Recent theoretical, neural, and clinical advances in sustained attention research

Fortenbaugh, Francesca C.; DeGutis, Joseph; Esterman, Michael · 2017 · Crossref

DOI: 10.1111/nyas.13318

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Summary

This review synthesizes recent theoretical, neural, and clinical advances in sustained attention research, addressing the challenge of maintaining focused attention over extended periods. While classic models distinguish sustained attention from orienting and switching, its neurophysiological basis has historically received less attention despite its critical role in daily functioning and its deficits in clinical populations. The authors aim to bridge behavioral, neuroimaging, and patient-oriented research by examining four key questions: why sustained attention is challenging, how it fluctuates, the underlying neural networks, and its implications for clinical deficits. The paper evaluates competing theoretical models of the vigilance decrement, the decline in performance over time. Traditional resource depletion (overload) and mindlessness (underload) accounts are critiqued for failing to explain all behavioral findings. Instead, the review highlights two newer frameworks: the opportunity-cost model, which posits that limited cognitive resources are allocated based on subjective value and motivation rather than diminishing capacity, and the resource-control theory, which suggests a continuous bias toward mind-wandering that executive control must actively suppress. Evidence from reward manipulation studies supports these models, showing that maintaining high task value can eliminate vigilance decrements, whereas traditional incremental rewards cannot. Pupillometry data further links these fluctuations to locus coeruleus activity and motivational states. Methodologically, the review emphasizes the shift from classic vigilance tasks to novel paradigms like the Gradual-Onset Continuous Performance Task (gradCPT). This paradigm removes exogenous cues to isolate endogenous attentional fluctuations, allowing for the calculation of a Variance Time Course (VTC). The VTC provides a trial-by-trial measure of reaction time variability, distinguishing periods of high stability ("in the zone") from instability ("out of the zone"). These behavioral metrics are linked to neural dynamics, revealing that sustained attention relies on distributed networks rather than isolated regions. Neuroimaging findings indicate that sustained attention involves a "vigilant attention network" spanning the frontoparietal, salience, and executive control systems. Crucially, the Default Mode Network (DMN), previously considered task-negative, is reconceptualized as playing a complex role in attentional fluctuations. The resource-control theory predicts an inverse relationship between executive attention networks and the DMN, which recent studies support. Fluctuations in sustained attention are associated with dynamic interactions between these networks, where failures in executive control allow attention to shift toward internal thoughts or external distractors. These advances provide potential biomarkers for diagnosing sustained attention deficits and inform the development of theoretically driven treatments for clinical populations.

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• sustained attention vigilance
• vigilance
• inattentional change blindness
• attention selective divided
• neuro workload indices
• attention

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• Theoretical Contribution: theory or model