JMIR Publications

ABSTRACT

Background:

Apathy is one of the most prevalent and disabling neuropsychiatric symptoms in dementia, characterized by reduced motivation and diminished goal-directed activity, with strong impacts for both the person living with dementia and their caregivers. Despite its prevalence, its assessment remains challenging, as it relies largely on subjective self-reports and scales. In response, objective and quantifiable biomarkers derived from digital health technologies have emerged as a promising approach. The ECOCAPTURE program at the Paris Brain Institute (ICM) has developed ecological paradigms to identify behavioral and physiological markers of apathy, highlighting a core “exploration deficit” associated with this symptom. The present paper describes ECOCAPTURE@HOME(EYE), the eye-tracking and neuroimaging component of the broader ECOCAPTURE@HOME-V2 protocol.

Objective:

This protocol aims to identify objective, ecologically valid, and clinically meaningful ocular markers of apathy in behavioral variant frontotemporal dementia (bvFTD) and AD and integrate them into an exploratory digital phenotype of apathy. It further seeks to characterize the behavioral and neural mechanisms underlying apathy by integrating laboratory- and home-based eye-tracking with traditional clinical assessments and neuroimaging, within the broader ECOCAPTURE@HOME-V2 framework.

Methods:

This observational study combines laboratory-based and ecological at-home eye-tracking with neuropsychological and clinical assessments, ecological momentary assessment, wearable sensor data, and structural and functional MRI. Eye-tracking data will be acquired across complementary paradigms assessing oculomotor control and visual exploration and analyzed using multimodal statistical approaches to derive ocular metrics and evaluate their relationships with behavioral, clinical, and neuroimaging measures.

Results:

Recruitment will begin in summer 2026 and is expected to continue through 2028, with a total sample of 24 dyads per group (HC, bvFTD, and AD), for an overall target of 72 dyads (144 participants). Preliminary data analyses will commence in January 2027. Results are expected to be disseminated in two phases: initial findings based on preliminary analyses in September 2027, followed by publication of the complete study results in 2029.

Conclusions:

This study will contribute to refining the digital phenotype of apathy within a multimodal framework and support the development of objective assessment tools for dementia-related apathy. More broadly, it aims to advance data-driven and individualized approaches to dementia care through the integration of ecological digital biomarkers and neuroimaging and seeks to be the first study, to our knowledge, to utilize eye-tracking in the home environment of people living with dementia. Clinical Trial: The ECOCAPTURE@HOME-V2 protocol, sponsored by Inserm (C25-78), has been approved by the Comité de Protection des Personnes (CPP) (approval number: 26.00946.000424 – 2026-A00614-47).