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

Gool, Jari K.; van der Werf, Ysbrand D.; Lammers, Gert Jan; Fronczek, Rolf · 2020 · Crossref

DOI: 10.3390/brainsci10070419

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Summary

This study investigates the neural mechanisms underlying vigilance deficits in individuals with narcolepsy type 1 (NT1), a condition characterized by excessive daytime sleepiness and impaired sustained attention. While behavioral deficits in NT1 are well-documented, the specific brain architecture regulating attention during high-demand tasks remains unclear. The researchers aimed to determine if a modified Sustained Attention to Response Task (SART) could be feasibly administered within an MRI environment to identify differences in brain activity between NT1 patients and healthy controls, particularly regarding vigilance regulation, time-on-task effects, and error processing. The study included 12 medication-free adults with NT1 and 11 matched healthy controls. Participants performed a modified SART consisting of baseline blocks and two difficulty levels (moderate and high), differentiated by stimulus duration (250 ms vs. 100 ms). Functional MRI data were acquired using a 3T scanner and analyzed using FSL software. The analysis focused on three main effects: overall task activation compared to baseline, time-on-task effects (changes in activation over repetitions and within blocks), and error-related activity. Behavioral metrics included error rates and reaction times. Behavioral results indicated that NT1 patients made significantly more errors than controls as task difficulty increased, although reaction times did not differ significantly. fMRI analysis revealed that both groups activated similar networks during the task, including the cingulo-opercular, frontoparietal, arousal, motor, and visual systems. However, during high-vigilance blocks, NT1 patients exhibited significantly lower activation in these regions compared to controls. Specifically, time-on-task analyses showed that while controls upregulated neural effort in attention- and arousal-related regions as blocks progressed, NT1 patients maintained stable, lower activation levels. This suggests an inability to sufficiently engage these networks when transitioning from attention initiation to stable attention under high demand. Additionally, NT1 patients showed reduced error-related activity in the left pre- and postcentral gyri, indicating impaired inhibitory motor control. The findings demonstrate that the modified SART is a feasible tool for probing vigilance regulation in NT1. The reduced cingulo-opercular and frontoparietal activity in patients, particularly during high-demand periods and in response to errors, highlights a specific deficit in the neural regulation of sustained attention and executive functioning. These results provide neurobiological evidence that vigilance complaints in NT1 are linked to insufficient recruitment of attentional networks rather than a complete absence of activation, offering insights into the cognitive impairments associated with hypocretin deficiency.

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• neuro workload indices