Digital Oculomotor Biomarkers in Dementia

Abstract

Dementia is an umbrella term that covers a number of neurodegenerative syndromes featuring gradual disturbance of various cognitive functions that are severe enough to interfere with tasks of daily life. The diagnosis of dementia occurs frequently when pathological changes have been developing for years, symptoms of cognitive impairment are evident and the quality of life of the patients has already been deteriorated significantly. Although brain imaging and fluid biomarkers allow the monitoring of disease progression in vivo, they are expensive, invasive and not necessarily diagnostic in isolation. Recent studies suggest that eye-tracking technology is an innovative tool that holds promise for accelerating early detection of the disease, as well as, supporting the development of strategies that minimise impairment during every day activities. However, the optimal methods for quantitative evaluation of oculomotor behaviour during complex and naturalistic tasks in dementia have yet to be determined. This thesis investigates the development of computational tools and techniques to analyse eye movements of dementia patients and healthy controls under naturalistic and less constrained scenarios to identify novel digital oculomotor biomarkers. Three key contributions are made. First, the evaluation of the role of environment during navigation in patients with typical Alzheimer disease and Posterior Cortical Atrophy compared to a control group using a combination of eye movement and egocentric video analysis. Secondly, the development of a novel method of extracting salient features directly from the raw eye-tracking data of a mixed sample of dementia patients during a novel instruction-less cognitive test to detect oculomotor biomarkers of dementia-related cognitive dysfunction. Third, the application of unsupervised anomaly detection techniques for visualisation of oculomotor anomalies during various cognitive tasks. The work presented in this thesis furthers our understanding of dementia-related oculomotor dysfunction and gives future research direction for the development of computerised cognitive tests and ecological interventions

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