The Sustained Attention to Response Task Shows Lower Cingulo-Opercular and Frontoparietal Activity in People with Narcolepsy Type 1: An fMRI Study on the Neural Regulation of Attention

Brain Sciences, vol. 10, pp. 419

Abstract

Vigilance complaints often occur in people with narcolepsy type 1 and severely impair effective daytime functioning. We tested the feasibility of a three-level sustained attention to response task (SART) paradigm within a magnetic resonance imaging (MRI) environment to understand brain architecture underlying vigilance regulation in individuals with narcolepsy type 1. Twelve medication-free people with narcolepsy type 1 and 11 matched controls were included. The SART included four repetitions of a baseline block and two difficulty levels requiring moderate and high vigilance. Outcome measures were between and within-group performance indices on error rates and reaction times, and functional MRI (fMRI) parameters: mean activity during the task and between-group activity differences across the three conditions and related to changes in activation over time (time-on-task) and error-related activity. Patients-but not controls-made significantly more mistakes with increasing difficulty. The modified SART is a feasible MRI vigilance task showing similar task-positive brain activity in both groups within the cingulo-opercular, frontoparietal, arousal, motor, and visual networks. During blocks of higher vigilance demand, patients had significantly lower activation in these regions than controls. Patients had lower error-related activity in the left pre- and postcentral gyrus. The time-on-task activity differences between groups suggest that those with narcolepsy are insufficiently capable of activating attention- and arousal-related regions when transitioning from attention initiation to stable attention, specifically when vigilance demand is high. They also show lower inhibitory motor activity in relation to errors, suggesting impaired executive functioning.

Authors 4

1. Jari K. Gool corresponding Aachen Department of Neurology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center · Stichting Epilepsie Instellingen Nederland · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Anatomy and Neurosciences, Amsterdam UMC, Location VUmc, De Boelelaan 1108, 1081HZ Amsterdam, Noord-Holland, The Netherlands

   Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, 2333ZA Leiden, The Netherlands

   Sleep-Wake Centre SEIN, Achterweg 2, 2103SW Heemstede, Noord-Holland, The Netherlands

2. Ysbrand D. van der Werf

   Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Anatomy and Neurosciences, Amsterdam UMC, Location VUmc, De Boelelaan 1108, 1081HZ Amsterdam, Noord-Holland, The Netherlands

3. Gert Jan Lammers Aachen Department of Neurology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center · Stichting Epilepsie Instellingen Nederland

   Affiliation as printed

   Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, 2333ZA Leiden, The Netherlands

   Sleep-Wake Centre SEIN, Achterweg 2, 2103SW Heemstede, Noord-Holland, The Netherlands

4. Rolf Fronczek Aachen Department of Neurology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center · Stichting Epilepsie Instellingen Nederland

   Affiliation as printed

   Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, 2333ZA Leiden, The Netherlands

   Sleep-Wake Centre SEIN, Achterweg 2, 2103SW Heemstede, Noord-Holland, The Netherlands