NEW FRONTIERS IN THE COGNITIVE ASSESSMENT OF AMYOTROPHIC LATERAL SCLEROSIS: BRAIN COMPUTER INTERFACE AND EYE TRACKING

Background: Over the last 20 years, cognitive and behavioural alterations in amyotrophic lateral sclerosis (ALS) have been recognized as an integral part of the disease. A proportion of patients present with a full-blown frontotemporal dementia syndrome, while selective cognitive changes are more commonly found, especially regarding frontal-executive abilities. Moreover, recent studies have highlighted a broader cognitive involvement in this population, concerning language and social cognition. Despite the increased awareness of ALS as a multisystem disorder and the importance of an accurate cognitive evaluation of these patients, the traditional neuropsychological ‘paper and pencil’ tools do not compensate for patients’ physical disability and can not be adequately used in the moderate-advanced stages of the disease. Objective: To investigate the use of P300-based Brain Computer Interface (BCI) and Eye Tracking (ET) technology for the administration of motor-verbal free cognitive measures in ALS. Materials and Methods: 34 patients diagnosed with ALS and 30 healthy subjects have been recruited. All participants underwent the BCI and ET-based neuropsychological assessment, together with three traditional cognitive screening tools (Frontal Assessment Battery - FAB; Montreal Cognitive Assessment – MoCA; Working Memory subtest of the Brief Assessment of Cognition in Schizophrenia), two psychological questionnaires (Beck Depression Inventory - BDI; State-Trate Anxiety Inventory - STAI-Y) and a usability questionnaire. For patients, also respiratory examination was performed, and the Frontal Behavioural Inventory - FBI was carried out with caregivers. Results: Significant correlations were observed between the traditional cognitive measures and the BCI- and ET-based neuropsychological assessment, mainly concerning accuracy and time-related variables in the ALS patients sample. Patients provided comparable rates than controls with regard to the BCI and ET usability. Conclusions: The developed motor-verbal free neuropsychological battery allows a longitudinal cognitive assessment during the course of the disease, also when traditional measures are not fully administrable, providing relevant information for clinical practice and ethical issues. Further work will be aimed at refining the developed system and enlarging the cognitive spectrum investigated.