The Attention Network Test in Parkinson and Lewy Body Disease: A Systematic Review

Abstract

Background: The Attention Network Test (ANT) is a wellestablished measure of efficiency for the alerting, orienting, and executive attentional networks. However, its novel application in Parkinson disease (PD) and Lewy body dementia (LBD) research more broadly has yet to be evaluated systematically.Objective: To compare and consolidate the outcomes of studies reporting use of the ANT in PD and LBD groups and to identify the methodological considerations for the conduct of such studies.Method: We performed a systematic literature search for articles exploring attention in PD and LBD groups using the ANT. We excluded articles on the basis of irrelevant scope, non-English, and groups other than PD and LBD. Once the full text articles were identified, we extracted the data and assessed the studies' quality. Results:The final sample included 16 articles ranging from low to moderate quality. Behavioral findings suggested a general slowing of responses yet preserved accuracy from the PD group compared with controls. Overall, the evidence was inconclusive regarding the state of the alerting network in the PD and LBD groups, mostly supportive of an intact orienting network, and strongly suggestive of an impaired executive network. Differences in sample stratification, patient symptomatology, and dopaminergic medication levels were identified as influential factors in the attentional results across studies. Conclusion:Although sparse, the existing evidence indicates that the ANT is a viable option for measuring attention in PD; it can also be harnessed to explore the impact of symptoms and medications on attentional networks in PD and LBD groups.

Molecular signatures of attention networks

“…Furthermore, direct manipulations of the noradrenergic system by blocking the norepinephrine reuptake impact orienting attention but not alerting and control (Reynaud et al, 2019), while indirect measure of locus coeruleus activity suggest an involvement of norepinephrine in all three attention networks (Gabay et al, 2011; Geva et al, 2013). Only for dopamine, the evidence is more favorable, with clear demonstrations of increased dopamine release during task performance (Badgaiyan & Wack, 2011) and dissociating effects in patients with Parkinson's disease whose cardinal symptom is dopaminergic impairment (Yang et al, 2022). It needs to be noted, however, that many studies have used rather indirect approaches to the neuromodulators and that neuroimaging work has been able to detect neuromodulation at the brain level in the absence of behavioral effects (Ikeda et al, 2017; Thienel et al, 2009).…”

Attentional impairment and altered brain activity in healthcare workers after mild COVID-19

“…In contrast, the standardized Attention Network Test (ANT), a computer-based test designed by Fan et al, can quickly and effectively assess functional changes in three separate attentional networks (alerting, orienting, and executive control networks) (Fan et al, 2002 ). The ANT has been widely used in population studies of attention deficit hyperactivity disorder, Parkinson’s disease, schizophrenia, Alzheimer’s disease, and brain injury (Arora et al, 2020 ; Pultsina et al, 2022 ; Wang et al, 2023 ; Yang et al, 2022 ).…”

Molecular Signatures of Attention Networks

“…Furthermore, direct manipulations of the noradrenergic system by blocking the noradrenaline reuptake impact orienting attention but not alerting and control (Reynaud et al, 2019), while indirect measure of locus coeruleus activity suggest an involvement of noradrenaline in all three attention networks (Gabay et al, 2011;Geva et al, 2013). Only for dopamine, the evidence is more favorable, with clear demonstrations of increased dopamine release during task performance (Badgaiyan & Wack, 2011) and dissociating effects in patients with Parkinson's disease whose cardinal symptom is dopaminergic impairment (Yang et al, 2022). It needs to be noted, however, that many studies have used rather indirect approaches to the neuromodulators and that neuroimaging work has been able to detect neuromodulation at the brain level in the absence of behavioral effects (Ikeda et al, 2017;Thienel et al, 2009).…”