ORIGINAL COMMUNICATION An eye-tracker controlled cognitive battery: overcoming verbal-motor limitations in ALS Barbara Poletti 1 • Laura Carelli 1 • Federica Solca 1 • Annalisa Lafronza 1 • Elisa Pedroli 2 • Andrea Faini 3 • Nicola Ticozzi 1,4 • Andrea Ciammola 1 • Paolo Meriggi 5 • Pietro Cipresso 2 • Dorothe ´e Lule ´ 6 • Albert C. Ludolph 6 • Giuseppe Riva 2,7 • Vincenzo Silani 1,4 Received: 23 March 2017 / Accepted: 4 May 2017 Ó Springer-Verlag Berlin Heidelberg 2017 Abstract We assessed language, attention, executive, and social cognition abilities in a sample of patients with Amyotrophic Lateral Sclerosis (ALS) by means of a recently developed cognitive battery based on oculomotor control with eye-tracking (ET) technology. Twenty-one ALS patients and 21 age- and education-matched healthy subjects underwent the ET-based cognitive assessment, together with the standard cognitive screening tools [Frontal Assessment Battery (FAB); Montreal Cognitive Assessment (MoCA); and Digit Sequencing Task]. Psy- chological measures of anxiety (State-Trait Anxiety Inventory-Y) and depression (Beck Depression Inventory) were also collected, and an ET usability questionnaire was administered. For patients, clinical and respiratory exami- nations were also performed, together with behavioural assessment (Frontal Behavioural Inventory). The devel- oped battery discriminated among patients and controls with regard to measures of verbal fluency, frontal abilities, and social cognition. Measures of diagnostic utility con- firmed a higher diagnostic accuracy of such ET-based tests with respect to FAB; similar diagnostic accuracy emerged when comparing them to the other standard cognitive tools (MoCA, WM). Usability ratings about the ET tests were comparable among the two groups. The ET-based neu- ropsychological battery demonstrated good levels of diag- nostic accuracy and usability in a clinical population of non-demented ALS patients, compared to matched healthy controls. Future studies will be aimed at further investigate validity and usability components by recruiting larger sample of patients, both in moderate-to-severe stages of the disease and affected by more severe cognitive impairment. Keywords Amyotrophic lateral sclerosis Á Eye tracker Á Cognitive assessment Á Behavioural assessment Á Oculomotor control Á Verbal-motor limitations Introduction Cognitive and behavioural changes in patients with amy- otrophic lateral sclerosis (ALS) have been increasingly recognized as an integral feature of the disease, with the most commonly reported alterations regarding executive functions [1, 2]. Recent studies have depicted cognitive impairment in ALS as a heterogeneous feature, with changes involving a range of cognitive functions beyond Barbara Poletti and Laura Carelli contributed equally to this work. Electronic supplementary material The online version of this article (doi:10.1007/s00415-017-8506-z) contains supplementary material, which is available to authorized users. & Barbara Poletti b.poletti@auxologico.it 1 Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy 2 Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy 3 Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy 4 Department of Pathophysiology and Transplantation, ‘‘Dino Ferrari’’ Center, Universita ` degli Studi di Milano, Milan, Italy 5 ICT and Biomedical Technology Integration Unit, Centre for Innovation and Technology Transfer (CITT), Fondazione Don Carlo Gnocchi Onlus, Milan, Italy 6 Department of Neurology, University of Ulm, Ulm, Germany 7 Department of Psychology, Universita ` Cattolica del Sacro Cuore, Milan, Italy 123 J Neurol DOI 10.1007/s00415-017-8506-z