Development and validation of an eye-tracking-based cognitive impairment screening system for older adults in China:
Wei Si1, XiaoHan Ma2, Jiayue Lin3
1Shanghai University of Medicine & Health Sciences, Shanghai, China; Shanghai Zhongqiao Vocational And Technical University, Shanghai, China.
Background:
Global population ageing has rendered cognitive impairment a critical public health issue. Early screening is essential for timely intervention; however, traditional tools are limited by their reliance on professionals, cultural and educational biases, and high cost.
Purpose:
This study aimed to develop and validate an unobtrusive, eye-tracking-based cognitive screening system (CIS-ET) for older adults in China, evaluating its efficacy in distinguishing between healthy controls (HCs), mild cognitive impairment (MCI), and Alzheimer's disease (AD).
Methods:
In this cross-sectional study, 113 participants (41 HCs, 41 with MCI, and 31 with AD) were recruited in Shanghai. All participants completed the CIS-ET (assessing 6 cognitive domains via 43 items), the Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). Statistical analyses included receiver operating characteristic (ROC) curve analysis, partial correlation, and Cronbach's α for reliability.
Results:
The CIS-ET demonstrated excellent discriminative validity. The area under the curve (AUC) for distinguishing HCs from participants with MCI was 0.878 (95% CI: 0.796 to 0.959), with a sensitivity of 85.37% and specificity of 87.80%. For differentiating MCI from AD, the AUC was 0.893 (95% CI: 0.821 to 0.965; sensitivity 77.42%, specificity 87.80%). When distinguishing HCs from the combined cognitive impairment group (MCI + AD), the AUC reached 0.927 (95% CI: 0.876 to 0.978; sensitivity 91.67%, specificity 87.80%). After adjusting for age and education, the CIS-ET total score showed strong positive correlations with MMSE (r = 0.870, p < 0.001) and MoCA (r = 0.891, p < 0.001). Internal consistency reliability was acceptable (Cronbach's α = 0.685).
Conclusions:
The CIS-ET is a valid, reliable, and user-friendly tool for the early screening of cognitive impairment in older adults in China. Its design supports potential for large-scale use in community healthcare settings. (Trial registration: Chinese Clinical Trial Registry, ChiCTR2400085172.).
