Cognitive Assessments

Can Your Eye’s Predict the Future?

Is it possible to know the future? Maybe something as simple as what you will eat for breakfast tomorrow, but what about things like where you will be in five years. Twenty? What about medical questions? Will you break a bone? Get cancer? Will there ever be a time when you lose your memory?

The answer to the last question may lie with a company called NeuroTrack, co-founded by neuroscientist Stuart Zola, PhD, the retired director of primate research at Emory. NeuroTrack has multiple technologies that enable people to assess and strengthen their cognitive health to decrease the risk of Alzheimer’s. It includes digital tests using eye-tracking technology to assess cognitive state, as well as a cognitive health program that intervenes in six lifestyle-related risk factors for dementia and Alzheimer’s (factors: stress management, social engagement, nutrition, cognitive training, sleep, and exercise).

NeuroTrack is based on Zola’s groundbreaking research on memory at Emory. In the course of studying Alzheimer’s disease, Zola made a discovery that would lead to the invention of NeuroTrack. “One of the strategies was to try and understand some aspects about attention and focus and where people were looking when they were looking at stimuli,” Zola said. Using an eye tracking task, Zola, along with colleagues Elizabeth Buffalo and Cecelia Manzanares, found that scores on the task could predict the onset of cognitive decline as well as whether the patient would develop Alzheimer's within three to five years. Zola’s team began with a group of individuals, none of whom had Alzheimer’s disease, and who were around 65 years old, because that age is the biggest risk factor for the disease. “We are talking about idiopathic Alzheimer’s,” Zola explained, “That is, Alzheimer’s for which we don't have an understanding or a cause... You do eye tracking with them, follow them for 5-10 years and see if those earlier scores were predictive.”

Stuart Zola, PhD

The eye tracking task itself consisted of showing people two identical objects. After 20 seconds, the people were again shown two objects - one new object and one object from the previous set. “The individual will ordinarily spend more time looking at the novel stimulus than at the same stimulus because the same stimulus you saw before was the familiar one,” Zola explained, “That is the very simple foundational idea behind Neurotrack: that novelty turns out to be important for us, because if you can't remember what you saw before, then you will spend equal amounts of time at looking at the old one and the new one, and that was the differentiator we were able to measure.” Zola and his team found that people who scored in a particular range on the test were virtually guaranteed to get Alzheimer’s later in life. Others had scores that indicated that they would not get Alzheimer’s. The tricky part came with a middle group, around 40% of the people tested, whose scores were not indicative of an outcome either way. The company shifted its focus to gaining more insight as to how to better predict results for this group. The eye tracking task proved difficult to modify. “It showed yes and no, but it didn’t show maybe very well,” said Zola, “So instead of trying to figure out that maybe, we went and developed some additional tasks that combined with the yes and no task [helped] us to increase our predictability.”

Convincing pharmaceutical companies to invest in NeuroTrack was more difficult than expected. No investors from Atlanta signed on. Instead, the company received backing from venture capitalists in California, which is why NeuroTrack is based in the West Coast. “The company is doing very well, and the product line has enlarged as well from just the eye-tracking things to additional programs focused on healthcare and how to slow down the decline associated with Alzheimer’s disease and other degenerative diseases,” Zola said.

Brain Scan

Alzheimer’s poses many challenges in the medical field. For one thing, nothing has changed in terms of finding a cure, and few treatments to address symptoms. “One of the challenges is that we don’t have a promise of an intervention so far,” Zola said, “For the company, that turns out to be really important because it means that the behavioral assessments that we do are still going to be very key for a very long time because at least we know that if you have risk factors, you can modify those risk factors behaviorally and prolong the integrity of your cognitive systems and other systems.”

Is it possible to know whether you will lose your memory? The theory behind NeuroTrack is that the damage that leads to Alzheimer’s starts long before you see symptoms. Twenty or thirty years before we hit old age, things happen in our nervous system that go undetected but result in memory loss. “When people look back carefully in the details of people’s lives you see episodes of things that were tell-tale that things were going on for years before the actual diagnosis happened,” Zola explained, “Alzheimer’s is just surrounded with mysteries.” Neurotrack helps us solve them.