Oculomotor, vestibular, reaction time, and cognitive tests as objective measures of neural deficits in patients post COVID-19 infection

Kevin M Kelly; R Anghinah; A Kullmann; R C Ashmore; A S Synowiec; L C Gibson; L Manfrinati; A de Araújo; R R Spera; S M D Brucki; R L Tuma; A Braverman; A Kiderman

doi:10.3389/fneur.2022.919596

Oculomotor, vestibular, reaction time, and cognitive tests as objective measures of neural deficits in patients post COVID-19 infection

Front Neurol. 2022 Sep 12:13:919596. doi: 10.3389/fneur.2022.919596. eCollection 2022.

Authors

Kevin M Kelly¹, R Anghinah^{2

3}, A Kullmann⁴, R C Ashmore⁴, A S Synowiec¹, L C Gibson⁴, L Manfrinati^{2

3}, A de Araújo², R R Spera², S M D Brucki², R L Tuma², A Braverman⁴, A Kiderman⁴

Affiliations

¹ Neurology Department, Allegheny Health Network, Pittsburgh, PA, United States.
² Neurology Department at Clinical Hospital of Medical School of University of Sáo Paulo, Sáo Paulo, Brazil.
³ Medical Department of Athletes Union of Sáo Paulo, Sáo Paulo, Brazil.
⁴ Neurolign USA LLC, A Subsidiary of Neurolign Technologies Inc., Pittsburgh, PA, United States.

Abstract

Objective: An alarming proportion (>30%) of patients affected by SARS-CoV-2 (COVID-19) continue to experience neurological symptoms, including headache, dizziness, smell and/or taste abnormalities, and impaired consciousness (brain fog), after recovery from the acute infection. These symptoms are self-reported and vary from patient to patient, making it difficult to accurately diagnose and initiate a proper treatment course. Objective measures to identify and quantify neural deficits underlying the symptom profiles are lacking. This study tested the hypothesis that oculomotor, vestibular, reaction time, and cognitive (OVRT-C) testing using eye-tracking can objectively identify and measure functional neural deficits post COVID-19 infection.

Methods: Subjects diagnosed with COVID-19 (n = 77) were tested post-infection with a battery of 20 OVRT-C tests delivered on a portable eye-tracking device (Neurolign Dx100). Data from 14 tests were compared to previously collected normative data from subjects with similar demographics. Post-COVID subjects were also administered the Neurobehavioral Symptom Inventory (NSI) for symptom evaluation.

Results: A significant percentage of post COVID-19 patients (up to 86%) scored outside the norms in 12 out of 14 tests, with smooth pursuit and optokinetic responses being most severely affected. A multivariate model constructed using stepwise logistic regression identified 6 metrics as significant indicators of post-COVID patients. The area under the receiver operating characteristic curve (AUC) was 0.89, the estimated specificity was 98% (with cutoff value of 0.5) and the sensitivity was 88%. There were moderate but significant correlations between NSI domain key variables and OVRT-C tests.

Conclusions: This study demonstrates the feasibility of OVRT-C testing to provide objective measures of neural deficits in people recovering from COVID-19 infection. Such testing may serve as an efficient tool for identifying hidden neurological deficits post COVID-19, screening patients at risk of developing long COVID, and may help guide rehabilitation and treatment strategies.

Keywords: COVID-19; Neurobehavioral Symptom Inventory (NSI); biomarker; eye-tracking; oculomotor.