Depression in amyotrophic lateral sclerosis: screening using attention bias assessment

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Abstract

Introduction. Depression is highly prevalent in amyotrophic lateral sclerosis (ALS) [9]. Its detection can be challenging, particularly in advanced disease when many patients develop bulbar dysfunction and upper limb muscle weakness. This necessitates objective methods for diagnosing affective disorders in ALS.

The study aimed to evaluate the potential utility of eye-tracking technology for detecting depression in ALS patients using an attention bias assessment.

Materials and methods. The study enrolled ALS patients meeting Gold Coast criteria. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). During eye-tracking sessions, patients viewed a screen displaying pairs of faces — one emotional (sad or happy) and one neutral.

Results. Data from 33 participants were analyzed. Comparative analysis of mean gaze fixation duration showed that ALS patients with depressive symptoms had significantly longer fixation times on sad faces compared to non-depressed patients. HADS depression scores correlated with mean fixation duration on sad (r = 0.421; p = 0.018) and neutral (r = 0.36; p = 0.047) faces. To analyze the interaction of sensitivity and specificity of mean fixation time on sad faces for detecting depressive disorders, ROC analysis was performed. An area under the curve was 0.722 (acceptable value).

Conclusion. Eye tracking-based attention bias screening assessment shows potential utility for depression detection in ALS. This method may be particularly valuable in advanced disease when patients become immobilized and lose capacity for verbal communication or questionnaire completion [9].

About the authors

Ekaterina V. Pervushina

Bashkir State Medical University

Email: ekaterina-pervushina@yandex.ru
ORCID iD: 0000-0002-9352-5783

Cand. Sci. (Med.), Assoc. Prof., Department of neurology

Russian Federation, 3 Lenin str., Ufa, 450008

Mansur A. Kutlubaev

Bashkir State Medical University

Author for correspondence.
Email: mansur.kutlubaev@yahoo.com
ORCID iD: 0000-0003-1001-2024

Dr. Sci. (Med.), Assoc. Prof., Head, Department of neurology

Russian Federation, 3 Lenin str., Ufa, 450008

Adelina E. Bikmetova

Bashkir State Medical University

Email: adelina.bikmetova@bk.ru
ORCID iD: 0009-0001-3147-0852

student

Russian Federation, 3 Lenin str., Ufa, 450008

Yulia I. Murzakova

Bashkir State Medical University

Email: murzakova02@mail.ru
ORCID iD: 0009-0005-4341-8321

student

Russian Federation, 3 Lenin str., Ufa, 450008

Vladimir D. Mendelevich

Kazan State Medical Universitу

Email: mendelevich_vl@mail.ru
ORCID iD: 0000-0002-8476-6083

Dr. Sci. (Med.), Prof., Head, Department of psychiatry and medical psychology

Russian Federation, Kazan

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Supplementary files

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2. Fig. 1. Heatmaps. A — patient V. with ALS and clinically significant depression exhibited longer visual fixation on sad faces compared to neutral ones; B — patient N. with ALS without depression showed longer fixation on neutral faces than sad ones.

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3. Fig. 2. ROC curve demonstrating the sensitivity and specificity of mean fixation duration on sad faces for detecting depressive symptoms in ALS patients.

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Copyright (c) 2025 Pervushina E.V., Kutlubaev M.A., Bikmetova A.E., Murzakova Y.I., Mendelevich V.D.

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