Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Jul 25, 2025
Date Accepted: Mar 12, 2026
Eye-Tracking Technologies for Cognitive Assessment After Acquired Brain Injury: Systematic Review
ABSTRACT
Background:
Acquired brain injury (ABI) represents a diverse set of conditions that often lead to cognitive dysfunction, but the constraints of conventional neuropsychological assessments, especially in individuals with motor or communicative challenges, necessitate more flexible and precise diagnostic strategies. Eye-tracking technology provides a viable alternative for retrieving oculomotor correlates of cognitive functioning in real time.
Objective:
This systematic review was undertaken to assess existing evidence of eye-tracking for cognitive evaluation in ABI populations.
Methods:
The search was conducted in seven major databases (PubMed, Scopus, Web of Science, etc.) in March to April 2025 with no specific time range. Reviews were conducted in accordance with peer-reviewed protocols, with studies that utilized eye-tracking to assess domains of cognition in ABI patients, including attention, memory, and executive function. Study selection, data extraction, and risk of bias assessments were conducted by independent reviewers according to PRISMA guidelines. This systematic review was registered in PROSPERO under the following number: CRD420251038768.
Results:
Twenty-seven studies met inclusion criteria, encompassing multiple ABI etiologies, ages, and cognitive outcomes (872 participants: 354 females and 518 males). Results show eye-tracking measures of saccadic latency, fixation time, and gaze asymmetry are sensitive to subtle neurocognitive deficits that are frequently missed by conventional methods. Moreover, integrating with multimodal technologies (e.g., EEG, VR) enhances the diagnostic accuracy. However, variability in methodology, small sample sizes, and limited longitudinal data limit the generalizability of current findings.
Conclusions:
Eye-tracking is a promising tool for cognitive assessment in ABI in regard to both its diagnostic sensitivity and translation potential. Future studies can assist with standardized protocols, larger samples, and longitudinal designs that will make it possible to translate results to clinical applications and provide measures for precision rehabilitation approaches.
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