Which aspects of visual attention are changed by deafness? The case of the Attentional Network Test

The loss of one sensory modality can lead to a reorganization of the other intact sensory modalities. In the case of individuals who are born profoundly deaf, there is growing evidence of changes in visual functions. Specifically, deaf individuals demonstrate enhanced visual processing in the periphery, and in particular enhanced peripheral visual attention. To further characterize those aspects of visual attention that may be modified by deafness, deaf and hearing individuals were compared on the Attentional Network Test (ANT). The ANT was selected as it provides a measure of the efficiency of three neurally distinct subsystems of visual attention: alerting, orienting and executive control. The alerting measure refers to the efficiency with which a temporal cue is used to direct attention towards a target event, and the orienting measure is an indicator of the efficiency with which a spatial cue focuses attention upon that target's spatial location. The executive control measure, on the other hand, is an indicator of the amount of interference from peripheral flankers on processing that central target. In two separate experiments, deaf and hearing individuals displayed similar alerting and orienting abilities indicating comparable attention across populations. As predicted by enhanced peripheral attention, deaf subjects were found to have larger flanker interference effects than hearing subjects. These results indicate that not all aspects of visual attention are modified by early deafness, suggesting rather specific effects of cross-modal plasticity.     

Presentation modality influences behavioral measures of alerting, orienting, and executive control.

The Attention Network Test (ANT) uses visual stimuli to separately assess the attentional skills of alerting (improved performance following a warning cue), spatial orienting (an additional benefit when the warning cue also cues target location), and executive control (impaired performance when a target stimulus contains conflicting information). This study contrasted performance on auditory and visual versions of the ANT to determine whether the measures it obtains are influenced by presentation modality. Forty healthy volunteers completed both auditory and visual tests. Reaction-time measures of executive control were of a similar magnitude and significantly correlated, suggesting that executive control might be a supramodal resource. Measures of alerting were also comparable across tasks. In contrast, spatial-orienting benefits were obtained only in the visual task. Auditory spatial cues did not improve response times to auditory targets presented at the cued location. The different spatial-orienting measures could reflect either separate orienting resources for each perceptual modality, or an interaction between a supramodal orienting resource and modality-specific perceptual processing.     

Testing the efficiency and independence of attentional networks

In recent years, three attentional networks have been defined in anatomical and functional terms. These functions involve alerting, orienting, and executive attention. Reaction time measures can be used to quantify the processing efficiency within each of these three networks. The Attention Network Test (ANT) is designed to evaluate alerting, orienting, and executive attention within a single 30-min testing session that can be easily performed by children, patients, and monkeys. A study with 40 normal adult subjects indicates that the ANT produces reliable single subject estimates of alerting, orienting, and executive function, and further suggests that the efficiencies of these three networks are uncorrelated. There are, however, some interactions in which alerting and orienting can modulate the degree of interference from flankers. This procedure may prove to be convenient and useful in evaluating attentional abnormalities associated with cases of brain injury, stroke, schizophrenia, and attention-deficit disorder. The ANT may also serve as an activation task for neuroimaging studies and as a phenotype for the study of the influence of genes on attentional networks.     

Neural correlates of the attention network test in schizophrenia

Attentional deficits are prominent in schizophrenia, affecting nearly all cognitive functions. Human attention comprises three essential components: alerting, orienting and executive control. For the assessment of these functions, the attention network test (ANT) has been proposed and used in healthy controls and patients. In schizophrenia, the ANT has revealed behavioral deficits; however, the corresponding neural correlates have not been examined. In the present study, neural correlates of attention were investigated in 17 schizophrenia patients and 17 healthy controls using the ANT with fMRI. Behavioral deficits emerged in the alertness system with a reduced efficiency for temporal cues. In fMRI, changes were observed for all three domains-alerting, orienting and conflict-and revealed hyper- as well as hypoactivation in patients. Affected regions during alerting comprised a broad fronto-temporo-parieto-occipito-cerebellar network, while differences during orienting mainly tapped fronto-parietal regions and during conflict processing a thalamo-frontal-temporal occipital network including the postcentral regions. In general, hyperactivations were positively correlated with more severe psychopathologial symptoms.     

Inferior frontal white matter asymmetry correlates with executive control of attention

White matter (WM) asymmetries of the human brain have been well documented using diffusion tensor imaging (DTI). However, the relationship between WM asymmetry pattern and cognitive performance is poorly understood. By means of tract‐based spatial statistics (TBSS) and voxel‐based analyses of whole brain, this study examined the WM asymmetries and the correlations between WM integrity/asymmetries and three distinct components of attention, namely alerting, orienting, and executive control (EC), which were assessed by attention network test (ANT). We revealed a number of WM anisotropy asymmetries, including leftward asymmetry of cingulum, corticospinal tract and cerebral peduncle, rightward asymmetry of internal capsule, superior longitudinal fasciculus and posterior corona radiata, as well as heterogeneous asymmetries in anterior corpus callosum and anterior corona radiata (ACR). Moreover, specific correlation was found between asymmetric pattern of inferior frontal ACR and EC performance. Additionally, this study also proposed that there were no significant relationships of WM anisotropy asymmetries to alerting and orienting functions. Further clusters of interest analyses and probabilistic fiber tracking validated our findings. In conclusion, there are a number of differences in WM integrity between human brain hemispheres. Specially, the anisotropy asymmetry in inferior frontal ACR plays a crucial role in EC function. Our finding is supportive of the functional studies of inferior frontal regions and in keeping with the theory of the brain lateralization on human ventral attention system. Hum Brain Mapp, 2013. © 2011 Wiley Periodicals, Inc.     

The effect of fear on attentional processing in a sample of healthy females

The present experiment examines the effect of fear on efficiency of three attention networks: executive attention, orienting and alerting, in a healthy female sample. International Affective Picture System (IAPS) images were used to elicit both a fear response and a non-emotional response in 100 participants. During the emotion manipulation, participants performed a modified version of the Attention Network Test (ANT). Results showed enhanced executive attention in the fear condition compared to the control condition. Specifically, during a fear experience participants were better able to inhibit irrelevant information resulting in faster response times to a target. There was no effect of fear on orienting while the effect of fear on alerting was inconclusive. It is suggested that enhanced executive attention in fear-eliciting situations may function to focus attention on a potentially threat-related target, thus facilitating subsequent rapid responding.     

The neuropsychological profile of early and continuously treated phenylketonuria: orienting,vigilance, and maintenance versus manipulation-functions of working memory

In this paper, we review neuropsychological test results of early and continuously treated Phenylketonuria (PKU) patients. To increase insight into the neuropsychological profile of this population, we have attempted to place the results within an attentional network model [Images of the mind, 1994], which proposes interacting but dissociable attentional networks for orienting, vigilance, and executive control of attention. Executive control of attention is discussed against the background of the process-specific theory of working memory (WM) [Handbook of neuropsychology, 1994], which postulates a distinction between the 'maintenance'-function of WM and the 'manipulation and monitoring'-function.Neuropsychological results are presented for 67 early and continuously treated PKU patients and 73 controls aged 7-14 years. Four neuropsychological tasks were employed to measure orienting, mnemonic processing, interference suppression, and top-down control in visual search. No differences were found in orienting and the maintenance-function of WM. In addition to previously reported impairments in sustained attention/vigilance and inhibition of prepotent responding, PKU patients exhibited deficits when top-down control was required in a visual search task, but showed no impairment when interference suppression was required. It is discussed how the specific neuropsychological impairments in PKU may be a consequence of mid-dorsolateral prefrontal cortex (DLPFC) dysfunctioning due to deficiencies in catecholamine modulation.     

Development of attention networks in deaf children: Support for the integrative hypothesis

Early auditory deprivation is known to affect visual attention, yet the early effects of auditory deprivation on visual attention cannot be described simply as deficiencies or enhancements, because selected aspects of visual attention could be modified in various ways along the developmental trajectory. However, few studies have explored the development of these various aspects of visual attention in deaf children. In this paper we study the developmental trajectory of three aspects of visual attention (alerting, orienting and executive control attention networks) in a group of deaf children between 6 and 12 years of age. We used the attention network test to explore the development of the three attention networks and a child-friendly version of the cost–benefit paradigm to characterize the development of the basic operations of orienting. Our results showed a pattern of specific but varied outcomes with respect to the effects of auditory deprivation on these attention networks. First, auditory deprivation can impair development of the alerting network. Second, auditory deprivation can enhance two elementary operations of orienting: moving and engaging. Third, the executive control network showed a developmental trajectory that was neither deficient nor enhanced, but rather similar to that observed with hearing children. Taken together, these results are consistent with the integrative hypothesis of the effects of auditory deprivation on visual attention.     

Selective impairments of alerting and executive control in HIV-infected patients: evidence from attention network test

Background

Attention ability can be subdivided into three functionally independent networks, i.e., alerting network, orienting network, and executive network. Previous literature has documented that deficits in attention are a common consequence of HIV infection. However, the precise nature of deficits of attention in HIV-infected patients is poorly understood. Accordingly, the aim of the study was to identify whether the HIV-infected patients showed a specific attention network deficit or a general attentional impairment.

Methods

We investigated 27 HIV-infected patients and 31 normal controls with the Attention Network Test (ANT).

Results

The patients exhibited less efficient alerting network and executive network than controls. No significant difference was found in orienting network effect between groups. Our results also indicate a tendency for poorer efficiency on alerting attention and executive attention in patients with CD4 ≤ 200.

Conclusions

Our findings suggest that HIV-infected patients exhibited selective impairments of attention network of alerting and executive control. The link between lower CD4 T cell count and poorer attention network function imply the importance of starting antiretroviral therapy earlier to avoid irreversible neurocognitive impairment.

     

The effect of focused attention and open monitoring meditation on attention network function in healthy volunteers

Mindfulness meditation techniques are increasingly popular both as a life-style choice and therapeutic adjunct for a range of mental and physical health conditions. However, little is known about the mechanisms through which mindfulness meditation and its constituent practices might produce positive change in cognition and emotion. Our study directly compared the effects of Focused Attention (FA) and Open-Monitoring (OM) meditation on alerting, orienting and executive attention network function in healthy individuals. Participants were randomized to three intervention groups: open-focused meditation, focused attention, and relaxation control. Participants completed an emotional variant of the Attention Network Test (ANT) at baseline and post-intervention. OM and FA practice improved executive attention, with no change observed in the relaxation control group. Improvements in executive attention occurred in the absence of change in subjective/self-report mood and cognitive function. Baseline levels of dispositional/trait mindfulness were positively correlated with executive control in the ANT at baseline. Our results suggest that mindfulness meditation might usefully target deficits in executive attention that characterise mood and anxiety disorders.     

Measuring vigilance while assessing the functioning of the three attentional networks: the ANTI-Vigilance task

Vigilance could be a crucial aspect of attention that may modulate the functioning of the attentional system. Some behavioural tests, such as the Attention Network Test (ANT), have been developed to obtain an individual index of the three attentional networks (alertness, orientation, and executive control). However, alerting network measures are usually inferred using a phasic alertness task, and some indirect indexes of tonic alertness or vigilance have been proposed but not properly evaluated. The general aim for the present study is to provide the ANT with a direct measure of vigilance and then to analyse the relationship between this measure and other alternative indirect indexes. The obtained results suggest that the proposed new test (ANTI-Vigilance or ANTI-V) is useful to achieve a direct measure of vigilance and could be considered as a new tool available in cognitive, clinical or behavioural neurosciences for analysing vigilance in addition to the usual ANT scores. Other alternative indexes (such as global reaction time and global accuracy averaged across conditions) are only moderately correlated to a direct vigilance measure. As a consequence, although they may be to some extent related to the participants' vigilance level, they could not be used isolatedly as appropriate indexes of vigilance. Also, the role played by these global measures in the ANT task, which have been previously associated with some performance measures in applied areas (such as driving performance), is discussed.     

Attentional network deficits in children with autism spectrum disorder

Statement of purpose: Individuals with autism spectrum disorder (ASD) often demonstrate deficient attentional ability, but the specific nature of the deficit is unclear. The Attention Networks model provides a useful approach to deconstruct this attentional deficit into its component parts. Method: Fifty-two neurotypical (NT) children and 14 children with ASD performed the child version of the Attention Network Test (ANT). The latter requires participants to indicate the direction of a centre target stimulus, which is presented above/below fixation and sometimes flanked by either congruent or incongruent distractor stimuli. Results: Relative to NT children, those with ASD were: (1) slower to react to spatially cued trials and (2) more error prone on executive (conflict) attention trials. Conclusions: Young children with ASD have intact alerting attention, but less-efficient orienting and executive attention.     

Development of attentional networks in childhood

Recent research in attention has involved three networks of anatomical areas that carry out the functions of orienting, alerting and executive control (including conflict monitoring). There have been extensive cognitive and neuroimaging studies of these networks in adults. We developed an integrated Attention Network Test (ANT) to measure the efficiency of the three networks with adults. We have now adapted this test to study the development of these networks during childhood. The test is a child-friendly version of the flanker task with alerting and orienting cues. We studied the development of the attentional networks in a cross-sectional experiment with four age groups ranging from 6 through 9 (Experiment 1). In a second experiment, we compared children (age 10 years) and adult performance in both child and adults versions of the ANT. Reaction time and accuracy improved at each age interval and positive values were found for the average efficiency of each of the networks. Alertness showed evidence of change up to and beyond age 10, while conflict scores appear stable after age seven and orienting scores do not change in the age range studied. A final experiment with forty 7-year-old children suggested that children like adults showed independence between the three networks under some conditions.     

Deficits in attention performance are associated with insufficiency of slow-wave sleep in insomnia

ObjectiveCognitive impairment is associated with insomnia. However, there is a lack of evidence suggesting a link between insomnia and cognitive dysfunction in objective testing. The objectives of our current study were to assess the differences in components of attentional performance between primary insomnia patients and normal-sleeping controls and to examine potential predictors of attention impairment in patients with insomnia.MethodsWe studied 36 patients (age 40.39 ± 12.36 years; 57.1% male) with insomnia and 25 normal-sleeping controls (age 39.88 ± 12.50 years; 52.9% male) who underwent one-night polysomnography followed by Multiple Sleep Latency Test (MSLT) and Attention Network Task (ANT). ANT reflected three attentional networks termed the alerting, orienting, and executive control networks.ResultsAfter controlling for age, gender, body mass index, depression, anxiety, and education levels, patients with insomnia scored higher on the executive control variable of the ANT compared with normal-sleeping controls (96.75 ± 7.60 vs. 57.00 ± 10.49, p = 0.01). This higher score was independently associated with insufficiency of slow-wave sleep during nighttime sleep (β = −0.38, p = 0.04).ConclusionOur findings suggest that insomnia is associated with deficits in executive control of attention and that the underlying mechanism may be insufficiency of slow-wave sleep in chronic insomnia.     

The executive control of attention differentiates patients with schizophrenia, their first-degree relatives and healthy controls

Attentional and executive impairments have been reported in patients with schizophrenia and in their healthy first-degree relatives. However, its nature remains unclear and discrepancies between studies have been observed. These might be due to differences in the clinical severity of the illness or in sociodemographic factors. The objective of the present work was to explore the efficiency of three attention networks: alerting, orienting and executive control (conflict inhibition) defined anatomically, using patients, their relatives and controls, assessing the possibility to use them as endophenotypes. We used three tests, the Attention Network Test (ANT), the Wisconsin Card Sorting Test (WCST) and the Stroop Test, and compared 52 patients with schizophrenia, 55 of their first-degree relatives and 53 unrelated healthy controls, taking into account demographic variables (age, sex and years of education) and clinical symptoms of schizophrenia. Patients had a longer overall mean reaction-time (p < 0.001), and took longer to resolve the ANT conflict (ANTc) (p = 0.04) than the control group. In the schizophrenia group, the SSPI disorganization score was significantly correlated to the ANTc performance. Additionally, first-degree relatives of patients with schizophrenia also performed significantly worse than controls in attention performance test. Our findings support a specific deficit in executive control of attention in patients with schizophrenia. This deficit was shown to be correlated with the intensity of the disorganization score in patients. Relative presented an intermediate phenotype between patients and controls; the ANT reaction time (but not the ANTc) may thus be considered as possible endophenotype marker for schizophrenia.     

Neural correlates of attentional deficits in Parkinson's disease patients with mild cognitive impairment

IntroductionDeficits in attentional processing observed in Parkinson's disease (PD) patients with mild cognitive impairment (MCI) increase risk of PD dementia. However, the neural basis of these attentional deficits are presently unknown. The present study aimed to explore the neural correlates of attention dysfunction in PD-MCI using the Attention Network Test (ANT) and functional Magnetic Resonance Imaging (fMRI).MethodFifteen (15) PD-MCI patients, 26 PD patients without MCI (PD-NC) and 22 healthy controls (HC) were scanned (3T Siemens PRISMA) whilst performing the ANT. Reaction time, accuracy and fMRI BOLD activation were compared between groups for the three attentional task components of 1) alerting, 2) orienting, and 3) executive control.ResultsPD-MCI patients showed an overall slower reaction time compared to PD-NC and HC, and showed less interference of reaction time in the orienting effect than HC. fMRI data demonstrated greater activation in the bilateral cerebellum crus 1 during the alerting attention condition in both PD-MCI and PD-NC compared to HC. However, activation was supressed in the left postcentral gyrus in PD-MCI compared to PD-NC and HC.DiscussionAlterations in the alerting attention functional network despite intact task performance in PD-MCI suggests that functional brain changes may precede cognitive changes in the attention domain. Furthermore, increased activation in the cerebellum may reflect an attentional compensatory mechanism unique to the PD pathology. Taken together, the findings suggest that PD has a complex effect on attentional ability that can, at least in part, be elucidated using functional neuroimaging.     

Plasma neuropeptide Y: a biomarker for symptom severity in chronic fatigue syndrome

Background

Attention deficits belong to the main cognitive symptoms of schizophrenia and come along with altered neural activity in previously described cerebral networks. Given the high heritability of schizophrenia the question arises if impaired function of these networks is modulated by susceptibility genes and detectable in healthy risk allele carriers.

Methods

The present event-related fMRI study investigated the effect of the single nucleotide polymorphism (SNP) rs1018381 of the DTNBP1 (dystrobrevin-binding protein 1) gene on brain activity in 80 subjects while performing the attention network test (ANT). In this reaction time task three domains of attention are probed simultaneously: alerting, orienting and executive control of attention.

Results

Risk allele carriers showed impaired performance in the executive control condition associated with reduced neural activity in the left superior frontal gyrus [Brodmann area (BA) 9]. Risk allele carriers did not show alterations in the alerting and orienting networks.

Conclusions

BA 9 is a key region of schizophrenia pathology and belongs to a network that has been shown previously to be involved in impaired executive control mechanisms in schizophrenia. Our results identified the impact of DTNBP1 on the development of a specific attention deficit via modulation of a left prefrontal network.     

Adult ADHD and working memory: Neural evidence of impaired encoding

ObjectivesTo investigate neural and behavioural correlates of visual encoding during a working memory (WM) task in young adults with and without Attention-Deficit/Hyperactivity Disorder (ADHD).MethodsA sample of 30 college students currently meeting a diagnosis of ADHD and 25 typically developing students, matched on age and gender, performed a delayed match-to-sample task with low and high memory load conditions. Dense-array electroencephalography was recorded. Specifically, the P3, an event related potential (ERP) associated with WM, was examined because of its relation with attentional allocation during WM. Task performance (accuracy, reaction time) as well as performance on other neuropsychological tasks of WM was analyzed.ResultsNeural differences were found between the groups. Specifically, the P3 amplitude was smaller in the ADHD group compared to the comparison group for both load conditions at parietal–occipital sites. Lower scores on behavioural working memory tasks were suggestive of impaired behavioural WM performance in the ADHD group.ConclusionsFindings from this study provide the first evidence of neural differences in the encoding stage of WM in young adults with ADHD, suggesting ineffective allocation of attentional resources involved in encoding of information in WM.SignificanceThese findings, reflecting alternate neural functioning of WM, may explain some of the difficulties related to WM functioning that college students with ADHD report in their every day cognitive functioning.     

Common and specific impairments in attention functioning in girls with chromosome 22q11.2 deletion,fragile X or Turner syndromes

Background

Chromosome 22q11.2 deletion syndrome (22q11.2DS), fragile X syndrome (FXS), and Turner syndrome (TS) are complex and variable developmental syndromes caused by different genetic abnormalities; yet, they share similar cognitive impairments in the domains of numbers, space, and time. The atypical development of foundational neural networks that underpin the attentional system is thought to result in further impairments in higher-order cognitive functions. The current study investigates whether children with similar higher-order cognitive impairments but different genetic disorders also show similar impairments in alerting, orienting, and executive control of attention.

Methods

Girls with 22q11.2DS, FXS, or TS and typically developing (TD) girls, aged 7 to 15 years, completed an attention network test, a flanker task with alerting and orienting cues. Exploration of reaction times and accuracy allowed us to test for potential commonalities in attentional functioning in alerting, orienting, and executive control. Linear regression models were used to test whether the predictors of group and chronological age were able to predict differences in attention indices.

Results

Girls with 22q11.2DS, FXS, or TS demonstrated unimpaired function of the alerting system and impaired function of the executive control system. Diagnosis-specific impairments were found such that girls with FXS made more errors and had a reduced orienting index, while girls with 22q11.2DS showed specific age-related deficits in the executive control system.

Conclusions

These results suggest that the control but not the implementation of attention is selectively impaired in girls with 22q11.2DS, TS or FXS. Additionally, the age effect on executive control in girls with 22q11.2DS implies a possible altered developmental trajectory.     

Impaired executive control of emotional information in social anhedonia

We examined the executive control of emotional information and its relationship to social functioning in individuals at risk for schizophrenia, defined by high social anhedonia (SA). Using the same structure as the Attentional Network Test (ANT), we developed a measure of executive control of emotional information (ANT-Emotion) in which subjects identify the direction of an arrow flanked by irrelevant angry or neutral faces. Subjects completed the ANT, ANT-Emotion, and the Social Adjustment Scale, Self-Report (SAS-SR), a measure of social functioning. While there were no group differences in the alerting, orienting, and executive control networks assessed by the ANT, high SA individuals exhibited a specific impairment in the executive control of emotional information. High SA individuals also reported poorer social functioning. However, executive control of emotional information did not mediate the relationship between SA and social functioning. These findings indicate that, in high-risk populations, the impaired ability to inhibit emotional information allows negative affective stimuli to exert inappropriate influence on cognitive processes. These results are consistent with studies indicating similar findings in schizophrenia patients, suggesting that impaired inhibition of negative emotion may be part of the liability for the disorder.