A Pilot Study to Improve Cognitive Performance and Pupil Responses in Mild Cognitive Impaired Patients Using Gaze-Controlled Gaming.

Mild cognitive impairment (MCI) may progress to severe forms of dementia, so therapy is needed to maintain cognitive abilities. The neural circuitry for oculomotor control is closely linked to that which controls cognitive behavior. In this study, we tested whether training the oculomotor system with gaze-controlled video games could improve cognitive behavior in MCI patients. Patients played a simple game for 2-3 weeks while a control group played the same game using a mouse. Cognitive improvement was assessed using the MoCA screening test and CANTAB. We also measured eye pupil and vergence responses in an oddball paradigm. The results showed an increased score on the MoCA test specifically for the visuospatial domain and on the Rapid Visual Information Processing test of the CANTAB battery. Pupil responses also increased to target stimuli. Patients in the control group did not show significant improvements. This pilot study provides evidence for the potential cognitive benefits of gaze-controlled gaming in MCI patients.

Cognitive Vergence Recorded with a Webcam-Based Eye-Tracker during an Oddball Task in an Elderly Population.

(1) Background: Our previous research provides evidence that vergence eye movements may significantly influence cognitive processing and could serve as a reliable measure of cognitive issues. The rise of consumer-grade eye tracking technology, which uses sophisticated imaging techniques in the visible light spectrum to determine gaze position, is noteworthy. In our study, we explored the feasibility of using webcam-based eye tracking to monitor the vergence eye movements of patients with Mild Cognitive Impairment (MCI) during a visual oddball paradigm. (2) Methods: We simultaneously recorded eye positions using a remote infrared-based pupil eye tracker. (3) Results: Both tracking methods effectively captured vergence eye movements and demonstrated robust cognitive vergence responses, where participants exhibited larger vergence eye movement amplitudes in response to targets versus distractors. (4) Conclusions: In summary, the use of a consumer-grade webcam to record cognitive vergence shows potential. This method could lay the groundwork for future research aimed at creating an affordable screening tool for mental health care.

Altered Vergence Eye Movements and Pupil Response of Patients with Alzheimer's Disease and Mild Cognitive Impairment During an Oddball Task.

BACKGROUND: Alzheimer's disease (AD) is characterized by progressive deterioration of cognitive functions and may be preceded by mild cognitive impairment (MCI). Evidence shows changes in pupil and vergence responses related to cognitive processing of visual information. OBJECTIVE: Here we test the hypothesis that MCI and AD are associated with specific patterns in vergence and pupil responses. METHODS: We employed a visual oddball task. In the distractor condition (80%of the trials), a blue stimulus was presented whereas in the target condition (20%of trials) it was red. Participants (23 Controls, 33 MCI patients, and 18 AD patients) were instructed to press a button when a target appeared. RESULTS: Participants briefly converged their eyes 200 ms after stimulus presentation. In controls, this transient peak response was followed by a delay response to targets but not to distractor stimuli. In the patient groups, delay responses to distractors were noticed. Consequently, the differential vergence response was strong in the control group, weak in the MCI group, and absent in the AD group. Pupils started to dilate 500-600 ms after the appearance of a target but slightly contracted after the presentation of a distractor. This differential pupil response was strongest in the AD group. CONCLUSION: Our findings support the idea of a role of vergence and pupil responses in attention and reveal altered responses in MCI and AD patients. Further studies should assess the value of vergence and pupil measurements as an objective support tool for early diagnosis of AD.

Vergence eye movements during figure-ground perception.

Figure-ground, that is the segmentation of visual information into objects and their surrounding backgrounds, provides structure for visual attention. Recent evidence shows a novel role of vergence eye movements in visual attention. In the present work, vergence responses during figure-ground segregation tasks are psychophysically investigated. We show that during a figure-ground detection task, subjects convergence their eyes. Vergence eye movements are larger in figure trials than in ground trials. In detected figures trials, vergence are stronger than in trials where the figure went unnoticed. Moreover in figure trials, vergence responses are stronger to low-contrast figures than to high-contrast figures. We argue that these discriminative vergence responses have a role in figure-ground.

Eye vergence responses in children with and without reading difficulties during a word detection task.

Vergence eye movements are movements of both eyes in opposite directions. Vergence is known to have a role in binocular vision. However recent studies link vergence eye movements also to attention and attention disorders. As attention may be involved in dyslexia, it is sensible to guess that the presence of reading difficulties can be associated with specific patterns in vergence responses. Data from school children performing a word-reading task have been analysed. In the task, children had to distinguish words from non-words (scrambled words or row of X's), while their eye positions were recorded. Our findings show that after stimulus presentation eyes briefly converge. These vergence responses depend on the stimulus type and age of the child, and are different for children with reading difficulties. Our findings support the idea of a role of attention in word reading and offer an explanation of altered attention in dyslexia.

Clinical Validation of Eye Vergence as an Objective Marker for Diagnosis of ADHD in Children.

OBJECTIVE: ADHD youth show poor oculomotor control. Recent research shows that attention-related eye vergence is weak in ADHD children. METHOD: To validate vergence as a marker to classify ADHD, we assessed the modulation in the angle of vergence of children ( n = 43) previously diagnosed with ADHD while performing an attention task and compared the results with age-matched clinical controls ( n = 19) and healthy peers ( n = 30). RESULTS: We observed strong vergence responses in healthy participants and weak vergence in the clinical controls. ADHD children showed no significant vergence responses. Machine-learning models classified ADHD patients ( n = 21) from healthy controls ( n = 21) with an accuracy of 96.3% (false positive [FP]: 5.12%; false negative [FN]: 0%; area under the curve [AUC]: 0.99) and ADHD children ( n = 11) from clinical controls ( n = 14) with an accuracy of 85.7% (FP: 4.5%; FN: 19.2%, AUC: 0.90). CONCLUSION: In combination with an attention task, vergence responses can be used as an objective marker to detect ADHD in children.

Eye vergence responses during a visual memory task.

In a previous report it was shown that covertly attending visual stimuli produce small convergence of the eyes, and that visual stimuli can give rise to different modulations of the angle of eye vergence, depending on their power to capture attention. Working memory is highly dependent on attention. Therefore, in this study we assessed vergence responses in a memory task. Participants scanned a set of 8 or 12 images for 10 s, and thereafter were presented with a series of single images. One half were repeat images - that is, they belonged to the initial set - and the other half were novel images. Participants were asked to indicate whether or not the images were included in the initial image set. We observed that eyes converge during scanning the set of images and during the presentation of the single images. The convergence was stronger for remembered images compared with the vergence for nonremembered images. Modulation in pupil size did not correspond to behavioural responses. The correspondence between vergence and coding/retrieval processes of memory strengthen the idea of a role for vergence in attention processing of visual information.

Attentional Selection Accompanied by Eye Vergence as Revealed by Event-Related Brain Potentials.

Neural mechanisms of attention allow selective sensory information processing. Top-down deployment of visual-spatial attention is conveyed by cortical feedback connections from frontal regions to lower sensory areas modulating late stimulus responses. A recent study reported the occurrence of small eye vergence during orienting top-down attention. Here we assessed a possible link between vergence and attention by comparing visual event related potentials (vERPs) to a cue stimulus that induced attention to shift towards the target location to the vERPs to a no-cue stimulus that did not trigger orienting attention. The results replicate the findings of eye vergence responses during orienting attention and show that the strength and time of eye vergence coincide with the onset and strength of the vERPs when subjects oriented attention. Our findings therefore support the idea that eye vergence relates to and possibly has a role in attentional selection.

Attention-Related Eye Vergence Measured in Children with Attention Deficit Hyperactivity Disorder.

Recent evidence shows a novel role for eye vergence in orienting attention in adult subjects. Here we investigated whether such modulation in eye vergence by attention is present in children and whether it is altered in children with ADHD compared to control subjects. We therefore measured the angle of eye vergence in children previously diagnosed with ADHD while performing a cue task and compared the results to those from age-matched controls. We observed a strong modulation in the angle of vergence in the control group and a weak modulation in the ADHD group. In addition, in the control group the modulation in eye vergence was different between the informative cue and uninformative cue condition. This difference was less noticeable in the ADHD group. Our study supports the observation of deficient binocular vision in ADHD children. We argue that the observed disruption in vergence modulation in ADHD children is manifest of altered cognitive processing of sensory information. Our work may provide new insights into attention disorders, like ADHD.

Evidence for a role of corrective eye movements during gaze fixation in saccade planning.

In a three-dimensional (3D) world most saccades are made towards visual targets that are located at different distances. We previously demonstrated that gaze shifts within 3D space consist of two stages: a target saccade followed by a corrective saccade during gaze fixation that directs the eyes to the physical target location. We proposed that, by accurately positioning the eyes on the visual object, the visual system maintains an orderly representation of the visual world. In this study we used a double saccade experiment to assess the function of corrective saccades in humans. We found that, when a corrective eye movement occurred during fixation on the first target point, the direction of the second saccade towards the next target point was accurate. When a corrective saccade was absent, a directional error of the second target saccade was observed. This finding, which cannot be explained by current models of eye movement control, supports the idea of a two-step model in saccade programming. We suggest that the motor system sends a corollary discharge when programming a corrective saccade for maintaining an orderly representation of the visual world. In conclusion, our results indicate that corrective saccades have a role in programming target saccades within 3D space.

Difference in visual processing assessed by eye vergence movements.

Orienting visual attention is closely linked to the oculomotor system. For example, a shift of attention is usually followed by a saccadic eye movement and can be revealed by micro saccades. Recently we reported a novel role of another type of eye movement, namely eye vergence, in orienting visual attention. Shifts in visuospatial attention are characterized by the response modulation to a selected target. However, unlike (micro-) saccades, eye vergence movements do not carry spatial information (except for depth) and are thus not specific to a particular visual location. To further understand the role of eye vergence in visual attention, we tested subjects with different perceptual styles. Perceptual style refers to the characteristic way individuals perceive environmental stimuli, and is characterized by a spatial difference (local vs. global) in perceptual processing. We tested field independent (local; FI) and field dependent (global; FD) observers in a cue/no-cue task and a matching task. We found that FI observers responded faster and had stronger modulation in eye vergence in both tasks than FD subjects. The results may suggest that eye vergence modulation may relate to the trade-off between the size of spatial region covered by attention and the processing efficiency of sensory information. Alternatively, vergence modulation may have a role in the switch in cortical state to prepare the visual system for new incoming sensory information. In conclusion, vergence eye movements may be added to the growing list of functions of fixational eye movements in visual perception. However, further studies are needed to elucidate its role.

A role of eye vergence in covert attention.

Covert spatial attention produces biases in perceptual and neural responses in the absence of overt orienting movements. The neural mechanism that gives rise to these effects is poorly understood. Here we report the relation between fixational eye movements, namely eye vergence, and covert attention. Visual stimuli modulate the angle of eye vergence as a function of their ability to capture attention. This illustrates the relation between eye vergence and bottom-up attention. In visual and auditory cue/no-cue paradigms, the angle of vergence is greater in the cue condition than in the no-cue condition. This shows a top-down attention component. In conclusion, observations reveal a close link between covert attention and modulation in eye vergence during eye fixation. Our study suggests a basis for the use of eye vergence as a tool for measuring attention and may provide new insights into attention and perceptual disorders.