Exploring Cognitive Dysfunction in LC Patients: Eye Movement Abnormalities and Frontal-Subcortical Circuits Implications, 2024, Benito-León+

SNT Gatchaman

SNT Gatchaman

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Exploring Cognitive Dysfunction in Long COVID Patients: Eye Movement Abnormalities and Frontal-Subcortical Circuits Implications via Eye-Tracking and Machine Learning
Julián Benito-León; José Lapeña; Lorena García-Vasco; Constanza Cuevas; Julie Viloria-Porto; Alberto Calvo-Córdoba; Estíbaliz Arrieta-Ortubay; María Ruiz-Ruigómez; Carmen Sánchez-Sánchez; Cecilia García-Cena

BACKGROUND
Cognitive dysfunction is regarded as one of the most severe aftereffects following coronavirus disease 2019 (COVID-19). Eye movements, controlled by various brain regions, including the dorsolateral prefrontal cortex and frontal-thalamic circuits, offer a potential metric for evaluating cognitive dysfunction. We aimed to examine the utility of eye movement measurements in identifying cognitive impairments in long COVID patients.

METHODS
We recruited 40 long COVID patients experiencing subjective cognitive complaints and 40 healthy controls and used a certified eye-tracking medical device to record saccades and antisaccades. Machine learning was applied to enhance the analysis of eye movement data.

RESULTS
Patients did not differ from the healthy controls regarding age, sex, and years of education. However, the patients' Montreal Cognitive Assessment total score was significantly lower than healthy controls. Most eye movement parameters were significantly worse in patients: the latencies, gain, and velocity of visually and memory-guided saccades, the number of correct memory saccades, the latencies and duration of reflexive saccades, and the number of errors in the antisaccade test. Machine learning permitted distinguishing between long COVID patients experiencing subjective cognitive complaints and healthy controls.

CONCLUSIONS
Our findings suggest impairments in frontal subcortical circuits in long COVID patients experiencing subjective cognitive complaints. Eye-tracking, combined with machine learning, offers a novel, efficient way to assess and monitor long COVID patients' cognitive dysfunctions, suggesting its utility in clinical settings for early detection and personalized treatment strategies. Further research is needed to determine the long-term implications of these findings and the reversibility of cognitive dysfunctions.


Link | PDF (The American Journal of Medicine)
 
The altered eye movement pattern in long COVID patients experiencing subjective cognitive complaints is similar to that observed in a variety of neurodegenerative conditions, where eye-tracking has been established as a tool for early detection and monitoring of diseases such as frontotemporal lobar degeneration, Alzheimer's, and Parkinson's disease, among others. The abnormalities in eye movement in these conditions suggest dysfunction in overlapping neural circuits, particularly those involving frontal-subcortical pathways.
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Our study raises questions about the potential long-term risks these individuals might face regarding neurodegenerative processes. While our findings do not directly link long COVID to neurodegenerative diseases, they do underscore a pattern of neural dysfunction commonly associated with these conditions.
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This study demonstrates that long COVID patients experiencing subjective cognitive complaints may suffer from frontal-subcortical circuit impairments, indicating that conditions like "brain fog" or "fade-in memory" are significant yet under-recognized.
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Neuropsychological evaluations, though thorough, often require considerable time and effort, which may constrain their prompt use in identifying cognitive impairments associated with long COVID. Hence, eye-tracking, combined with machine learning, offers a novel, efficient way to assess and monitor long COVID patients' cognitive dysfunctions, suggesting its utility in clinical settings for early detection and personalized treatment strategies.
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This is the kind of study I want to see a lot more of, properly controlled for PEM, of course.

I think we are missing a large body of critical data on how the range of basic motor-sensory functions are disrupted in these conditions (LC, ME/CFS, etc), including the dynamic patterns over time.

There are some, typically small, studies going back many years (for ME/CFS), but no robust comprehensive research program.
 
I think I've mentioned this before...

I got a diagnosis of nystagmus after seeing a neurologist who was very short, and in order to see my eyes with his optical light gadget (?ophthalmoscope?) he got really, really close to me to the point that he was invading my personal space to an excruciating degree. I kept flicking my eyes to see what he was doing. I knew I was going to spoil any possible diagnoses but just couldn't stop myself because I was so embarrassed and uncomfortable. So I ended up with this wrong diagnosis on my medical records.
 
This paper is from a Madrid team, the Hohberger work is by a Bavarian team. A Melbourne team has been working on ocular function as a biomarker of ME/CFS - I can't recall if they have published yet.

abstract said:
We recruited 40 long COVID patients experiencing subjective cognitive complaints and 40 healthy controls
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I guess there's a risk that some patients reporting cognitive complaints following a Covid infection were developing cognitive issues unrelated to the infection. Some prospective work on this would be helpful.
 
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