Sustained Attention in Mild Alzheimer's Disease

Abstract

The vigilance decrement in perceptual sensitivity was examined in 10 patients with mild Alzheimer's disease (AD) and 20 age-matched controls. A visual high-event rate digit-discrimination task lasting 7.2 min. (six 1.2 min blocks) was presented at different levels of stimulus degradation. Previous studies have shown that sensitivity decrements (d′) over time at high-stimulus degradation result from demands on effortful processing. For all degradation levels, the overall level of vigilance (d′) was lower in AD patients than in controls. All participants showed sensitivity decrement over blocks, with greater decrement at higher degradation levels. AD patients exhibited greater sensitivity decrement over time at the highest degradation level they all could perform relative to control participants. There were no concomitant changes in either response bias (C) or response times. The results indicate that mild AD patients have overall lower levels of vigilance under conditions that require both automatic and effortful processing. Mild AD patients also exhibit a deficit in the maintenance of vigilance over time under effortful processing conditions. Although the sample of AD patients was small, results further suggest that both possible and probable AD patients had greater sensitivity decrement over time at the highest degradation level than did control participants, but only probable AD patients had lower overall levels of vigilance. In the possible AD patients as a group, the decrement in vigilance occurred in the absence of concurrent deficits on standard attentional tasks, such as the Stroop and Trail Making tests, suggesting that deficits in vigilance over time may appear earlier than deficits in selective attention.Alzheimer's disease (AD) is a progressive, degenerative brain disorder, the most usual and early clinical manifestation of which is memory impairment (Baddeley, Della Sala, Logie, & Spinnler, 1986;Morris & Kopelman, 1986). Attentional functions, particularly selective and divided attention, are also affected early in the course of AD (Parasuraman & Haxby, 1993). Although sustained attention has been less extensively studied, this aspect of attention is worthy of further investigation in relation to dementia, for several reasons. First, clinical observations indicate that demented patients have difficulty concentrating and fatigue easily (Lezak, 1995). Altered sustained attention in AD patients may also contribute to their deficits in other cognitive functions. Furthermore, everyday activities such as safe driving (Ball, 1997;Duchek, Hunt, Ball, Buckles, & Morris, 1997Hunt, Morris, Edwards, & Wilson, 1993; and prevention of falls (Buchner & Larson, 1987) may depend on intact maintenance of attention.Several different experimental paradigms have been used to investigate sustained attention, including signal detection (Bushnell & Rice, 1999), serial reaction (Robbins, 1998), responseRequests for reprints should be sent to Anna Maria Berardi, Department of Psychology, University of Metz, Ile du Sau...

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