眼跟踪控制，以评估患者的认知功能与肌萎缩性脊髓侧索硬化症
Summary
Cognitive deficits are common in about one third of patients with amyotrophic lateral sclerosis, a neurological condition leading to progressive impairments in speech and movement abilities. To conduct cognitive tests in patients unable to speak or write a reliable and easy to administer eye-tracking paradigm was developed.
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.
Introduction
肌萎缩性侧索硬化症（ALS）是一种致命的神经变性疾病通常是导致死亡在3至5年。在病理学的过程中，本与在运动能力1呼吸和延髓运作以及损伤的渐进性丧失的患者。这股与额颞叶痴呆2一些临床，病理学和遗传特征，它是有据可查的ALS患者的约30％显示出认知缺陷3。这些赤字是在执行功能，言语流畅性和语言的4域最突出和对生存的5，6合规性和照顾者的负担7的影响。因此，可靠的神经心理学评估是本病的关键。
在电机和语音能力前进损伤，然而，对于在疾病8的后期阶段的认知能力的全面评估的限制因素。她的即，基于动眼神经方法似乎是非常有前途的，因为基本的眼动控制保持不变为ALS，为广大患者9的过程中，一个同等长的时间。眼睛跟踪参数本身已被用来获得关于患者的认知状态的ALS 10信息，并还与ALS 11的顺序扩频模式相关。眼球运动，以控制认知测试中的ALS的上下文中的装置也已研究了以往的作品。使用的动眼神经基于版本的一项研究已经成功地证明了其易用性健康对照者的足迹，测验12，而另一个发现合适的基于认知能力和健康对照和ALS患者之间的区分认知越来越少受损患者区分13。
这里所描述的研究使用基于眼球运动的方法来研究AL认知障碍病患者，特别是在执行功能的领域。两个很好的验证和常用的神经心理测验进行了调整，以眼动控制：乌鸦的彩色渐进矩阵（CPM）14和D2测试15。该CPM是用来衡量行政机关和视觉空间能力以及流体智力非语言手段。的D2-测试也是用于揭示在选择性和持续的注意力和可视处理速度的域执行功能障碍的非口头的工具。两个广泛用于已在以往的研究评估疾病16和ALS患者的神经心理状态相比健康对照17的过程中潜在的认知衰退已成功地用于临床工具。
这项工作的目的是展示使用REL在ALS独立运动和语言障碍的认知缺陷的成功评估的要求iable，眼睛跟踪基础版的CPM和D2-测试。重要的是，这里所描述的方法有可能使被扩展研究的重症患者运动障碍等的人群。
Protocol
Representative Results
Discussion
这是一个具有挑战性的任务成功评估患者的认知状态与ALS谁不能说和写。使用videooculography系统提供了一个有前途的方法。兹介绍技术在检测的认知缺陷，从而起到照顾者的负担和疾病管理20 ALS患者的背景下举足轻重的作用可靠。此外，CPM和D2的测试的动眼神经版本各自标准纸铅笔版本显著相关，但需要对权利要求的临床环境的有用的进一步支持。
研究者需要确保眼球…
Divulgaciones
The authors have nothing to disclose.
Acknowledgements
笔者想感谢拉尔夫Kuhne公司的技术支持。这项工作是由德意志研究联合会（DFG）和德国联邦联邦教育与研究部（BMBF＃01GM1103A）的资助。这是一个欧盟联合规划署，神经退行性疾病研究（JPND）项目。该项目是通过JPND- 例如 ，德国，德国联邦联邦教育与研究部（BMBF，FKZ），瑞典，VetenskaprådetSVERIGE，波兰，Narodowe中枢巴丹我Rozwoju（NCBR）的支持下，下面的组织的支持。
Materials
| EyeSeeCam | EyeSeeTec GmbH; 82256 Fürstenfeldbruck, Germany | Videooculography device |
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