Deep Stroop: Using eye tracking and speech processing to characterize people with neurodegenerative disorders while performing the Stroop Test

Although many neurodegenerative diseases affect different neural circuits, they often express complex and overlapping symptom profiles making them difficult to differentiate precisely. Current methods of analyzing patients are limited to bedside examination, patient self-rating scales, semiquantitative clinician-rating scales, and other observational evidence, which are often non-specific, resulting in open multiple interpretations and ambiguity in diagnosis and treatment plans. We present a method to analyze patient symptom profiles using multimodal analysis of subjects performing the Stroop Test. We use high-sample-rate eye tracking and speech recording tools to record subject behavior while completing the Stroop Test and simultaneously analyze multiple traits of their interaction with the test. We compare the performance of healthy controls to patients with Parkinsons Disease, Alzheimers Disease, and other neurodegenerative diseases with clinical parkinsonism. We automatically extract metrics based on eye motor behavior, gaze characteristic uttered responses, and the temporal relationship between gaze and uttered responses. We identify many that have clinical relevance through high correlations with existing MoCA and MDS-UPDRS, many of which have significantly different distributions between groups. We present here our analysis approach, provide freely available source code to replicate it and demonstrate the potential of multi-modal recording and analysis of patients throughout their execution of neuro-psychological tests like the Stroop Test. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by Richman Family PMCoE-AD Venture Discovery Fund and Consolidated Anti-Aging Foundation ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The IRB of Johns Hopkins Medical Institue gave ethical approval for the data collection and this work under number IRB00234370. All participants signed informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The authors plan to share all data produced in the present study in the future.