlights subjective perspectives and preferences in medical decision making in ALS.
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Affiliation(s)
- Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Andrea Kübler
- Interventional Psychology, Psychology III, University of Würzburg, Würzburg, Germany
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10
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Keller J, Böhm S, Aho-Özhan HEA, Loose M, Gorges M, Kassubek J, Uttner I, Abrahams S, Ludolph AC, Lulé D. Functional reorganization during cognitive function tasks in patients with amyotrophic lateral sclerosis. Brain Imaging Behav 2019; 12:771-784. [PMID: 28600740 DOI: 10.1007/s11682-017-9738-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cognitive deficits, especially in the domains of social cognition and executive function including verbal fluency, are common in amyotrophic lateral sclerosis (ALS) patients. There is yet sparse understanding of pathogenesis of the underlying, possibly adaptive, cortical patterns. To address this issue, 65 patients with ALS and 33 age-, gender- and education-matched healthy controls were tested on cognitive and behavioral deficits with the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Using functional magnetic resonance imaging (fMRI), cortical activity during social cognition and executive function tasks (theory of mind, verbal fluency, alternation) adapted from the ECAS was determined in a 3 Tesla scanner. Compared to healthy controls, ALS patients performed worse in the ECAS overall (p < 0.001) and in all of its subdomains (p < 0.02), except memory. Imaging revealed altered cortical activation during all tasks, with patients consistently showing a hyperactivation in relevant brain areas compared to healthy controls. Additionally, cognitively high performing ALS patients consistently exhibited more activation in frontal brain areas than low performing patients and behaviorally unimpaired patients presented with more neuronal activity in orbitofrontal areas than behaviorally impaired patients. In conclusion, hyperactivation in fMRI cognitive tasks seems to represent an early adaptive process to overcome neuronal cell loss in relevant brain areas. The hereby presented cortical pattern change might suggest that, once this loss passes a critical threshold and no cortical buffering is possible, clinical representation of cognitive and behavioral impairment evolves. Future studies might shed light on the pattern of cortical pattern change in the course of ALS.
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Affiliation(s)
- Jürgen Keller
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Sarah Böhm
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Helena E A Aho-Özhan
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Markus Loose
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Martin Gorges
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Sharon Abrahams
- Psychology-PPLS, Euan MacDonald Centre for Motor Neuron Disease Research & Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 7 George Square, Edinburgh, EH89JZ, UK
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
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11
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Lulé D, Hörner K, Vazquez C, Aho-Özhan H, Keller J, Gorges M, Uttner I, Ludolph AC. Screening for Cognitive Function in Complete Immobility Using Brain-Machine Interfaces: A Proof of Principle Study. Front Neurosci 2018; 12:517. [PMID: 30158845 PMCID: PMC6104564 DOI: 10.3389/fnins.2018.00517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022] Open
Abstract
Background: In many neurological conditions, there is a combination of decline in physical function and cognitive abilities. For far advanced stages of physical disability where speaking and hand motor abilities are severely impaired, there is a lack of standardized approach to screen for cognitive profile. Methods:N = 40 healthy subjects were included in the study. For proof of principle, N = 6 ALS patients were additionally measured. For cognitive screening, we used the Edinburgh cognitive and behavioral ALS screen (ECAS) in the standard paper-and-pencil version. Additionally, we adapted the ECAS to a brain-machine interface (BMI) control module to screen for cognition in severely advanced patients. Results: There was a high congruency between BMI version and the paper-and-pencil version of the ECAS. Sensitivity and specificity of the ECAS-BMI were mostly high whereas stress and weariness for the patient were low. Discussion/Conclusion: We hereby present evidence that adaptation of a standardized neuropsychological test for BMI control is feasible. BMI driven neuropsychological test provides congruent results compared to standardized tests with a good specificity and sensitivity but low patient load.
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Affiliation(s)
- Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | | | - Jürgen Keller
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Martin Gorges
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, University of Ulm, Ulm, Germany
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12
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Poletti B, Carelli L, Faini A, Solca F, Meriggi P, Lafronza A, Ciringione L, Pedroli E, Ticozzi N, Ciammola A, Cipresso P, Riva G, Silani V. The Arrows and Colors Cognitive Test (ACCT): A new verbal-motor free cognitive measure for executive functions in ALS. PLoS One 2018; 13:e0200953. [PMID: 30091987 PMCID: PMC6084851 DOI: 10.1371/journal.pone.0200953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/04/2018] [Indexed: 11/18/2022] Open
Abstract
Background and objective The presence of executive deficits in patients with Amyotrophic Lateral Sclerosis is well established, even if standardized measures are difficult to obtain due to progressive physical disability of the patients. We present clinical data concerning a newly developed measure of cognitive flexibility, administered by means of Eye-Tracking (ET) technology in order to bypass verbal-motor limitations. Methods 21 ALS patients and 21 age-and education-matched healthy subjects participated in an ET-based cognitive assessment, including a newly developed test of cognitive flexibility (Arrows and Colors Cognitive Test–ACCT) and other oculomotor-driven measures of cognitive functions. A standard screening of frontal and working memory abilities and global cognitive efficiency was administered to all subjects, in addition to a psychological self-rated assessment. For ALS patients, a clinical examination was also performed. Results ACCT successfully discriminated between patients and healthy controls, mainly concerning execution times obtained at different subtests. A qualitative analysis performed on error distributions in patients highlighted a lower prevalence of perseverative errors, with respect to other type of errors. Correlations between ACCT and other ET-based frontal-executive measures were significant and involved different frontal sub-domains. Limited correlations were observed between ACCT and standard ‘paper and pencil’ cognitive tests. Conclusions The newly developed ET-based measure of cognitive flexibility could be a useful tool to detect slight frontal impairments in non-demented ALS patients by bypassing verbal-motor limitations through the oculomotor-driven administration. The findings reported in the present study represent the first contribution towards the development of a full verbal-motor free executive test for ALS patients.
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Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience—IRCCS Istituto Auxologico Italiano, Milan, Italy
- * E-mail:
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience—IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences—IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Federica Solca
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy
| | - Paolo Meriggi
- ICT & Biomedical Technology Integration Unit, Centre for Innovation and Technology Transfer (CITT), Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Annalisa Lafronza
- Department of Neurology and Laboratory of Neuroscience—IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Luciana Ciringione
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience—IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience—IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience—IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy
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13
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Linse K, Aust E, Joos M, Hermann A. Communication Matters-Pitfalls and Promise of Hightech Communication Devices in Palliative Care of Severely Physically Disabled Patients With Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:603. [PMID: 30100896 PMCID: PMC6072854 DOI: 10.3389/fneur.2018.00603] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease, leading to progressive paralysis, dysarthria, dysphagia, and respiratory disabilities. Therapy is mostly focused on palliative interventions. During the course of the disease, verbal as well as nonverbal communicative abilities become more and more impaired. In this light, communication has been argued to be “the essence of human life” and crucial for patients' quality of life. High-tech augmentative and alternative communication (HT-AAC) technologies such as eyetracking based computer devices and brain-computer-interfaces provide the possibility to maintain caregiver-independent communication and environmental control even in the advanced disease state of ALS. Thus, they enable patients to preserve social participation and to independently communicate end-of-life-decisions. In accordance with these functions of HT-AAC, their use is reported to strengthen self-determination, increase patients' quality of life and reduce caregiver burden. Therefore, HT-AAC should be considered as standard of (palliative) care for people with ALS. On the other hand, the supply with individually tailored HT-AAC technologies is limited by external and patient-inherent variables. This review aims to provide an overview of the possibilities and limitations of HT-AAC technologies and discuss their role in the palliative care for patients with ALS.
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Affiliation(s)
- Katharina Linse
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Elisa Aust
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Markus Joos
- Interactive Minds Dresden GmbH, Dresden, Germany
| | - Andreas Hermann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
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14
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Poletti B, Carelli L, Solca F, Lafronza A, Pedroli E, Faini A, Ticozzi N, Ciammola A, Meriggi P, Cipresso P, Lulé D, Ludolph AC, Riva G, Silani V. An eye-tracker controlled cognitive battery: overcoming verbal-motor limitations in ALS. J Neurol 2017; 264:1136-1145. [PMID: 28503706 DOI: 10.1007/s00415-017-8506-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/04/2017] [Indexed: 11/24/2022]
Abstract
We assessed language, attention, executive, and social cognition abilities in a sample of patients with Amyotrophic Lateral Sclerosis (ALS) by means of a recently developed cognitive battery based on oculomotor control with eye-tracking (ET) technology. Twenty-one ALS patients and 21 age- and education-matched healthy subjects underwent the ET-based cognitive assessment, together with the standard cognitive screening tools [Frontal Assessment Battery (FAB); Montreal Cognitive Assessment (MoCA); and Digit Sequencing Task]. Psychological measures of anxiety (State-Trait Anxiety Inventory-Y) and depression (Beck Depression Inventory) were also collected, and an ET usability questionnaire was administered. For patients, clinical and respiratory examinations were also performed, together with behavioural assessment (Frontal Behavioural Inventory). The developed battery discriminated among patients and controls with regard to measures of verbal fluency, frontal abilities, and social cognition. Measures of diagnostic utility confirmed a higher diagnostic accuracy of such ET-based tests with respect to FAB; similar diagnostic accuracy emerged when comparing them to the other standard cognitive tools (MoCA, WM). Usability ratings about the ET tests were comparable among the two groups. The ET-based neuropsychological battery demonstrated good levels of diagnostic accuracy and usability in a clinical population of non-demented ALS patients, compared to matched healthy controls. Future studies will be aimed at further investigate validity and usability components by recruiting larger sample of patients, both in moderate-to-severe stages of the disease and affected by more severe cognitive impairment.
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Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Annalisa Lafronza
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Meriggi
- ICT and Biomedical Technology Integration Unit, Centre for Innovation and Technology Transfer (CITT), Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
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15
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Keller J, Krimly A, Bauer L, Schulenburg S, Böhm S, Aho-Özhan HEA, Uttner I, Gorges M, Kassubek J, Pinkhardt EH, Abrahams S, Ludolph AC, Lulé D. A first approach to a neuropsychological screening tool using eye-tracking for bedside cognitive testing based on the Edinburgh Cognitive and Behavioural ALS Screen. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:443-450. [DOI: 10.1080/21678421.2017.1313869] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jürgen Keller
- Department of Neurology, University of Ulm, Ulm, Germany and
| | - Amon Krimly
- Department of Neurology, University of Ulm, Ulm, Germany and
| | - Lisa Bauer
- Department of Neurology, University of Ulm, Ulm, Germany and
| | | | - Sarah Böhm
- Department of Neurology, University of Ulm, Ulm, Germany and
| | | | - Ingo Uttner
- Department of Neurology, University of Ulm, Ulm, Germany and
| | - Martin Gorges
- Department of Neurology, University of Ulm, Ulm, Germany and
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany and
| | | | - Sharon Abrahams
- Human Cognitive Neuroscience-PPLS, Centre for Cognitive Ageing and Cognitive Epidemiology, Euan MacDonald Centre for Motor Neuron Disease Research, and Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
| | | | - Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany and
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16
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Poletti B, Carelli L, Solca F, Lafronza A, Pedroli E, Faini A, Zago S, Ticozzi N, Ciammola A, Morelli C, Meriggi P, Cipresso P, Lulé D, Ludolph AC, Riva G, Silani V. An eye-tracking controlled neuropsychological battery for cognitive assessment in neurological diseases. Neurol Sci 2017; 38:595-603. [PMID: 28078566 DOI: 10.1007/s10072-016-2807-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/23/2016] [Indexed: 12/11/2022]
Abstract
Traditional cognitive assessment in neurological conditions involving physical disability is often prevented by the presence of verbal-motor impairment; to date, an extensive motor-verbal-free neuropsychological battery is not available for such purposes. We adapted a set of neuropsychological tests, assessing language, attentional abilities, executive functions and social cognition, for eye-tracking (ET) control, and explored its feasibility in a sample of healthy participants. Thirty healthy subjects performed a neuropsychological assessment, using an ET-based neuropsychological battery, together with standard "paper and pencil" cognitive measures for frontal (Frontal Assessment Battery-FAB) and working memory abilities (Digit Sequencing Task) and for global cognitive efficiency (Montreal Cognitive Assessment-MoCA). Psychological measures of anxiety (State-Trait Anxiety Inventory-Y-STAI-Y) and depression (Beck Depression Inventory-BDI) were also collected, and a usability questionnaire was administered. Significant correlations were observed between the "paper and pencil" screening of working memory abilities and the ET-based neuropsychological measures. The ET-based battery also correlated with the MoCA, while poor correlations were observed with the FAB. Usability aspects were found to be influenced by both working memory abilities and psychological components. The ET-based neuropsychological battery developed could provide an extensive assessment of cognitive functions, allowing participants to perform tasks independently from the integrity of motor or verbal channels. Further studies will be aimed at investigating validity and usability components in neurological populations with motor-verbal impairments.
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Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Annalisa Lafronza
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefano Zago
- Department of Neuroscience and Mental Health, Università degli Studi di Milano, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Claudia Morelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Meriggi
- ICT and Biomedical Technology Integration Unit, Centre for Innovation and Technology Transfer (CITT), Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
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17
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Keller J, Gorges M, Aho-Özhan HEA, Uttner I, Schneider E, Kassubek J, Pinkhardt EH, Ludolph AC, Lulé D. Eye-Tracking Control to Assess Cognitive Functions in Patients with Amyotrophic Lateral Sclerosis. J Vis Exp 2016. [PMID: 27768047 DOI: 10.3791/54634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with pathological involvement of upper and lower motoneurons, subsequently leading to progressive loss of motor and speech abilities. In addition, cognitive functions are impaired in a subset of patients. To evaluate these potential deficits in severely physically impaired ALS patients, eye-tracking is a promising means to conduct cognitive tests. The present article focuses on how eye movements, an indirect means of communication for physically disabled patients, can be utilized to allow for detailed neuropsychological assessment. The requirements, in terms of oculomotor parameters that have to be met for sufficient eye-tracking in ALS patients are presented. The properties of stimuli, including type of neuropsychological tests and style of presentation, best suited to successfully assess cognitive functioning, are also described. Furthermore, recommendations regarding procedural requirements are provided. Overall, this methodology provides a reliable, easy to administer and fast approach for assessing cognitive deficits in patients who are unable to speak or write such as patients with severe ALS. The only confounding factor might be deficits in voluntary eye movement control in a subset of ALS patients.
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Affiliation(s)
| | | | | | | | - Erich Schneider
- Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg
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18
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An eye-controlled version of the Kaufman Brief Intelligence Test 2 (KBIT-2) to assess cognitive functioning. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2016.05.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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19
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Riva N, Agosta F, Lunetta C, Filippi M, Quattrini A. Recent advances in amyotrophic lateral sclerosis. J Neurol 2016; 263:1241-54. [PMID: 27025851 PMCID: PMC4893385 DOI: 10.1007/s00415-016-8091-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/12/2016] [Indexed: 10/28/2022]
Abstract
ALS is a relentlessly progressive and fatal disease, with no curative therapies available to date. Symptomatic and palliative care, provided in a multidisciplinary context, still remains the cornerstone of ALS management. However, our understanding of the molecular mechanisms underlying the disease has advanced greatly over the past years, giving new hope for the development of novel diagnostic and therapeutic approaches. Here, we have reviewed the most recent studies that have contributed to improving both clinical management and our understanding of ALS pathogenesis.
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Affiliation(s)
- Nilo Riva
- Neuropathology Unit, INSPE and Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Via Olgettina 48, 20132, Milan, Italy.
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Christian Lunetta
- NEuroMuscular Omnicentre (NEMO), Niguarda Ca Granda Hospital, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Quattrini
- Neuropathology Unit, INSPE and Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Via Olgettina 48, 20132, Milan, Italy
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20
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Poletti B, Solca F, Carelli L, Madotto F, Lafronza A, Faini A, Monti A, Zago S, Calini D, Tiloca C, Doretti A, Verde F, Ratti A, Ticozzi N, Abrahams S, Silani V. The validation of the Italian Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:489-498. [PMID: 27219526 DOI: 10.1080/21678421.2016.1183679] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study presents the Italian validation of the recently developed Edinburgh Cognitive and Behavioural ALS Screen (ECAS), a short screen for cognitive/behavioural alterations in patients with amyotrophic lateral sclerosis (ALS). We evaluated the psychometric properties of the ECAS Italian version in terms of reliability and convergent validity for both cognitive and behavioural features. Furthermore, we investigated the relationship with affective and clinical variables, in addition to ECAS usability and patients' insight into cognitive/behaviour changes. Finally, correlations between genetic and cognitive/behavioural data were analysed. We recruited 107 patients with ALS. Normative data were collected on 248 healthy subjects. Participants were administered the ECAS and two standard cognitive screening tools (FAB, MoCA), two psychological questionnaires (BDI, STAI/Y) and an ad hoc usability questionnaire. The FBI was also carried out with caregivers. Results showed that the ECAS Italian version discriminated well between patients and controls. The most prevalent deficit occurred in executive functions and fluency. Correlations were observed between the ECAS and standard cognitive screening tools and between the ECAS carer interview and the FBI, supporting its full convergent validity. In conclusion, the ECAS Italian version provides clinicians with a rapid, feasible and sensitive tool, useful to identify different profiles of cognitive-behavioural impairment in ALS.
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Affiliation(s)
- Barbara Poletti
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Federica Solca
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Laura Carelli
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Fabiana Madotto
- b Research Centre on Public Health, Department of Medicine and Surgery , University of Milano-Bicocca , Milan , Italy
| | - Annalisa Lafronza
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Andrea Faini
- c Department of Cardiovascular, Neural and Metabolic Sciences - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Alessia Monti
- d Department of Neurorehabilitation Sciences , Casa Cura Policlinico , Milan , Italy
| | - Stefano Zago
- e Department of Neuroscience and Mental Health , Università degli Studi di Milano, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Daniela Calini
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Cinzia Tiloca
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Alberto Doretti
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy.,f Department of Pathophysiology and Transplantation , 'Dino Ferrari' Centre, Università degli Studi di Milano , Milan , Italy , and
| | - Federico Verde
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy.,f Department of Pathophysiology and Transplantation , 'Dino Ferrari' Centre, Università degli Studi di Milano , Milan , Italy , and
| | - Antonia Ratti
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy.,f Department of Pathophysiology and Transplantation , 'Dino Ferrari' Centre, Università degli Studi di Milano , Milan , Italy , and
| | - Nicola Ticozzi
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy.,f Department of Pathophysiology and Transplantation , 'Dino Ferrari' Centre, Università degli Studi di Milano , Milan , Italy , and
| | - Sharon Abrahams
- g Euan MacDonald Centre for Motor Neurone Disease Research, Anne Rowling Regenerate Neurology Clinic, Centre for Cognitive Ageing and Cognitive Epidemiology, Human Cognitive Neuroscience-PPLS, University of Edinburgh , Edinburgh , UK
| | - Vincenzo Silani
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy.,f Department of Pathophysiology and Transplantation , 'Dino Ferrari' Centre, Università degli Studi di Milano , Milan , Italy , and
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