Multicenter validation of a bedside antisaccade task as a measure of executive function

Department of Neurology, Memory and Aging Center, University of California, San Francisco, USA.
Neurology (Impact Factor: 8.29). 05/2012; 78(23):1824-31. DOI: 10.1212/WNL.0b013e318258f785
Source: PubMed


To create and validate a simple, standardized version of the antisaccade (AS) task that requires no specialized equipment for use as a measure of executive function in multicenter clinical studies.
The bedside AS (BAS) task consisted of 40 pseudorandomized AS trials presented on a laptop computer. BAS performance was compared with AS performance measured using an infrared eye tracker in normal elders (NE) and individuals with mild cognitive impairment (MCI) or dementia (n = 33). The neuropsychological domain specificity of the BAS was then determined in a cohort of NE, MCI, and dementia (n = 103) at UCSF, and the BAS was validated as a measure of executive function in a 6-center cohort (n = 397) of normal adults and patients with a variety of brain diseases.
Performance on the BAS and laboratory AS task was strongly correlated and BAS performance was most strongly associated with neuropsychological measures of executive function. Even after controlling for disease severity and processing speed, BAS performance was associated with multiple assessments of executive function, most strongly the informant-based Frontal Systems Behavior Scale.
The BAS is a simple, valid measure of executive function in aging and neurologic disease.

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    • "Another task that has been used to examine eye movements in MCI is the antisaccade (AS) task, in which individuals must inhibit a prepotent response towards a stimulus and voluntarily shift their eyes in the opposite direction when a stimulus is presented. The AS task has been shown to correlate most strongly with measures of executive function in combined groups of healthy older adults, MCI, and dementia participants (Hellmuth et al. 2012; Heuer et al. 2013). It has been demonstrated that performance on this task is similarly impaired in individuals with aMCI and AD compared to controls (Peltsch et al. 2014). "
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    ABSTRACT: Mild cognitive impairment (MCI) refers to the intermediate period between the typical cognitive decline of normal aging and more severe decline associated with dementia, and it is associated with greater risk for progression to dementia. Research has suggested that functional abilities are compromised in MCI, but the degree of impairment and underlying mechanisms remain poorly understood. The development of sensitive measures to assess subtle functional decline poses a major challenge for characterizing functional limitations in MCI. Eye-tracking methodology has been used to describe visual processes in everyday, naturalistic action among healthy older adults as well as several case studies of severely impaired individuals, and it has successfully differentiated healthy older adults from those with MCI on specific visual tasks. These studies highlight the promise of eye-tracking technology as a method to characterize subtle functional decline in MCI. However, to date no studies have examined visual behaviors during completion of naturalistic tasks in MCI. This review describes the current understanding of functional ability in MCI, summarizes findings of eye-tracking studies in healthy individuals, severe impairment, and MCI, and presents future research directions to aid with early identification and prevention of functional decline in disorders of aging.
    Full-text · Article · Apr 2015 · Neuropsychology Review
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    • "In Study 1, we investigated the ecological validity of the Executive Composite with an informant-based measure of real-world executive behavior, the Frontal Systems Behavior Scale TM (FrSBe) (Grace & Malloy, 2001), in a sample of patients with a variety of neurological disorders and neurologically healthy controls. The FrSBe has been validated as a measure of executive behavior by several studies (Basso et al., 2008;Chiaravalloti & DeLuca, 2003;Hellmuth et al., 2012;Lane-Brown & Tate, 2009;Malloy & Grace, 2005;Malloy, Tremont, Grace, & Frakey, 2007;Velligan, Ritch, Sui, DiCocco, & Huntzinger, 2002). The Composite was considered to have good ecological validity if it was a significant predictor of the FrSBe in regression models. "
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    ABSTRACT: Executive functions refer to a constellation of higher-level cognitive abilities that enable goal-oriented behavior. The NIH EXAMINER battery was designed to assess executive functions comprehensively and efficiently. Performance can be summarized by a single score, the "Executive Composite," which combines measures of inhibition, set-shifting, fluency, and working memory. We evaluated the ecological validity of the Executive Composite in a sample of 225 mixed neurological patients and controls using the Frontal Systems Behavior Scale (FrSBe), an informant-based measure of real-world executive behavior. In addition, we investigated the neuroanatomical correlates of the Executive Composite using voxel-based morphometry in a sample of 37 participants diagnosed with dementia, mild cognitive impairment, or as neurologically healthy. The Executive Composite accounted for 28% of the variance in Frontal Systems Behavior Scale scores beyond age. Even after including two widely used executive function tests (Trails B and Stroop) as covariates, the Executive Composite remained a significant predictor of real-world behavior. Anatomically, poorer scores on the Executive Composite were associated with smaller right and left dorsolateral prefrontal volumes, brain regions critical for good executive control. Taken together, these results suggest that the Executive Composite measures important aspects of executive function not captured by standard measures and reflects the integrity of frontal systems. (JINS, 2013, 19, 1-9).
    Full-text · Article · Jun 2013 · Journal of the International Neuropsychological Society
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    • "It also lends itself to more complex tasks still, in which the subject must switch from one mode of response to another (Cameron et al., 2010; Evens & Ludwig, 2010; Olk & Jin, 2011 ). The growing importance of antisaccades in clinical investigatio n is reflected by an article and associated editorial that appeared while this paper was in the final stages of preparation (Hellmuth et al., 2012; Kaufer, 2012 ), that underline the utility of antisaccades in quantifyi ng the effects of both aging and neurological disease; their increasing use in psychiatr ic disorders has been the subject of another useful set of reviews (Gooding & Basso, 2008; Klein & Ettinger, 2008; Rommelse, van der Stigchel, & Sergeant , 2008 ). Unfortunate ly there are currently two major obstacles to a wider adoption of the antisaccade in clinical practice. "
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    ABSTRACT: Detailed measurements of saccadic latency - the time taken to make an eye movement to a suddenly-presented visual target - have proved a valuable source of detailed and quantitative information in a wide range of neurological conditions, as well as shedding light on the mechanisms of decision, currently of intense interest to cognitive neuroscientists. However, there is no doubt that more complex oculomotor tasks, and in particular the antisaccade task in which a participant must make a saccade in the opposite direction to the target, are potentially more sensitive indicators of neurological dysfunction, particularly in neurodegenerative conditions. But two obstacles currently hinder their widespread adoption for this purpose. First, that much of the potential information from antisaccade experiments, notably about latency distribution and amplitude, is typically thrown away. Second, that there is no standardized protocol for carrying out antisaccade experiments, so that results from one laboratory cannot easily be compared with those from another. This paper, the outcome of a recent international meeting of oculomotor scientists and clinicians with an unusually wide experience of such measurements, sets out a proposed protocol for clinical antisaccade trials: its adoption will greatly enhance the clinical and scientific benefits of making these kinds of measurements.
    Full-text · Article · Mar 2013 · Vision research
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