Naturalistic Eye Movements as Clinical Markers of Everyday Cognition in Older Adults

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PROJECT SUMMARY/ABSTRACT Loss of independence in the ability to successfully complete activities of daily living (ADL), such as meal preparation, is a core diagnostic criterion of Alzheimer’s disease and related dementias (ADRD) and is associated with increased costs of care and decreased quality of life in older adults, but even mild, age- associated changes in cognition negatively influence the performance of everyday tasks. Thus, there exists a need for sensitive methods of assessing everyday functioning that are scalable to clinical settings and identify mechanisms for targeted intervention. Studies of individuals with dementia posit two possible distinct cognitive mechanisms for functional difficulties: impaired cognitive control and degraded task schema knowledge. However, the primary mechanisms contributing to functional changes in older adults with milder cognitive decline remain poorly understood, in part due to a lack of sensitive methods for studying everyday functioning in individuals without dementia. Eye tracking has emerged as a potential sensitive method for studying such changes. The proposed study will recruit a racially diverse sample of older adults to examine the relation between eye fixations during completion of a computer-based task of everyday functioning and clinical measures of real-world functional difficulties (e.g., performance-based test and self/informant-report questionnaires) and cognitive abilities. 110 individuals aged 65 and older without dementia (healthy n=55, mild cognitive impairment/MCI n=55) will complete a non-immersive virtual reality (VR) test of goal-directed everyday activities (making a breakfast and lunch) while eye fixation data are collected. Participants also will complete a real-world performance-based test of everyday function and cognitive tests, and participants and a knowledgeable informant will complete clinical questionnaires of everyday functioning and demographics. We predict that (i) inefficiencies in eye fixations during completion of the VR task of everyday functioning are a sensitive and valid measure of subtle functional difficulties, and (ii) patterns of eye movements during everyday tasks reflect distinct cognitive mechanisms for functional difficulties. Results of the proposed study will 1) develop a highly sensitive and scalable assessment for cognitive skills most critical for everyday functioning in a diverse aging population and 2) identify the cognitive mechanisms underlying mild difficulties with everyday activities to inform future development of targeted interventions from a precision-medicine approach that matches the interventions with individuals’ functional/cognitive profile. A training plan has been designed that consists of formal classwork, workshops, experiential learning, and mentorship to develop the applicant’s expertise in eye tracking methods, human-computer interactions, technological advancements in cognitive assessment, and advanced statistical analysis. The proposed study will take place in Temple University’s clinical psychology program, which has a successful track record of conducting impactful NIH-funded research and training research scientists.