How EXACTLY will this get survivors recovered? Oh, nothing, so fucking useless? You're all fired! 'Assessments' have NEVER GOTTEN SURVIVORS RECOVERED! You need EXACT REHAB PROTOCOLS for that! This has none, so fucking useless!
Eye-tracking phenotypes reveal clinically meaningful heterogeneity of attention and executive control dysfunction after stroke
Abstract
Background
Post-stroke impairments in attention and executive control are common and clinically relevant, whereas conventional neuropsychological tests mainly capture task outcomes and provide limited information about process-level task behavior. Eye tracking can quantify fixation behavior, saccadic activity, and visual sampling, but whether integrated eye-tracking features can reveal clinically interpretable heterogeneity after stroke remains insufficiently defined.
Objective
This study examined whether integrated multi-paradigm eye-tracking features could identify exploratory eye-movement phenotypes in individuals with stroke and whether these phenotypes were associated with behavioral, clinical, lesion-related, and functional characteristics.
Methods
In this single-center exploratory case-control study, 72 subacute stroke participants (14–90 days post-onset) and 36 matched healthy controls completed five tasks of attention and executive control and six eye-tracking paradigms. Group differences in behavioral and eye-tracking measures were examined with false discovery rate correction. Within the stroke group, K-means clustering was performed using four nonredundant integrated eye-tracking features: total fixation duration, first-fixation duration, number of fixations, and total saccade distance. Cluster stability and sensitivity analyses were conducted using bootstrap resampling, alternative feature sets, and combined clustering with healthy controls. Post-clustering comparisons and exploratory regression analyses were used to evaluate the clinical relevance of the identified phenotypes.
Results
Compared with healthy controls, participants with stroke showed lower performance across attention/executive-control tasks and altered eye-tracking metrics across paradigms. The most consistent eye-movement pattern was shorter total fixation duration and a higher number of fixations across the six paradigms, whereas total saccade distance differed most clearly during the antisaccade task. K-means clustering identified two exploratory eye-movement phenotypes: a High-Fixation/Low-Saccade phenotype and a Low-Fixation/High-Saccade phenotype. The two-cluster solution remained stable across bootstrap and sensitivity analyses. The Low-Fixation/High-Saccade phenotype showed poorer cognitive performance, greater neurological and functional impairment, higher emotional symptom burden, and more frequent frontal involvement and bilateral or multifocal involvement. In exploratory hierarchical regression, eye-movement phenotype explained additional variance in Barthel Index scores beyond demographic variables, post-stroke timing, neurological severity, and conventional attention/executive-control performance.
Conclusions
Integrated multi-paradigm eye-tracking features identified two exploratory eye-movement phenotypes in individuals with subacute stroke. The Low-Fixation/High-Saccade phenotype was associated with broader clinical burden. These findings suggest that eye tracking may provide process-level information complementary to conventional assessment of post-stroke attention and executive-control dysfunction. Given the single-center and cross-sectional design, these preliminary phenotypes require validation in longitudinal and multicenter studies.
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