Publications by authors named "Joseph DeGutis"

61 Publications

A randomized clinical trial of plasticity-based cognitive training in mild traumatic brain injury.

Brain 2021 08;144(7):1994-2008

Posit Science Corporation, San Francisco, CA, USA.

Clinical practice guidelines support cognitive rehabilitation for people with a history of mild traumatic brain injury (mTBI) and cognitive impairment, but no class I randomized clinical trials have evaluated the efficacy of self-administered computerized cognitive training. The goal of this study was to evaluate the efficacy of a self-administered computerized plasticity-based cognitive training programmes in primarily military/veteran participants with a history of mTBI and cognitive impairment. A multisite randomized double-blind clinical trial of a behavioural intervention with an active control was conducted from September 2013 to February 2017 including assessments at baseline, post-training, and after a 3-month follow-up period. Participants self-administered cognitive training (experimental and active control) programmes at home, remotely supervised by a healthcare coach, with an intended training schedule of 5 days per week, 1 h per day, for 13 weeks. Participants (149 contacted, 83 intent-to-treat) were confirmed to have a history of mTBI (mean of 7.2 years post-injury) through medical history/clinician interview and persistent cognitive impairment through neuropsychological testing and/or quantitative participant reported measure. The experimental intervention was a brain plasticity-based computerized cognitive training programme targeting speed/accuracy of information processing, and the active control was composed of computer games. The primary cognitive function measure was a composite of nine standardized neuropsychological assessments, and the primary directly observed functional measure a timed instrumental activities of daily living assessment. Secondary outcome measures included participant-reported assessments of cognitive and mental health. The treatment group showed an improvement in the composite cognitive measure significantly larger than that of the active control group at both the post-training [+6.9 points, confidence interval (CI) +1.0 to +12.7, P = 0.025, d = 0.555] and the follow-up visit (+7.4 points, CI +0.6 to +14.3, P = 0.039, d = 0.591). Both large and small cognitive function improvements were seen twice as frequently in the treatment group than in the active control group. No significant between-group effects were seen on other measures, including the directly-observed functional and symptom measures. Statistically equivalent improvements in both groups were seen in depressive and cognitive symptoms.
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http://dx.doi.org/10.1093/brain/awab202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370402PMC
August 2021

Evidence for a Specific Association Between Sustained Attention and Gait Speed in Middle-to-Older-Aged Adults.

Front Aging Neurosci 2021 5;13:703434. Epub 2021 Jul 5.

Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, United States.

Although cognitive decline has previously been associated with mobility limitations and frailty, the relationship between sustained attention and gait speed is incompletely characterized. To better quantify the specificity of the sustained attention and gait speed association, we examined the extent to which this relationship is unique rather than accounted for by executive functioning and physical health characteristics. 58 middle-to-older-aged community-dwelling adults without overt evidence of cognitive impairment (45-90 years old; 21 females) participated in the study. Each participant completed a 4-meter gait speed assessment and validated neuropsychological tests to examine various domains of executive functioning including working memory (i.e., Digit Span), inhibitory control (i.e., D-KEFS Color-Word Interference), and task switching (i.e., D-KEFS Number/Letter Switching). Multiple physical and vascular risk factors were also evaluated. Sustained attention was assessed using the gradual onset continuous performance task (gradCPT), a well-validated go/no-go sustained attention task. A series of linear regression models were used to examine how different aspects of cognition, including sustained attention and traditional measures of executive functioning, related to gait speed while controlling for a variety of physical and vascular risk factors. Among all predictors, gradCPT accuracy explained the most variance in gait speed ( = 0.19, < 0.001) and was the only significant predictor (β = 0.35, = 0.01) when accounting for executive functioning and other physical and vascular risk factors. The present results indicate that sustained attention may be uniquely sensitive and mechanistically linked to mobility limitations in middle-to-older adults.
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http://dx.doi.org/10.3389/fnagi.2021.703434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8289388PMC
July 2021

Variable rather than extreme slow reaction times distinguish brain states during sustained attention.

Sci Rep 2021 Jul 21;11(1):14883. Epub 2021 Jul 21.

Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA.

A common behavioral marker of optimal attention focus is faster responses or reduced response variability. Our previous study found two dominant brain states during sustained attention, and these states differed in their behavioral accuracy and reaction time (RT) variability. However, RT distributions are often positively skewed with a long tail (i.e., reflecting occasional slow responses). Therefore, a larger RT variance could also be explained by this long tail rather than the variance around an assumed normal distribution (i.e., reflecting pervasive response instability based on both faster and slower responses). Resolving this ambiguity is important for better understanding mechanisms of sustained attention. Here, using a large dataset of over 20,000 participants who performed a sustained attention task, we first demonstrated the utility of the exGuassian distribution that can decompose RTs into a strategy factor, a variance factor, and a long tail factor. We then investigated which factor(s) differed between the two brain states using fMRI. Across two independent datasets, results indicate unambiguously that the variance factor differs between the two dominant brain states. These findings indicate that 'suboptimal' is different from 'slow' at the behavior and neural level, and have implications for theoretically and methodologically guiding future sustained attention research.
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http://dx.doi.org/10.1038/s41598-021-94161-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8295386PMC
July 2021

Evaluating the Feasibility and Effects of a Short-Term Task Specific Power Training With and Without Cognitive Training Among Older Adults With Slow Gait Speed: A Pilot Study.

Arch Rehabil Res Clin Transl 2021 Jun 9;3(2):100118. Epub 2021 Mar 9.

New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA.

Objective: To investigate the feasibility and efficacy of short-term functional power training and further examine whether the addition of cognitive training targeting sustained attention and inhibitory control would augment the effect on the outcomes.

Design: Randomized pilot study.

Setting: Clinical research facility.

Participants: Community-dwelling primary care patients (N=25) aged >65 years with mobility limitation within the VA Boston Healthcare System.

Interventions: Participants were randomly assigned to either functional power training (n=14) or functional power+cognitive training (n=11), offered 3 times a week for 6 weeks. Session durations were either 70 minutes (functional power+cognitive training) or 40 minutes (functional power training).

Main Outcome Measures: We evaluated feasibility (dropouts, attendance), mobility performance (Short Physical Performance Battery [SPPB]), leg power [stair climb test]), dynamic balance [figure-of-8], and gait characteristics [gait speed, stance time, step width, swing time, step length, variabilities under single-task and dual-task conditions]). Nonparametric analyses were used to compare overall pre-post changes and between-group differences.

Results: Of the 39 veterans screened, 25 were randomized and enrolled. Twenty-one men with a mean age 76±7 years completed the study; 86% were white. Participants had a mean SPPB score of 8.3±1.6 out of 12. For those completing the study, overall attendance was 79%. Among all participants, clinically relevant and/or statistically significant median change in mobility performance (∆1 point), leg power (∆25.0W), dynamic balance (∆-1.1s), and gait characteristics (gait speed [∆0.08s, ∆0.09s], step length [∆1.9cm, ∆3.8cm], and stance time [∆-0.02s, ∆-0.05s] under single- and dual-task, respectively) were observed after 6 weeks of training. There were no statistically significant group differences in dropouts, attendance rate, or any of the outcomes based on cognitive training status.

Conclusions: Short-term functional power training with or without a cognitive training led to clinically meaningful improvements in mobility performance, leg power, dynamic balance, and gait characteristics. These findings add to the body of evidence supporting the benefits of functional power training on clinically relevant outcomes. Additional cognitive training did not have an added effect on the study outcomes from our study. Further research is needed.
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http://dx.doi.org/10.1016/j.arrct.2021.100118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8211979PMC
June 2021

Impaired executive function exacerbates neural markers of posttraumatic stress disorder.

Psychol Med 2021 Apr 21:1-14. Epub 2021 Apr 21.

National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.

Background: A major obstacle in understanding and treating posttraumatic stress disorder (PTSD) is its clinical and neurobiological heterogeneity. To address this barrier, the field has become increasingly interested in identifying subtypes of PTSD based on dysfunction in neural networks alongside cognitive impairments that may underlie the development and maintenance of symptoms. The current study aimed to determine if subtypes of PTSD, based on normative-based cognitive dysfunction across multiple domains, have unique neural network signatures.

Methods: In a sample of 271 veterans (90% male) that completed both neuropsychological testing and resting-state fMRI, two complementary, whole-brain functional connectivity analyses explored the link between brain functioning, PTSD symptoms, and cognition.

Results: At the network level, PTSD symptom severity was associated with reduced negative coupling between the limbic network (LN) and frontal-parietal control network (FPCN), driven specifically by the dorsolateral prefrontal cortex and amygdala Hubs of Dysfunction. Further, this relationship was uniquely moderated by executive function (EF). Specifically, those with PTSD and impaired EF had the strongest marker of LN-FPCN dysregulation, while those with above-average EF did not exhibit PTSD-related dysregulation of these networks.

Conclusion: These results suggest that poor executive functioning, alongside LN-FPCN dysregulation, may represent a neurocognitive subtype of PTSD.
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http://dx.doi.org/10.1017/S0033291721000842DOI Listing
April 2021

Apolipoprotein E (APOE) ε4 moderates the relationship between c-reactive protein, cognitive functioning, and white matter integrity.

Brain Behav Immun 2021 07 23;95:84-95. Epub 2021 Feb 23.

National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA; Boston Attention and Learning Laboratory, VA Healthcare System, Boston, MA, USA.

Elevated serum C-reactive protein (CRP) and possessing an APOE ε4 allele are two of the most prominent risk factors for cognitive and neurological dysfunction in older adults, but little is known about the unique or cumulative effects of these risk factors in young-to-middle-aged adults. To further characterize these potential relationships, measures of cognition and microstructural white matter integrity were examined using data from a sample of 329 post-9/11 war veterans that was collected as part of a comprehensive evaluation that included assessment of neuropsychological functioning, MRI scanning, psychiatric diagnoses, health screening, markers of inflammation, and APOE genotypes. Hierarchical linear regression analyses revealed the CRP and APOE ε4 interaction was associated with global cognition (β = -0.633), executive functioning (β = -0.566), and global fractional anisotropy (β = -0.470), such that elevated CRP was associated with worse cognition and white matter integrity in APOE ε4 carriers. Diffusion tensor imaging (DTI) was used to determine if CRP × APOE ε4 presence was associated with regionally specific fractional anisotropy in white matter tracts. Tract-based spatial statistics revealed CRP × APOE ε4 presence was associated with fractional anisotropy in the corpus callosum, right superior longitudinal fasciculus, right posterior corona radiata, as well as the bilateral anterior and superior corona radiatas. This suggests that APOE ε4 carriers may be uniquely vulnerable to the potentially negative impact of elevated systematic inflammation to cognition and microstructural white matter integrity.
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http://dx.doi.org/10.1016/j.bbi.2021.02.016DOI Listing
July 2021

Apolipoprotein E (APOE) ε4 moderates the relationship between c-reactive protein, cognitive functioning, and white matter integrity.

Brain Behav Immun 2021 07 23;95:84-95. Epub 2021 Feb 23.

National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA; Boston Attention and Learning Laboratory, VA Healthcare System, Boston, MA, USA.

Elevated serum C-reactive protein (CRP) and possessing an APOE ε4 allele are two of the most prominent risk factors for cognitive and neurological dysfunction in older adults, but little is known about the unique or cumulative effects of these risk factors in young-to-middle-aged adults. To further characterize these potential relationships, measures of cognition and microstructural white matter integrity were examined using data from a sample of 329 post-9/11 war veterans that was collected as part of a comprehensive evaluation that included assessment of neuropsychological functioning, MRI scanning, psychiatric diagnoses, health screening, markers of inflammation, and APOE genotypes. Hierarchical linear regression analyses revealed the CRP and APOE ε4 interaction was associated with global cognition (β = -0.633), executive functioning (β = -0.566), and global fractional anisotropy (β = -0.470), such that elevated CRP was associated with worse cognition and white matter integrity in APOE ε4 carriers. Diffusion tensor imaging (DTI) was used to determine if CRP × APOE ε4 presence was associated with regionally specific fractional anisotropy in white matter tracts. Tract-based spatial statistics revealed CRP × APOE ε4 presence was associated with fractional anisotropy in the corpus callosum, right superior longitudinal fasciculus, right posterior corona radiata, as well as the bilateral anterior and superior corona radiatas. This suggests that APOE ε4 carriers may be uniquely vulnerable to the potentially negative impact of elevated systematic inflammation to cognition and microstructural white matter integrity.
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http://dx.doi.org/10.1016/j.bbi.2021.02.016DOI Listing
July 2021

Evaluating the evidence for a neuroimaging subtype of posttraumatic stress disorder.

Sci Transl Med 2020 11;12(568)

Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA 02130, USA.

A recent study used functional neuroimaging and cognitive tasks to identify posttraumatic stress disorder (PTSD) subtypes. Specifically, this study found that a subgroup of patients with verbal memory impairment had a unique neural signature, namely, decreased ventral attention network (VAN) resting-state functional connectivity, and these same individuals responded poorly to psychotherapy. Although this represents one of the first studies to propose a neurocognitive subtype of PTSD and has far-reaching translational potential, the generalizability and specificity of the observed neural network and cognitive domain remain unclear. We attempted to conceptually replicate and extend these findings in a similar cohort of combat-exposed veterans ( = 229) tested using a standardized battery of neuropsychological tests and a priori criteria for cognitive impairments. First, we conducted identical and complementary analyses to determine whether subjects with PTSD and neuropsychologically defined verbal memory deficits exhibited the VAN connectivity biomarker. Second, we examined whether cognitive deficits in other domains implicated in PTSD (executive functioning and attention) exhibited the VAN signature. Across multiple measures of verbal memory, we did not find that the subgroup of individuals with PTSD and memory impairments had lower VAN connectivity. However, a subgroup of individuals with PTSD and attentional impairments did have lower VAN connectivity, suggesting that the original subtype could have been related to attention and not memory impairments. Overall, our findings suggest that the previously identified memory-impaired PTSD subtype may not generalize. Further consideration of neuropsychological methods will be important for neurocognitive markers to be implemented clinically.
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http://dx.doi.org/10.1126/scitranslmed.aaz9343DOI Listing
November 2020

Apolipoprotein E () ε4 Status Moderates the Relationship Between Close-Range Blast Exposure and Cognitive Functioning.

J Int Neuropsychol Soc 2021 04 3;27(4):315-328. Epub 2020 Nov 3.

Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA02130, USA.

Objectives: Recent studies suggest that close-range blast exposure (CBE), regardless of acute concussive symptoms, may have negative long-term effects on brain health and cognition; however, these effects are highly variable across individuals. One potential genetic risk factor that may impact recovery and explain the heterogeneity of blast injury's long-term cognitive outcomes is the inheritance of an apolipoprotein (APOE) ε4 allele, a well-known genetic risk factor for Alzheimer's disease. We hypothesized that APOE ε4 carrier status would moderate the impact of CBE on long-term cognitive outcomes.

Methods: To test this hypothesis, we examined 488 post-9/11 veterans who completed assessments of neuropsychological functioning, psychiatric diagnoses, history of blast exposure, military and non-military mild traumatic brain injuries (mTBIs), and available APOE genotypes. We separately examined the effects of CBE on attention, memory, and executive functioning in individuals with and without the APOE ε4 allele.

Results: As predicted, we observed a differential impact of CBE status on cognition as a function of APOE ε4 status, in which CBE ε4 carriers displayed significantly worse neuropsychological performance, specifically in the domain of memory. These results persisted after adjusting for clinical, demographic, and genetic factors and were not observed when examining other neurotrauma variables (i.e., lifetime or military mTBI, distant blast exposure), though these variables displayed similar trends.

Conclusions: These results suggest APOE ε4 carriers are more vulnerable to the impact of CBE on cognition and highlight the importance of considering genetic risk when studying cognitive effects of neurotrauma.
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http://dx.doi.org/10.1017/S1355617720001034DOI Listing
April 2021

Evidence for normal novel object recognition abilities in developmental prosopagnosia.

R Soc Open Sci 2020 Sep 23;7(9):200988. Epub 2020 Sep 23.

Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA, USA.

The issue of the face specificity of recognition deficits in developmental prosopagnosia (DP) is fundamental to the organization of high-level visual memory and has been increasingly debated in recent years. Previous DP investigations have found some evidence of object recognition impairments, but have almost exclusively used familiar objects (e.g. cars), where performance may depend on acquired object-specific experience and related visual expertise. An object recognition test not influenced by experience could provide a better, less contaminated measure of DPs' object recognition abilities. To investigate this, in the current study we tested 30 DPs and 30 matched controls on a novel object memory test (NOMT Ziggerins) and the Cambridge Face Memory Test (CFMT). DPs with severe impairment on the CFMT showed no differences in accuracy or reaction times compared with controls on the NOMT. We found similar results when comparing DPs with a larger sample of 274 web-based controls. Additional individual analyses demonstrated that the rate of object recognition impairment in DPs did not differ from the rate of impairment in either control group. Together, these results demonstrate unimpaired object recognition in DPs for a class of novel objects that serves as a powerful index for broader novel object recognition capacity.
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http://dx.doi.org/10.1098/rsos.200988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540787PMC
September 2020

Searching for the Backfire Effect: Measurement and Design Considerations.

J Appl Res Mem Cogn 2020 Sep 2;9(3):286-299. Epub 2020 Sep 2.

Network Science Institute, Northeastern University, Boston, USA.

One of the most concerning notions for science communicators, fact-checkers, and advocates of truth, is the backfire effect; this is when a correction leads to an individual their belief in the very misconception the correction is aiming to rectify. There is currently a debate in the literature as to whether backfire effects exist at all, as recent studies have failed to find the phenomenon, even under theoretically favorable conditions. In this review, we summarize the current state of the worldview and familiarity backfire effect literatures. We subsequently examine barriers to measuring the backfire phenomenon, discuss approaches to improving measurement and design, and conclude with recommendations for fact-checkers. We suggest that backfire effects are not a robust empirical phenomenon, and more reliable measures, powerful designs, and stronger links between experimental design and theory could greatly help move the field ahead.
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http://dx.doi.org/10.1016/j.jarmac.2020.06.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462781PMC
September 2020

Interpersonal early life trauma is associated with increased cerebral perfusion and poorer memory performance in post-9/11 veterans.

Neuroimage Clin 2020 1;28:102365. Epub 2020 Aug 1.

National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.

Background: Cerebral blood flow (CBF) is critically important in the overall maintenance of brain health, and disruptions in normal flow have been linked to the degradation of the brain's structural integrity and function. Recent studies have highlighted the potential role of CBF as a link between psychiatric disorders and brain integrity. Although interpersonal early life trauma (IP-ELT) is a risk factor for the development of psychiatric disorders and has been linked to disruptions in brain structure and function, the mechanisms through which IP-ELT alters brain integrity and development remain unclear. The goal of this study was to understand whether IP-ELT was associated with alterations in CBF assessed during adulthood. Further, because the cognitive implications of perfusion disruptions in IP-ELT are also unclear, this study sought to investigate the relationship between IP-ELT, perfusion, and cognition.

Methods: 179 Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) Veterans and military personnel completed pseudo-continuous arterial spin labeling (pCASL) imaging, clinical interviews, the Traumatic Life Events Questionnaire (TLEQ), and a battery of neuropsychological tests that were used to derive attention, memory, and executive function cognitive composite scores. To determine whether individuals were exposed to an IP-ELT, events on the TLEQ that specifically queried interpersonal trauma before the age of 18 were tallied for each individual. Analyses compared individuals who reported an interpersonal IP-ELT (IP-ELT+, n = 48) with those who did not (IP-ELT-, n = 131).

Results: Whole brain analyses revealed that IP-ELT+ individuals had significantly greater CBF in the right inferior/middle temporal gyrus compared to those in the IP-ELT- group, even after controlling for age, sex, and posttraumatic stress disorder (PTSD). Further, perfusion in the right inferior/middle temporal gyrus significantly mediated the relationship between IP-ELT and memory, not attention or executive function, such that those with an IP-ELT had greater perfusion, which, in turn, was associated with poorer memory. Examination of other clinical variables such as current PTSD diagnosis and severity as well as the interaction between IP-ELT and PTSD yielded no significant effects.

Conclusions: These results extend prior work demonstrating an association between ELT and cerebral perfusion by suggesting that increased CBF may be an important neural marker with cognitive implications in populations at risk for psychiatric disorders.
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http://dx.doi.org/10.1016/j.nicl.2020.102365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417939PMC
June 2021

Alertness Training Improves Spatial Bias and Functional Ability in Spatial Neglect.

Ann Neurol 2020 10 4;88(4):747-758. Epub 2020 Sep 4.

Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA, USA.

Objective: We conducted a multisite, randomized, double-blinded, controlled trial to examine the effectiveness of a digital health intervention targeting the intrinsic regulation of goal-directed alertness in patients with chronic hemispatial neglect.

Methods: Forty-nine participants with hemispatial neglect, who demonstrated significant spatially biased attention after acquired brain injury, were randomly assigned to the experimental attention remediation treatment or the active control group. The participants engaged with the remotely administered interventions for 12 weeks. The primary outcome was spatial bias on the Posner cueing task (response time difference: left minus right target trials). Secondary outcomes included functional abilities (measured via the Catherine Bergego scale and Barthel index), spatial cognition, executive function, quality of life, and sleep. Assessments were conducted before and immediately after participation in the experimental intervention or control condition, and again after a 3-month no-contact period.

Results: Compared with the active control group, the intervention group exhibited a significant improvement in the primary outcome, a reduction in spatially biased attention on the Posner cueing task (p = 0.010, Cohen's d = 0.96), in addition to significant improvements in functional abilities as measured on the Catherine Bergego and Barthel indices (p = 0.027, Cohen's d = 0.24).

Interpretation: Our results demonstrate that our attention training program was effective in improving the debilitating attention deficits common to hemispatial neglect. This benefit generalized to improvements in real-world functional abilities. This safe, highly scalable, and self-administered treatment for hemispatial neglect might serve as a useful addition to the existing standard of care. ANN NEUROL 2020;88:747-758.
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http://dx.doi.org/10.1002/ana.25862DOI Listing
October 2020

Characterizing developmental prosopagnosia beyond face perception: Impaired recollection but intact familiarity recognition.

Cortex 2020 09 18;130:64-77. Epub 2020 May 18.

Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Electronic address:

Converging lines of research suggests that many developmental prosopagnosics (DPs) have impairments beyond face perception, but currently no framework exists to characterize these impaired mechanisms. One potential extra-perceptual deficit is that DPs encode/retrieve faces in a distinct manner from controls that does not sufficiently support individuation. To test this possibility, 30 DPs and 30 matched controls performed an old/new face recognition task while providing confidence ratings, to which a model-based ROC analysis was applied. DPs had significantly reduced recollection compared to controls, driven by fewer 'high-confidence target' responses, but intact familiarity. Recollection and face perception ability uniquely predicted objective and subjective prosopagnosia symptoms, together explaining 51% and 56% of the variance, respectively. These results suggest that a specific deficit in face recollection in DP may represent a core aspect of the difficulty in confidently identifying an individual by their face.
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http://dx.doi.org/10.1016/j.cortex.2020.04.016DOI Listing
September 2020

Childhood Adversity and Dimensional Variations in Adult Sustained Attention.

Front Psychol 2020 16;11:691. Epub 2020 Apr 16.

Department of Psychiatry, Harvard Medical School, Boston, MA, United States.

Background And Objective: Sustained attention is a transdiagnostic phenotype linked with most forms of psychopathology. We sought to understand factors that influence the development of sustained attention, by looking at the relationship between childhood adversity and adult sustained attention.

Participants Setting And Methods: Participants were 5,973 TestMyBrain.org visitors from English-speaking countries who completed a continuous performance task (gradCPT) of sustained attention and a childhood adversity questionnaire. We analyzed gradCPT performance using a signal detection approach.

Results: Discrimination ability (the main metric of performance on the gradCPT) was associated with total childhood adversity load, even when controlling for covariates related to age, gender, parental education, race, country of origin, and relative socioeconomic status (β = -0.079, = -0.032).

Conclusion: Our results demonstrate that attention differences related to childhood adversity exposure can (1) be measured using brief, performance-based measures of sustained attention, (2) persist into adulthood, and (3) be detected at the population level. These results, paired with the well-documented associations between sustained attention and psychopathology, indicate that sustained attention may be an important mechanism for understanding early influences on mental health.
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http://dx.doi.org/10.3389/fpsyg.2020.00691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180319PMC
April 2020

Gender Differences in Familiar Face Recognition and the Influence of Sociocultural Gender Inequality.

Sci Rep 2019 11 29;9(1):17884. Epub 2019 Nov 29.

Department of Psychiatry, Harvard Medical school, Boston, MA, USA.

Are gender differences in face recognition influenced by familiarity and socio-cultural factors? Previous studies have reported gender differences in processing unfamiliar faces, consistently finding a female advantage and a female own-gender bias. However, researchers have recently highlighted that unfamiliar faces are processed less efficiently than familiar faces, which have more robust, invariant representations. To-date, no study has examined whether gender differences exist for familiar face recognition. The current study addressed this by using a famous faces task in a large, web-based sample of  > 2000 participants across different countries. We also sought to examine if differences varied by socio-cultural gender equality within countries. When examining raw accuracy as well when controlling for fame, the results demonstrated that there were no participant gender differences in overall famous face accuracy, in contrast to studies of unfamiliar faces. There was also a consistent own-gender bias in male but not female participants. In countries with low gender equality, including the USA, females showed significantly better recognition of famous female faces compared to male participants, whereas this difference was abolished in high gender equality countries. Together, this suggests that gender differences in recognizing unfamiliar faces can be attenuated when there is enough face learning and that sociocultural gender equality can drive gender differences in familiar face recognition.
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http://dx.doi.org/10.1038/s41598-019-54074-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884510PMC
November 2019

Trauma-related psychiatric and behavioral conditions are uniquely associated with sustained attention dysfunction.

Neuropsychology 2019 Jul 30;33(5):711-724. Epub 2019 May 30.

Translational Research Center for TBI and Stress Disorders.

Objective: It is increasingly recognized that trauma victims, particularly Veterans, have co-occurring psychological and physical conditions that impact cognition, especially the domains of sustained attention and executive functioning. Although previous work has generally attempted to isolate the unique cognitive effects of common combat-related comorbidities, less work has been done to examine how these conditions co-occur, and whether unique cognitive signatures accompany certain clinical combinations.

Method: To address this gap, we examined how several deployment-related conditions were associated with performance on a well-validated measure of sustained attention (i.e., gradual onset continuous performance task [gradCPT]) and a battery of standard neuropsychological measures in 123 Veterans from the Translational Research Center for TBI and Stress Disorders. Initially, a Principal component analysis was conducted to investigate how comorbid conditions grouped together.

Results: Several sustained attention measures from the gradCPT were differentially associated with four unique combinations of trauma-related pathology. Specifically, a somatic component representing the combination of current pain, sleep disturbance, and mild traumatic brain injury was associated with a higher rate of failures of attentional engagement. On the other hand, a comorbid posttraumatic stress disorder (PTSD) and mood disorder component (moodPTSD), as well as a substance use disorder component, were associated with higher rates of inhibitory control failures. Increased attentional instability was associated with moodPTSD as well as an anxiety disorder component. In contrast, the cognitive effects of deployment-related trauma were not observed on standard neuropsychological measures.

Conclusion: These findings suggest that unique combinations of trauma-related pathology have dissociable effects on sustained attentional control. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/neu0000525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912598PMC
July 2019

Metabolic risk in older adults is associated with impaired sustained attention.

Neuropsychology 2019 Oct 16;33(7):947-955. Epub 2019 May 16.

Geriatric Research, Education, & Clinical Center (GRECC).

Objective: Metabolic syndrome (MetS), the presence of three or more cardiovascular risk factors, has been associated with subtle and diffuse neural compromise but has not been consistently associated with cognitive dysfunction. Sustained attention is a fundamental cognitive operation that relies on multiple brain networks and is impaired in a broad array of neurologic conditions. We examined whether a well-validated measure of sustained attention would be sensitive to vascular risk, as compared with more standard neuropsychological measures of attention and executive functioning.

Method: We assessed vascular risk factors (VRFs; blood pressure, waist circumference, cholesterol, glucose, and triglycerides) in 93 middle-to-older aged adults (45-75 years). MetS was defined based on current guidelines from the National Cholesterol Education Program Adult Training Program (NCEP ATP III). Participants were grouped according to number of VRFs: high risk (MetS; 3+ VRFs; = 32), medium risk (1 or 2 VRFs; = 35), and low risk (0 VRFs; = 26). All participants underwent a neuropsychological battery of tests measuring executive functioning. Participants also performed the gradual-onset continuous performance task (gradCPT), a measure of sustained attention.

Results: There was a significant main effect of VRF group on sustained attention performance; participants with lower vascular risk were better able to sustain attention. No significant effects were detected on standard neuropsychological tests of executive function.

Conclusion: Our results suggest that the gradCPT is sensitive to the potentially negative effects of MetS on subtle aspects of neurocognitive functioning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/neu0000554DOI Listing
October 2019

Individual differences in sustained attention are associated with cortical thickness.

Hum Brain Mapp 2019 08 13;40(11):3243-3253. Epub 2019 Apr 13.

Translational Research Center for TBI and Stress Disorders (TRACTS), VA RR&D TBI National Research Center, VA Boston Healthcare System, Boston, Massachusetts.

Several studies have examined how individual differences in sustained attention relate to functional brain measures (e.g., functional connectivity), but far fewer studies relate sustained attention ability, or cognition in general, to individual differences in cortical structure. Functional magnetic resonance imaging meta-analyses and patient work have highlighted that frontoparietal regions, lateralized to the right hemisphere, are critical for sustained attention, though recent work implicates a broader expanse of brain regions. The current study sought to determine if and where variation in cortical thickness is significantly associated with sustained attention performance. Sustained attention was measured using the gradual onset continuous performance task and the Test of Variables of Attention in 125 adult Veteran participants after acquiring two high-resolution structural MRI scans. Whole-brain vertex-wise analyses of the cortex demonstrated that better sustained attention was associated with increased thickness in visual, somatomotor, frontal, and parietal cortices, especially in the right hemisphere. Network-based analyses revealed relationships between sustained attention and cortical thickness in the dorsal attention, ventral attention, somatomotor, and visual networks. These results indicate cortical thickness in multiple regions and networks is associated with sustained attention, and add to the growing knowledge of how structural MRI can help explain individual differences in cognition.
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http://dx.doi.org/10.1002/hbm.24594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6865816PMC
August 2019

Clinically significant cognitive dysfunction in OEF/OIF/OND veterans: Prevalence and clinical associations.

Neuropsychology 2019 May 4;33(4):534-546. Epub 2019 Apr 4.

Translational Research Center for TBI and Stress Disorders, VA RR&D TBI Center of Excellence, VA Boston Healthcare System.

Objective: Cognitive performance in trauma-exposed populations, such as combat Veterans, has been shown to be worse than in nonexposed peers. However, cognitive performance has typically been within the normal range (within 1 SD of normative mean), and the prevalence of clinically significant cognitive dysfunction (i.e., performance more than 1 SD below the mean on multiple measures in a domain) in younger adults with trauma exposure remains unknown. The objective of our study was to measure this.

Method: We applied Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) cutoffs for clinically significant cognitive dysfunction (>1 SD below the mean in multiple measures within a domain) in the domains of memory, executive function, and attention to a sample of combat-exposed Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND; N = 368, mean age = 31.7 years, 90% men) Veterans. We then compared psychiatric, physiological, and neural measures, as well as functional outcomes, between those with and without cognitive dysfunction.

Results: Veterans with cognitive dysfunction (n = 129, 35.1%) had lower premorbid reading ability and more severe psychological distress, including increased anxiety, depression, posttraumatic stress disorder (PTSD), sleep difficulties, pain, and alcohol consumption. Those with cognitive dysfunction also had worse functional outcomes, with mild but significant disability. In contrast, we found associations between outcome and age, traumatic brain injury, physiological and neural measures to be weak or not significant.

Conclusions: Together, this suggests that premorbid abilities and trauma-related psychological symptoms contribute significantly to cognitive dysfunction in OEF/OIF/OND Veterans, and that neurological insult and aging may play less of a role. Cognitive dysfunction may be at least partially ameliorated by treating trauma-related symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/neu0000529DOI Listing
May 2019

Self-reported face recognition is highly valid, but alone is not highly discriminative of prosopagnosia-level performance on objective assessments.

Behav Res Methods 2019 06;51(3):1102-1116

Department of Psychiatry, Harvard Medical School, Boston, MA, USA.

Severe developmental deficits in face recognition ability (developmental prosopagnosia, or DP) have been vigorously studied over the past decade, yet many questions remain unanswered about their origins, nature, and social consequences. A rate-limiting factor in answering such questions is the challenge of recruiting rare DP participants. Although self-reported experiences have long played a role in efforts to identify DPs, much remains unknown about how such self-reports can or should contribute to screening or diagnosis. Here, in a large, population-based web sample, we investigated the effectiveness of self-report, used on its own, as a screen to identify individuals who will ultimately fail, at a conventional cutoff, the two types of objective tests that are most commonly used to confirm DP diagnoses: the Cambridge Face Memory Test (CFMT) and the famous faces memory test (FFMT). We used a highly reliable questionnaire (alpha = .91), the Cambridge Face Memory Questionnaire (CFMQ), and revealed strong validity via high correlations of .44 with the CFMT and .52 with the FFMT. However, cutoff analyses revealed that no CFMQ score yielded a clinical-grade combination of sensitivity and positive predictive value in enough individuals to support using it alone as a DP diagnostic or screening tool. This result was replicated in an analysis of data from the widely used PI20 questionnaire, a 20-question self-assessment of facial recognition similar in form to the CFMQ. We therefore recommend that screens for DP should, wherever possible, include objective as well as subjective assessment tools.
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http://dx.doi.org/10.3758/s13428-018-01195-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527346PMC
June 2019

Reward Ameliorates Posttraumatic Stress Disorder-Related Impairment in Sustained Attention.

Chronic Stress (Thousand Oaks) 2018 Jan-Dec;2. Epub 2018 Nov 26.

Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.

Background: Posttraumatic stress disorder is associated with impairments in a fundamental cognitive process important for a variety of social and occupational tasks. To date, however, the precise nature of these impairments and the posttraumatic stress disorder symptoms associated with them have not been well understood.

Methods: Using a well-characterized sample of returning United States military OEF/OIF/OND Veterans who varied in posttraumatic stress disorder symptoms, we employed a validated sustained attention paradigm designed to probe fluctuations across two attentional states characterized by prior research, including a peak state termed "in the zone" and a less efficient, more error-prone state termed "out of the zone." Rewarded and nonrewarded conditions were employed to examine whether motivating strong task performance could ameliorate sustained attention deficits. Analyses examined associations between attentional state, availability of reward, and posttraumatic stress disorder symptoms.

Results: Results indicated that, consistent with prior findings, higher levels of posttraumatic stress disorder symptoms were broadly associated with impaired task performance. This impairment was driven largely by performance deficits during individuals' optimal ("in the zone") attentional state, and follow-up analyses indicated that the performance deficit was primarily associated with anhedonia and emotional numbing symptoms. However, the deficit was partially ameliorated when better performance was rewarded.

Conclusion: Our results provide a more complex understanding of the sustained attention deficits associated with posttraumatic stress disorder and suggest that external incentives may help to enhance sustained attention performance for affected individuals.
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http://dx.doi.org/10.1177/2470547018812400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350805PMC
November 2018

Attentional Fluctuations Influence the Neural Fidelity and Connectivity of Stimulus Representations.

J Cogn Neurosci 2018 09 13;30(9):1209-1228. Epub 2018 Jul 13.

VA Boston Healthcare System.

Attention is thought to facilitate both the representation of task-relevant features and the communication of these representations across large-scale brain networks. However, attention is not "all or none," but rather it fluctuates between stable/accurate (in-the-zone) and variable/error-prone (out-of-the-zone) states. Here we ask how different attentional states relate to the neural processing and transmission of task-relevant information. Specifically, during in-the-zone periods: (1) Do neural representations of task stimuli have greater fidelity? (2) Is there increased communication of this stimulus information across large-scale brain networks? Finally, (3) can the influence of performance-contingent reward be differentiated from zone-based fluctuations? To address these questions, we used fMRI and representational similarity analysis during a visual sustained attention task (the gradCPT). Participants ( n = 16) viewed a series of city or mountain scenes, responding to cities (90% of trials) and withholding to mountains (10%). Representational similarity matrices, reflecting the similarity structure of the city exemplars ( n = 10), were computed from visual, attentional, and default mode networks. Representational fidelity (RF) and representational connectivity (RC) were quantified as the interparticipant reliability of representational similarity matrices within (RF) and across (RC) brain networks. We found that being in the zone was characterized by increased RF in visual networks and increasing RC between visual and attentional networks. Conversely, reward only increased the RC between the attentional and default mode networks. These results diverge with analogous analyses using functional connectivity, suggesting that RC and functional connectivity in tandem better characterize how different mental states modulate the flow of information throughout the brain.
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http://dx.doi.org/10.1162/jocn_a_01306DOI Listing
September 2018

Randomized control trial of computer-based training targeting alertness in older adults: the ALERT trial protocol.

BMC Psychol 2018 May 3;6(1):22. Epub 2018 May 3.

Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA, USA.

Background: Healthy aging is associated with a decline in multiple functional domains including perception, attention, short and long-term memory, reasoning, decision-making, as well as cognitive and motor control functions; all of which are significantly modulated by an individual's level of alertness. The control of alertness also significantly declines with age and contributes to increased lapses of attention in everyday life, ranging from minor memory slips to a lack of vigilance and increased risk of falls or motor-vehicle accidents. Several experimental behavioral therapies designed to remediate age-related cognitive decline have been developed, but differ widely in content, method and dose. Preliminary studies demonstrate that Tonic and Phasic Alertness Training (TAPAT) can improve executive functions in older adults and may be a useful adjunct treatment to enhance benefits gained in other clinically validated treatments. The purpose of the current trial (referred to as the Attention training for Learning Enhancement and Resilience Trial or ALERT) is to compare TAPAT to an active control training condition, include a larger sample of patients, and assess both cognitive and functional outcomes.

Methods/design: We will employ a multi-site, longitudinal, blinded randomized controlled trial (RCT) design with a target sample of 120 patients with age-related cognitive decline. Patients will be asked to complete 36 training sessions remotely (30 min/day, 5 days a week, over 3 months) of either the experimental TAPAT training program or an active control computer games condition. Patients will be assessed on a battery of cognitive and functional outcomes at four time points, including: a) immediately before training, b) halfway through training, c) within forty-eight hours post completion of total training, and d) after a three-month no-contact period post completion of total training, to assess the longevity of potential training effects.

Discussion: The strengths of this protocol are that it tests an innovative, in-home administered treatment that targets a fundamental deficit in adults with age-related cognitive decline; employs highly sensitive computer-based assessments of cognition as well as functional abilities, and incorporates a large sample size in an RCT design.

Trial Registration: ClinicalTrials.gov identifier: NCT02416401.
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http://dx.doi.org/10.1186/s40359-018-0233-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934832PMC
May 2018

Association vs dissociation and setting appropriate criteria for object agnosia.

Cogn Neuropsychol 2018 Feb - Mar;35(1-2):55-58

c Department of Psychiatry , Harvard Medical School, VA Boston Healthcare System , Boston , MA , USA.

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http://dx.doi.org/10.1080/02643294.2018.1431875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522223PMC
February 2019

Sensitivity to stimulus similarity is associated with greater sustained attention ability.

Atten Percept Psychophys 2018 08;80(6):1390-1408

Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA, 02130, USA.

Sustained attention is critical for tasks where perceptual information must be continuously processed, like reading or driving; however, the cognitive processes underlying sustained attention remain incompletely characterized. In the experiments that follow, we explore the relationship between sustaining attention and the contents and maintenance of task-relevant features in an attentional template. Specifically, we administered the gradual onset continuous performance task (gradCPT), a sensitive measure of sustained attention, to a large web-based sample (N>20,000) and a smaller laboratory sample for validation and extension. The gradCPT requires participants to respond to most stimuli (city scenes - 90 %) and withhold to rare target images (mountain scenes - 10 %). By using stimulus similarity to probe the representational content of task-relevant features-assuming either exemplar- or category-based feature matching-we predicted that RTs for city stimuli that were more "mountain-like" would be slower and "city-like" mountain stimuli would elicit more erroneous presses. We found that exemplar-based target-nontarget (T-N) similarity predicted both RTs and erroneous button presses, suggesting a stimulus-specific feature matching process was adopted. Importantly, individual differences in the degree of sensitivity to these similarity measures correlated with conventional measures of attentional ability on the gradCPT as well as another CPT that is perceptually less demanding. In other words, individuals with greater sustained attention ability (assessed by two tasks) were more likely to be influenced by stimulus similarity on the gradCPT. These results suggest that sustained attention facilitates the construction and maintenance of an attentional template that is optimal for a given task.
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http://dx.doi.org/10.3758/s13414-018-1504-0DOI Listing
August 2018

Tracking behavioral and neural fluctuations during sustained attention: A robust replication and extension.

Neuroimage 2018 05 4;171:148-164. Epub 2018 Jan 4.

Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA 02130, United States; Boston Attention & Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, United States; Geriatric Research, Education, & Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, United States.

Novel paradigms have allowed for more precise measurements of sustained attention ability and fluctuations in sustained attention over time, as well as the neural basis of fluctuations and lapses in performance. However, in recent years, concerns have arisen over the replicability of neuroimaging studies and psychology more broadly, particularly given the typically small sample sizes. One recently developed paradigm, the gradual-onset continuous performance task (gradCPT) has been validated behaviorally in large samples of participants. Yet neuroimaging studies investigating the neural basis of performance on this task have only been collected in small samples. The present study completed both a robust replication of the original neuroimaging findings and extended previous results from the gradCPT task using a large sample of 140 Veteran participants. Results replicate findings that fluctuations in attentional stability are tracked over time by BOLD activity in task positive (e.g., dorsal and ventral attention networks) and task negative (e.g., default network) regions. Extending prior results, we relate this coupling between attentional stability and on-going brain activity to overall sustained attention ability and demonstrate that this coupling strength, along with across-network coupling, could be used to predict individual differences in performance. Additionally, the results extend previous findings by demonstrating that temporal dynamics across the default and dorsal attention networks are associated with lapse-likelihood on subsequent trials. This study demonstrates the reliability of the gradCPT, and underscores the utility of this paradigm in understanding attentional fluctuations, as well as individual variation and deficits in sustained attention.
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http://dx.doi.org/10.1016/j.neuroimage.2018.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857436PMC
May 2018

Time-of-day variation in sustained attentional control.

Chronobiol Int 2017 16;34(7):993-1001. Epub 2017 Jun 16.

a Geriatric Research, Education and Clinical Center , Department of Veterans Affairs, Boston Healthcare System , Boston , MA , USA.

Sustained attention is a fundamental cognitive function underlying many activities in daily life including workplace safety, but its natural variation throughout the day is incompletely characterized. To examine time-of-day variation, we collected a large online data set (N = 6,363) with participation throughout the day and around the world on the gradual-onset continuous performance task, a sensitive measure of sustained attention. This allowed us to examine accuracy, attentional stability, and strategy. Results show that both accuracy and attentional stability peak between 9:00 and 11:00 a.m. and progressively decline throughout the day, whereas strategy is more stable.
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http://dx.doi.org/10.1080/07420528.2017.1308951DOI Listing
June 2018

Interpersonal early-life trauma alters amygdala connectivity and sustained attention performance.

Brain Behav 2017 05 10;7(5):e00684. Epub 2017 Apr 10.

Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston MA USA.

Introduction: Interpersonal early life trauma (I-ELT) is associated with a myriad of functional impairments in adulthood, increased risk of drug addiction, and neuropsychiatric disorders. While deficits in emotional regulation and amygdala functioning are well characterized, deficits in general cognitive functioning have also been documented. However, the neural underpinnings of cognitive dysfunction in adults with a history of I-ELT and the potential relationship between amygdala-based functional connectivity and behavioral performance are currently poorly understood. This study examined how I-ELT affects the cognitive and neural mechanisms supporting sustained attention.

Methods: A total of 66 Veterans (18 with and 48 without a history of I-ELT) completed a nonemotional sustained attention task during functional MRI.

Results: The individuals with I-ELT showed significant impairments in sustained attention (i.e., higher error rates, greater response variability). This cohort exhibited increased amygdala functional connectivity with the prefrontal cortex and decreased functional connectivity with the parahippocampal gyrus when compared to those without I-ELT. These connections were significantly correlated with individual differences in sustained attention performance. Notably, classification analyses revealed that the pattern of amygdala connectivity across the whole brain was able to classify I-ELT status with 70% accuracy.

Conclusion: These results provide evidence of a lasting negative impact for those with a history of I-ELT on sustained attention ability. They also highlight a critical role for amygdala functioning in cognitive control and sustained attention for those with a history of I-ELT, which may underlie the observed attention deficits in clinical assessments and cognitive tests involving both emotional and nonemotional stimuli.
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http://dx.doi.org/10.1002/brb3.684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434189PMC
May 2017

Network-targeted cerebellar transcranial magnetic stimulation improves attentional control.

Neuroimage 2017 08 8;156:190-198. Epub 2017 May 8.

Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, United States.

Developing non-invasive brain stimulation interventions to improve attentional control is extremely relevant to a variety of neurological and psychiatric populations, yet few studies have identified reliable biomarkers that can be readily modified to improve attentional control. One potential biomarker of attention is functional connectivity in the core cortical network supporting attention - the dorsal attention network (DAN). We used a network-targeted cerebellar transcranial magnetic stimulation (TMS) procedure, intended to enhance cortical functional connectivity in the DAN. Specifically, in healthy young adults we administered intermittent theta burst TMS (iTBS) to the midline cerebellar node of the DAN and, as a control, the right cerebellar node of the default mode network (DMN). These cerebellar targets were localized using individual resting-state fMRI scans. Participants completed assessments of both sustained (gradual onset continuous performance task, gradCPT) and transient attentional control (attentional blink) immediately before and after stimulation, in two sessions (cerebellar DAN and DMN). Following cerebellar DAN stimulation, participants had significantly fewer attentional lapses (lower commission error rates) on the gradCPT. In contrast, stimulation to the cerebellar DMN did not affect gradCPT performance. Further, in the DAN condition, individuals with worse baseline gradCPT performance showed the greatest enhancement in gradCPT performance. These results suggest that temporarily increasing functional connectivity in the DAN via network-targeted cerebellar stimulation can enhance sustained attention, particularly in those with poor baseline performance. With regard to transient attention, TMS stimulation improved attentional blink performance across both stimulation sites, suggesting increasing functional connectivity in both networks can enhance this aspect of attention. These findings have important implications for intervention applications of TMS and theoretical models of functional connectivity.
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http://dx.doi.org/10.1016/j.neuroimage.2017.05.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5973536PMC
August 2017
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