Preparatory neural networks are impaired in adults with attention-deficit/hyperactivity disorder during the antisaccade task

Neuro-ophthalmologic and blood biomarker responses in ADHD following subconcussive head impacts: a case-control trial

Introduction

This clinical trial aimed to determine the influence of attention-deficit/hyperactivity disorder (ADHD) on neuro-ophthalmologic function and brain-derived blood biomarkers following acute subconcussive head impacts.

Methods

The present trial consisted of age- and sex-matched samples with a ratio of 1:1 between two groups with a total sample size of 60 adults (age ± SD; 20.0 ± 1.8 years). Soccer players diagnosed with and medicated daily for ADHD were assigned into an ADHD group (n = 30). Soccer players without ADHD were assigned into a non-ADHD group (n = 30). Participants performed 10 soccer headers with a soccer ball projected at a velocity of 25mph. King-Devick test (KDT), near point of convergence (NPC), and serum levels of NF-L, tau, GFAP, and UCH-L1 were assessed at baseline (pre-heading) and at 2 h and 24 h post-heading.

Results

There were no statistically significant group-by-time interactions in outcome measures. However, at baseline, the ADHD group exhibited lower neuro-ophthalmologic functions compared to the non-ADHD group (NPC: p = 0.019; KDT: p = 0.018), and persisted at 2 h-post (NPC: p = 0.007; KDT: p = 0.014) and 24 h-post heading (NPC: p = 0.001). NPC significantly worsened over time in both groups compared to baseline [ADHD: 2 h-post, 1.23 cm, 95%CI:(0.77, 1.69), p < 0.001; 24 h-post, 1.68 cm, 95%CI:(1.22, 2.13), p = 0.001; Non-ADHD: 2 h-post, 0.96 cm, 95%CI:(0.50, 1.42), p < 0.001; 24 h-post, 1.09 cm, 95%CI:(0.63, 1.55), p < 0.001]. Conversely, improvements in KDT time compared to baseline occurred at 2 h-post in the non-ADHD group [-1.32 s, 95%CI:(-2.55, -0.09), p = 0.04] and at 24 h-post in both groups [ADHD: -4.66 s, 95%CI:(-5.89, -3.43), p < 0.001; Non-ADHD: -3.46 s, 95%CI:(-4.69, -2.23), p < 0.001)]. There were no group-by-time interactions for GFAP as both groups exhibited increased levels at 2 h-post [ADHD: 7.75 pg./mL, 95%CI:(1.41, 14.10), p = 0.019; Non-ADHD: 7.91 pg./mL, 95%CI:(1.71, 14.14), p = 0.015)] that returned to baseline at 24 h-post. NF-L levels increased at 2 h-post heading in the ADHD group [0.45 pg./mL, 95%CI:(0.05, 0.86), p = 0.032], but no significant NF-L changes were observed in the non-ADHD group over time.

Discussion

Ten soccer headers elevated GFAP levels and NPC impairment in both groups. However, persisting group difference in NPC, blunted KDT performance, and increased NF-L levels in the ADHD group suggest that ADHD may reduce neuro-ophthalmologic function and heighten axonal response to soccer headers.

Clinical trial registration

ClinicalTrials.gov, identifier ID: (NCT04880304).

Motor synchronization and impulsivity in pediatric borderline personality disorder with and without attention-deficit hyperactivity disorder: an eye-tracking study of saccade, blink and pupil behavior

Shifting motor actions from reflexively reacting to an environmental stimulus to predicting it allows for smooth synchronization of behavior with the outside world. This shift relies on the identification of patterns within the stimulus - knowing when a stimulus is predictable and when it is not - and launching motor actions accordingly. Failure to identify predictable stimuli results in movement delays whereas failure to recognize unpredictable stimuli results in early movements with incomplete information that can result in errors. Here we used a metronome task, combined with video-based eye-tracking, to quantify temporal predictive learning and performance to regularly paced visual targets at 5 different interstimulus intervals (ISIs). We compared these results to the random task where the timing of the target was randomized at each target step. We completed these tasks in female pediatric psychiatry patients (age range: 11-18 years) with borderline personality disorder (BPD) symptoms, with (n = 22) and without (n = 23) a comorbid attention-deficit hyperactivity disorder (ADHD) diagnosis, against controls (n = 35). Compared to controls, BPD and ADHD/BPD cohorts showed no differences in their predictive saccade performance to metronome targets, however, when targets were random ADHD/BPD participants made significantly more anticipatory saccades (i.e., guesses of target arrival). The ADHD/BPD group also significantly increased their blink rate and pupil size when initiating movements to predictable versus unpredictable targets, likely a reflection of increased neural effort for motor synchronization. BPD and ADHD/BPD groups showed increased sympathetic tone evidenced by larger pupil sizes than controls. Together, these results support normal temporal motor prediction in BPD with and without ADHD, reduced response inhibition in BPD with comorbid ADHD, and increased pupil sizes in BPD patients. Further these results emphasize the importance of controlling for comorbid ADHD when querying BPD pathology.

The Eyes Have It: A Meta-analysis of Oculomotor Inhibition in Attention-Deficit/Hyperactivity Disorder

BACKGROUND

Diminished inhibitory control is one of the main characteristics of attention-deficit/hyperactivity disorder (ADHD), and impairments in oculomotor inhibition have been proposed as a potential biomarker of the disorder. The present meta-analysis summarizes the effects reported in studies comparing oculomotor inhibition in ADHD patients and healthy control subjects.

METHODS

Inhibitory outcomes were derived from oculomotor experimental paradigms including the antisaccade (AS), memory-guided saccade, and prolonged fixation tasks. Temporal and spatial measures were also extracted from these tasks and from visually guided saccade tasks as secondary outcomes. Data were available from k = 31 studies (N = 1567 participants). Summary effect sizes were computed using random-effects models and a restricted maximum-likelihood estimator.

RESULTS

Among inhibitory outcomes, direction errors in AS, after correcting for publication bias, showed a moderate effect and large between-study heterogeneity (k = 18, n = 739, g = 0.57, 95% confidence interval [CI] [0.27, 0.88], I²= 74%); anticipatory saccades in memory-guided saccade showed a large effect and low heterogeneity (k = 11, n = 487; g = 0.86, 95% CI [0.64, 1.08], I² = 17.7%); and saccades during prolonged fixation evidenced large effect size and heterogeneity (k = 6, n = 325 g = 1.11, 95% CI [0.56, 1.65], I² = 79.1%) partially related to age. Among secondary outcomes, saccadic reaction time in AS (k = 22, n = 932, g = 0.34, 95% CI [0.06, 0.63], I² = 53.12%) and coefficient of variability in visually guided saccade (k = 5, n = 282, g = 0.53, 95% CI [0.28, 0.78], I² = 0.01%) indicated significant effects with small to moderate effects sizes.

CONCLUSIONS

ADHD groups commit more oculomotor inhibition failures than control groups. The substantial effects support the conclusion that oculomotor disinhibition is a relevant ADHD-related mechanism. Moderate effects observed in saccadic reaction time variability suggest that fluctuant performance in oculomotor tasks is another relevant characteristic of ADHD.

Interleaved Pro/Anti-saccade Behavior Across the Lifespan

The capacity for inhibitory control is an important cognitive process that undergoes dynamic changes over the course of the lifespan. Robust characterization of this trajectory, considering age continuously and using flexible modeling techniques, is critical to advance our understanding of the neural mechanisms that differ in healthy aging and neurological disease. The interleaved pro/anti-saccade task (IPAST), in which pro- and anti-saccade trials are randomly interleaved within a block, provides a simple and sensitive means of assessing the neural circuitry underlying inhibitory control. We utilized IPAST data collected from a large cross-sectional cohort of normative participants (n = 604, 5–93 years of age), standardized pre-processing protocols, generalized additive modeling, and change point analysis to investigate the effect of age on saccade behavior and identify significant periods of change throughout the lifespan. Maturation of IPAST measures occurred throughout adolescence, while subsequent decline began as early as the mid-20s and continued into old age. Considering pro-saccade correct responses and anti-saccade direction errors made at express (short) and regular (long) latencies was crucial in differentiating developmental and aging processes. We additionally characterized the effect of age on voluntary override time, a novel measure describing the time at which voluntary processes begin to overcome automated processes on anti-saccade trials. Drawing on converging animal neurophysiology, human neuroimaging, and computational modeling literature, we propose potential frontal-parietal and frontal-striatal mechanisms that may mediate the behavioral changes revealed in our analysis. We liken the models presented here to “cognitive growth curves” which have important implications for improved detection of neurological disease states that emerge during vulnerable windows of developing and aging.

Purkinje Cell Activity in the Medial and Lateral Cerebellum During Suppression of Voluntary Eye Movements in Rhesus Macaques

Volitional suppression of responses to distracting external stimuli enables us to achieve our goals. This volitional inhibition of a specific behavior is supposed to be mainly mediated by the cerebral cortex. However, recent evidence supports the involvement of the cerebellum in this process. It is currently not known whether different parts of the cerebellar cortex play differential or synergistic roles in the planning and execution of this behavior. Here, we measured Purkinje cell (PC) responses in the medial and lateral cerebellum in two rhesus macaques during pro- and anti-saccade tasks. During an antisaccade trial, non-human primates (NHPs) were instructed to make a saccadic eye movement away from a target, rather than toward it, as in prosaccade trials. Our data show that the cerebellum plays an important role not only during the execution of the saccades but also during the volitional inhibition of eye movements toward the target. Simple spike (SS) modulation during the instruction and execution periods of pro- and anti-saccades was prominent in PCs of both the medial and lateral cerebellum. However, only the SS activity in the lateral cerebellar cortex contained information about stimulus identity and showed a strong reciprocal interaction with complex spikes (CSs). Moreover, the SS activity of different PC groups modulated bidirectionally in both of regions, but the PCs that showed facilitating and suppressive activity were predominantly associated with instruction and execution, respectively. These findings show that different cerebellar regions and PC groups contribute to goal-directed behavior and volitional inhibition, but with different propensities, highlighting the rich repertoire of the cerebellar control in executive functions.

Sensory processing sensitivity predicts performance in an emotional antisaccade paradigm

Sensory Processing Sensitivity (SPS) is a common, heritable, and evolutionarily conserved trait, describing inter-individual differences in responsiveness and a more cautious approach to novel stimuli. It is associated with increased activation of brain regions involved in awareness, integration of sensory information, and empathy during processing of emotional faces. Furthermore, SPS is related to better performance in a visual detection task. Even though SPS is conceptualized to be closely related to traits characterized by pausing before acting, no study to date has assessed the relation between SPS and inhibitory control in a behavioral inhibition task. The present study fills this gap by investigating how SPS influences individual performance on two different antisaccade paradigms including emotional face stimuli. In addition, we assessed self-reported mood, anxiety, and depressiveness. Results showed that SPS was related to faster processing speed on the emotional, but not the classic antisaccade paradigm. Moreover, SPS predicted inhibitory control speed above mood and depressiveness. Our results provide evidence that higher SPS participants show superior inhibitory abilities, especially during the processing of emotional stimuli. This is in line with earlier findings showing better performance in a visual detection task as well as increased brain activation during emotional face processing.

First‐Dose Methylphenidate‐Induced Changes in the Anti‐Saccade Task Performance and Outcome in Adults with Attention‐Deficit/Hyperactivity Disorder

Objective

We examined whether the anti‐saccade task (AST) performance after the first methylphenidate (MPH) dose could be associated with subsequent clinical outcome in adults with attention‐deficit/hyperactivity disorder (ADHD).

Methods

Ninety‐seven drug‐naive DSM‐5 ADHD adults participated in this study. The AST parameters were measured at baseline, after the first MPH‐dose (10 mg orally), and 6 months after chronic MPH treatment. Results were compared with those of 50 healthy control (HC) subjects.

Results

At baseline, ADHDs showed longer saccadic reaction times and more direction errors than HCs (both p < 0.00001). Acute and chronic MPH administration resulted in normalization of the AST performances. Multivariate regression analysis after adjusting for age, sex, weight, and severity of symptoms at baseline, revealed that a low percentage of direction errors after the first MPH‐dose (i.e., ≤10%) could predict remission at month 6 (OR: 5.84; 95% CI: 2.00–17.11; p = 0.001).

Conclusions

Our findings indicate that: (1) impairments of motor planning and response inhibition in adults with ADHD are improved with MPH, and (2) a low direction error percentage after the first MPH‐dose may be an independent predictor of remission.

ClinicalTrials.gov identifier: NCT03411434

The antisaccade task (AST) is useful to reveal impairments in inhibitory control in ADHD.

Never‐medicated adult ADHD subjects show delays in reaction times and increased direction errors.

Methyphenidate (MPH) administration, either acute or chronic, normalizes AST performances.

Direction error percentages after the first MPH‐dose could predict treatment outcome.

Oculomotor deficits in attention deficit hyperactivity disorder (ADHD): A systematic review and comprehensive meta-analysis

Atypical motor coordination and cognitive processes, such as response inhibition and working memory, have been extensively researched in individuals with attention deficit hyperactivity disorder (ADHD). Oculomotor neural circuits overlap extensively with regions involved in motor planning and cognition, therefore studies of oculomotor function may offer unique insights into motor and cognitive control in ADHD. We performed a series of pairwise meta-analyses based on data from 26 oculomotor studies in ADHD to examine whether there were differences in performance on visually-guided saccade, gap, antisaccade, memory-guided, pursuit eye movements and fixation tasks. These analyses revealed oculomotor disturbances in ADHD, particularly for difficulties relating to saccade inhibition, memorizing visual target locations and initiating antisaccades. There was no evidence for pursuit eye movement disturbances or saccade dysmetria. Investigating oculomotor abnormalities in ADHD may provide insight into top-down cognitive control processes and motor control, and may serve as a promising biomarker in ADHD research and clinical practice.

Objective and Subjective Evaluation of Saccadic Eye Movements in Healthy Children and Children with Neurodevelopmental Disorders: A Pilot Study

The objective of this study was to characterize saccades in children with neurodevelopmental disorders (NDDG, 17 children, age: 7-12 years) and compare them with a control group (CG, 15 children, age: 7-12 years), comparing the outcomes obtained with a subjective score system (Northeastern State University College of Optometry's Oculomotor test, NSUCO) with the objective analysis obtained through a commercially available Eye Tracker (Tobii Eye X, Tobii, Stockholm, Sweden) and a specialized software analysis (Thomson Software Solutions, Welham Green, UK). Children from the NDDG obtained significantly lower NSUCO scores (p < 0.001) compared with CG. Concerning eye tracking analyses, we found a significantly higher number of hypometric saccades in NDGG (p ≤ 0.044). Likewise, we found a significantly higher percentage of regressions in the NDDG for a time interval of presentation of stimuli of 1 s (p = 0.012). Significant correlations were found between different NSUCO scores and percentage of regressions, number of saccades completed and number of hypometric saccades. The presence of hypometric saccades and regressions seems to be a differential characteristic sign of children with neurodevelopmental disorders that can be detected using an objective eye tracking analysis, but also using the subjective test NSUCO that can be easily implemented in all clinical settings.

Testing the attention-distractibility trait

Forster and Lavie (Journal of Experimental Psychology: Learning, Memory, and Cognition, 40[1], 251-260, 2014; Psychological Science, 27[2], 203-212, 2016) found that task-irrelevant distraction correlated positively with a measure of mind-wandering and a report of attention-deficit/hyperactivity disorder (ADHD) symptomology. Based primarily on these results, Forster and Lavie claimed to establish an attention-distractibility trait. Here, I tested whether these associations could be distinguished from associations with working memory capacity and task-relevant distraction (measured with an antisaccade task). With data collected from 226 subjects (ns differ among analyses), the results from the current study suggest that the measures of task-irrelevant distraction and working memory capacity were not (or only very weakly) associated with measures of mind wandering (measured both with a stand-alone questionnaire and in-task thought probes) and ADHD symptomology. Task-relevant interference (i.e., antisaccade accuracy) was associated with mind-wandering reports from in-task thought probes (presented in a separate task), but not the stand-alone mind wandering questionnaire or ADHD symptomology. Additionally, the measure of irrelevant-distraction exhibited low internal consistency suggesting that (as measured) it may not be a suitable individual difference measure. [Preregistration, data, analysis scripts and output are available via the Open Science Framework: https://osf.io/bhs24/ ].

Diagnosis of oculomotor anomalies in children with learning disorders

This systematic review presents the existing scientific evidence for oculomotor anomalies in children with three different types of learning disorders - namely, dyslexia, dyspraxia and attention deficit-hyperactivity disorder (ADHD). This review was registered in the PROSPERO database (registration number: 139317). The QUADAS-2 tool was used to systematically evaluate the quality of the diagnostic tests used in the evaluated studies and to confirm whether the oculomotor alterations observed in the different groups of children with various learning disorders had a consistent diagnostic basis. Using this tool, the design of the articles was well elaborated, although concerns exist regarding the selection of patients and the diagnostic criteria for the binocular conditions. All the studies reviewed conclude that a pattern of oculomotor anomalies exist in the groups of children with these three types of learning disorders compared to healthy children. However, there is a concern regarding the diagnostic methodology, as no clear range of normality for the parameters used to characterise ocular motility was identified and no gold standard or reference test has been defined. In future studies, this range of normality must be developed for different oculomotor skills, and a reference test (possibly video-oculography) for the measurement of these skills must be established.

Aging and eye tracking: in the quest for objective biomarkers

Recent applications of eye tracking for diagnosis, prognosis and follow-up of therapy in age-related neurological or psychological deficits have been reviewed. The review is focused on active aging, neurodegeneration and cognitive impairments. The potential impacts and current limitations of using characterizing features of eye movements and pupillary responses (oculometrics) as objective biomarkers in the context of aging are discussed. A closer look into the findings, especially with respect to cognitive impairments, suggests that eye tracking is an invaluable technique to study hidden aspects of aging that have not been revealed using any other noninvasive tool. Future research should involve a wider variety of oculometrics, in addition to saccadic metrics and pupillary responses, including nonlinear and combinatorial features as well as blink- and fixation-related metrics to develop biomarkers to trace age-related irregularities associated with cognitive and neural deficits.

Dorsolateral prefrontal cortex hyperactivity during inhibitory control in children with ADHD in the antisaccade task

Children with ADHD show significant deficits in response inhibition. A leading hypothesis suggests prefrontal hypoactivation as a possible cause, though, there is conflicting evidence. We tested the hypoactivation hypothesis by analyzing the response inhibition process within the oculomotor system. Twenty-two children diagnosed with ADHD and twenty control (CTRL) children performed the antisaccade task while undergoing an fMRI study with concurrent eye tracking. This task included a preparatory stage that cued a prosaccade (toward a stimuli) or an antisaccade (away from a stimuli) without an actual presentation of a peripheral target. This allowed testing inhibitory control without the confounding activation from an actual response. The ADHD group showed longer reaction times and more antisaccade direction errors. While both groups showed activations in saccade network areas, the ADHD showed significant hyperactivation in the dorsolateral prefrontal cortex during the preparatory stage. No other areas in the saccade network had significant activation differences between groups. Further ADHD group analysis OFF and ON stimulant medication did not show drug-related activation differences. However, they showed a significant correlation between the difference in OFF/ON preparatory activation in the precuneus, and a decrease in the number of antisaccade errors. These results do not support the hypoactivity hypothesis as an inhibitory control deficit general explanation, but instead suggest less efficiency during the inhibitory period of the antisaccade task in children. Our findings contrast with previous results in ADHD adults showing decreased preparatory antisaccade activity, suggesting a significant age-dependent maturation effect associated to the inhibitory response in the oculomotor system.

Voluntary and involuntary contributions to perceptually guided saccadic choices resolved with millisecond precision

In the antisaccade task, which is considered a sensitive assay of cognitive function, a salient visual cue appears and the participant must look away from it. This requires sensory, motor-planning, and cognitive neural mechanisms, but what are their unique contributions to performance, and when exactly are they engaged? Here, by manipulating task urgency, we generate a psychophysical curve that tracks the evolution of the saccadic choice process with millisecond precision, and resolve the distinct contributions of reflexive (exogenous) and voluntary (endogenous) perceptual mechanisms to antisaccade performance over time. Both progress extremely rapidly, the former driving the eyes toward the cue early on (∼100 ms after cue onset) and the latter directing them away from the cue ∼40 ms later. The behavioral and modeling results provide a detailed, dynamical characterization of attentional and oculomotor capture that is not only qualitatively consistent across participants, but also indicative of their individual perceptual capacities.

To look or not to look? Reward, selection history, and oculomotor guidance

The current eye-tracking study examined the influence of reward on oculomotor performance, and the extent to which learned stimulus-reward associations interacted with voluntary oculomotor control with a modified paradigm based on the classical antisaccade task. Participants were shown two equally salient stimuli simultaneously: a gray and a colored circle, and they were instructed to make a fast saccade to one of them. During the first phase of the experiment, participants made a fast saccade toward the colored stimulus, and their performance determined a (cash) bonus. During the second, participants made a saccade toward the gray stimulus, with no rewards available. On each trial, one of three colors was presented, each associated with high, low or no reward during the first phase. Results from the first phase showed improved accuracy and shorter saccade latencies on high-reward trials, while those from the second replicated well-known effects typical of the antisaccade task, namely, decreased accuracy and increased latency during phase II, even despite the absence of abrupt asymmetric onsets. Crucially, performance differences between phases revealed longer latencies and less accurate saccades during the second phase for high-reward trials, compared with the low- and no-reward trials. Further analyses indicated that oculomotor capture by reward signals is mainly found for saccades with short latencies, while this automatic capture can be overridden through voluntary control with longer ones. These results highlight the natural flexibility and adaptability of the attentional system, and the role of reward in modulating this plasticity. NEW & NOTEWORTHY Typically, in the antisaccade task, participants need to suppress an automatic orienting reflex toward a suddenly appearing peripheral stimulus. Here, we introduce an alternative antisaccade task without such abrupt onsets. We replicate well-known antisaccade effects (more errors and longer latencies), demonstrating the role of reward in developing selective oculomotor biases. Results highlight how reward and selection history facilitate developing automatic biases from goal-driven behavior, and they suggest that this process responds to individual differences in impulsivity.

Corrective response times in a coordinated eye-head-arm countermanding task

Inhibition of motor responses has been described as a race between two competing decision processes of motor initiation and inhibition, which manifest as the reaction time (RT) and the stop signal reaction time (SSRT); in the case where motor initiation wins out over inhibition, an erroneous movement occurs that usually needs to be corrected, leading to corrective response times (CRTs). Here we used a combined eye-head-arm movement countermanding task to investigate the mechanisms governing multiple effector coordination and the timing of corrective responses. We found a high degree of correlation between effector response times for RT, SSRT, and CRT, suggesting that decision processes are strongly dependent across effectors. To gain further insight into the mechanisms underlying CRTs, we tested multiple models to describe the distribution of RTs, SSRTs, and CRTs. The best-ranked model (according to 3 information criteria) extends the LATER race model governing RTs and SSRTs, whereby a second motor initiation process triggers the corrective response (CRT) only after the inhibition process completes in an expedited fashion. Our model suggests that the neural processing underpinning a failed decision has a residual effect on subsequent actions. NEW & NOTEWORTHY Failure to inhibit erroneous movements typically results in corrective movements. For coordinated eye-head-hand movements we show that corrective movements are only initiated after the erroneous movement cancellation signal has reached a decision threshold in an accelerated fashion.

Using an emotional saccade task to characterize executive functioning and emotion processing in attention-deficit hyperactivity disorder and bipolar disorder

Despite distinct diagnostic criteria, attention-deficit hyperactivity disorder (ADHD) and bipolar disorder (BD) share cognitive and emotion processing deficits that complicate diagnoses. The goal of this study was to use an emotional saccade task to characterize executive functioning and emotion processing in adult ADHD and BD. Participants (21 control, 20 ADHD, 20 BD) performed an interleaved pro/antisaccade task (look toward vs. look away from a visual target, respectively) in which the sex of emotional face stimuli acted as the cue to perform either the pro- or antisaccade. Both patient groups made more direction (erroneous prosaccades on antisaccade trials) and anticipatory (saccades made before cue processing) errors than controls. Controls exhibited lower microsaccade rates preceding correct anti- vs. prosaccade initiation, but this task-related modulation was absent in both patient groups. Regarding emotion processing, the ADHD group performed worse than controls on neutral face trials, while the BD group performed worse than controls on trials presenting faces of all valence. These findings support the role of fronto-striatal circuitry in mediating response inhibition deficits in both ADHD and BD, and suggest that such deficits are exacerbated in BD during emotion processing, presumably via dysregulated limbic system circuitry involving the anterior cingulate and orbitofrontal cortex.

Sensorimotor and executive function slowing in anesthesiology residents after overnight shifts

STUDY OBJECTIVE

Medical residents working overnight call shifts experience sleep deprivation and circadian clock disruption. This leads to deficits in sensorimotor function and increases in workplace accidents. Using quick tablet-based tasks, we investigate whether measureable executive function differences exist following a single overnight call versus routine shift, and whether factors like stress, rest and caffeine affect these measures.

DESIGN

A prospective, observational, longitudinal, comparison study was conducted.

SETTING

An academic tertiary hospital's main operating room suite staffed by attending anesthesiologists, anesthesiology residents, anesthesiologist assistants and nurse anesthetists.

PATIENTS

Subjects were 30 anesthesiology residents working daytime shifts and 30 peers working overnight call shifts from the University of Texas Health Science Center at Houston.

INTERVENTIONS

Before and after their respective work shifts, residents completed the Stanford Sleepiness Scale (SSS) and the ProPoint and AntiPoint tablet-based tasks. These latter tasks are designed to measure sensorimotor and executive functions, respectively.

MEASUREMENTS

The SSS is a self-reported measure of sleepiness. Response times (RTs) are measured in the pointing tasks.

MAIN RESULTS

Call residents exhibited increased RTs across their shifts (post-pre) on both ProPoint (p=0.002) and AntiPoint (p<0.002) tasks, when compared to Routine residents. Increased stress was associated with decreases in AntiPoint RT for Routine (p=0.007), but with greater increases in sleepiness for Call residents (p<0.001). Further, whether or not a Call resident consumed caffeine habitually was associated with ProPoint RT changes; with Call residents who habitually drink caffeine having a greater Pre-Post difference (i.e., more slowing, p<0.001) in ProPoint RT.

CONCLUSIONS

These results indicate that (1) overnight Call residents demonstrate both sensorimotor and cognitive slowing compared to routine daytime shift residents, (2) sensorimotor slowing is greater in overnight Call residents who drink caffeine habitually, and (3) increased stress during a shift reduces (improves) cognitive RTs during routine daytime but not overnight call shifts.

Mechanisms of saccade suppression revealed in the anti-saccade task

The anti-saccade task has emerged as an important tool for investigating the complex nature of voluntary behaviour. In this task, participants are instructed to suppress the natural response to look at a peripheral visual stimulus and look in the opposite direction instead. Analysis of saccadic reaction times (SRT: the time from stimulus appearance to the first saccade) and the frequency of direction errors (i.e. looking toward the stimulus) provide insight into saccade suppression mechanisms in the brain. Some direction errors are reflexive responses with very short SRTs (express latency saccades), while other direction errors are driven by automated responses and have longer SRTs. These different types of errors reveal that the anti-saccade task requires different forms of suppression, and neurophysiological experiments in macaques have revealed several potential mechanisms. At the start of an anti-saccade trial, pre-emptive top-down inhibition of saccade generating neurons in the frontal eye fields and superior colliculus must be present before the stimulus appears to prevent express latency direction errors. After the stimulus appears, voluntary anti-saccade commands must compete with, and override, automated visually initiated saccade commands to prevent longer latency direction errors. The frequencies of these types of direction errors, as well as SRTs, change throughout the lifespan and reveal time courses for development, maturation, and ageing. Additionally, patients diagnosed with a variety of neurological and/or psychiatric disorders affecting the frontal lobes and/or basal ganglia produce markedly different SRT distributions and types of direction errors, which highlight specific deficits in saccade suppression and inhibitory control. The anti-saccade task therefore provides valuable insight into the neural mechanisms of saccade suppression and is a valuable tool in a clinical setting.This article is part of the themed issue 'Movement suppression: brain mechanisms for stopping and stillness'.

Age related prefrontal compensatory mechanisms for inhibitory control in the antisaccade task

Cognitive decline during aging includes impairments in frontal executive functions like reduced inhibitory control. However, decline is not uniform across the population, suggesting individual brain response variability to the aging process. Here we tested the hypothesis, within the oculomotor system, that older adults compensate for age-related neural alterations by changing neural activation levels of the oculomotor areas, or even by recruiting additional areas to assist with cognitive performance. We established that the observed changes had to be related to better cognitive performance to be considered as compensatory. To probe this hypothesis we used the antisaccade paradigm and analyzed the effect of aging on brain activations during the inhibition of prepotent responses to visual stimuli. While undergoing a fMRI scan with concurrent eye tracking, 25 young adults (21.7 y/o ± 1.9 SDM) and 25 cognitively normal older adults (66.2 y/o ± 9.8 SDM) performed an interleaved pro/antisaccade task consisting of a preparatory stage and an execution stage. Compared to young adults, older participants showed a larger increase in antisaccade reaction times, while also generating more antisaccade direction errors. BOLD signal analyses during the preparatory stage, when response inhibition processes are established to prevent an automatic response, showed decreased activations in the anterior cingulate and the supplementary eye fields in the older group. Moreover, older adults also showed additional recruitment of the frontal pole not seen in the younger group, and larger activations in the dorsolateral prefrontal cortex during antisaccade preparation. Additional analyses to address the performance variability in the older group showed distinct behavioral-BOLD signal correlations. Larger activations in the saccade network, including the frontal pole, positively correlated with faster antisaccade reaction times, suggesting a functional recruitment of this area. However, only the activation in the dorsolateral prefrontal cortex during the antisaccade events showed a negative correlation with the number of errors across older adults. These findings support the presence of two dissociable age-related plastic mechanisms that result in different behavioral outcomes. One related to the additional recruitment of neural resources within anterior pole to facilitate modulation of cognitive responses like faster antisaccade reaction times, and another related to increased activation of the dorsolateral prefrontal cortex resulting in a better inhibitory control in aging.

The Stochastic Early Reaction, Inhibition, and late Action (SERIA) model for antisaccades

The antisaccade task is a classic paradigm used to study the voluntary control of eye movements. It requires participants to suppress a reactive eye movement to a visual target and to concurrently initiate a saccade in the opposite direction. Although several models have been proposed to explain error rates and reaction times in this task, no formal model comparison has yet been performed. Here, we describe a Bayesian modeling approach to the antisaccade task that allows us to formally compare different models on the basis of their evidence. First, we provide a formal likelihood function of actions (pro- and antisaccades) and reaction times based on previously published models. Second, we introduce the Stochastic Early Reaction, Inhibition, and late Action model (SERIA), a novel model postulating two different mechanisms that interact in the antisaccade task: an early GO/NO-GO race decision process and a late GO/GO decision process. Third, we apply these models to a data set from an experiment with three mixed blocks of pro- and antisaccade trials. Bayesian model comparison demonstrates that the SERIA model explains the data better than competing models that do not incorporate a late decision process. Moreover, we show that the early decision process postulated by the SERIA model is, to a large extent, insensitive to the cue presented in a single trial. Finally, we use parameter estimates to demonstrate that changes in reaction time and error rate due to the probability of a trial type (pro- or antisaccade) are best explained by faster or slower inhibition and the probability of generating late voluntary prosaccades.

Diagnostic utility of brain activity flow patterns analysis in attention deficit hyperactivity disorder

BACKGROUND

A previous small study suggested that Brain Network Activation (BNA), a novel ERP-based brain network analysis, may have diagnostic utility in attention deficit hyperactivity disorder (ADHD). In this study we examined the diagnostic capability of a new advanced version of the BNA methodology on a larger population of adults with and without ADHD.

METHOD

Subjects were unmedicated right-handed 18- to 55-year-old adults of both sexes with and without a DSM-IV diagnosis of ADHD. We collected EEG while the subjects were performing a response inhibition task (Go/NoGo) and then applied a spatio-temporal Brain Network Activation (BNA) analysis of the EEG data. This analysis produced a display of qualitative measures of brain states (BNA scores) providing information on cortical connectivity. This complex set of scores was then fed into a machine learning algorithm.

RESULTS

The BNA analysis of the EEG data recorded during the Go/NoGo task demonstrated a high discriminative capacity between ADHD patients and controls (AUC = 0.92, specificity = 0.95, sensitivity = 0.86 for the Go condition; AUC = 0.84, specificity = 0.91, sensitivity = 0.76 for the NoGo condition).

CONCLUSIONS

BNA methodology can help differentiate between ADHD and healthy controls based on functional brain connectivity. The data support the utility of the tool to augment clinical examinations by objective evaluation of electrophysiological changes associated with ADHD. Results also support a network-based approach to the study of ADHD.

Neuropsychological measurement of inhibitory control in posttraumatic stress disorder: An exploratory antisaccade paradigm

OBJECTIVE

The aim of the study was to uncover inhibitory control dynamics and assess antisaccade eye-tracking tasks for relevance in a veteran posttraumatic stress disorder (PTSD) population.

METHOD

Participants were 36 veterans enrolled at the Washington DC Veterans Affairs Medical Center. The groups (PTSD diagnosed vs. controls) did not vary between age and sex. Participants completed a testing battery of clinical neuropsychological measures and two different eye-tracking conditions, one that utilized face stimuli and one with standard shape stimuli, which test pro- (PS) and antisaccade (AS) eye movements.

RESULTS

Veterans with PTSD, t(33) = 2.2, p = .04, took longer to respond than controls in the standard condition AS. In the face condition, a group by task interaction was seen with increased latency for PTSD veterans in the AS versus PS task, F(3, 33) = 3.99, p = .05, with a large overall effect (Hedges' g = 1.18, p < .001) compared to controls. After controlling for depression, analyses suggested that only the face condition AS task significantly predicted dimensions of PTSD symptomology measured by the Clinician Administered PTSD Scale (CAPS) for veterans with PTSD.

CONCLUSIONS

This is the first study to extend AS findings to PTSD and suggests a specific capability to measure inhibitory control using eye-tracking technology. We discuss the notion that reduced capacity to regulate facial-related processing affects cognitive and attentional control networks of PTSD patients, potentially representing a core cognitive deficit.

Antisaccade-related brain activation in children with attention-deficit/hyperactivity disorder--A pilot study

While antisaccade paradigms invoke circuitry associated with cognitive control and attention-deficit/hyperactivity disorder (ADHD), there is a dearth of functional magnetic resonance imaging (fMRI) investigations using antisaccade tasks among children with ADHD. Neural correlates associated with antisaccade performance were examined with fMRI in 11 children with ADHD (10 medicated) matched to 11 typically developing children. Significantly greater brain activation in regions in right dorsolateral prefrontal cortex and caudate nucleus was observed in children with ADHD relative to the control group. This pattern separated the children into their respective groups in a taxonomic manner. Sensitivity analyses probing comorbidity and medication-specific effects showed that results were consistent; however, the caudate nucleus difference was only detectable in the full sample, or in subsets with a more relaxed cluster threshold. Antisaccade performance did not significantly differ between the groups, perhaps as a result of greater brain activation or medication effects in the ADHD group. Thus, antisaccade paradigms may have sensitivity and specificity for the investigation of cognitive control deficits and associated neural correlates in ADHD, and may contribute towards the development of new treatment approaches for children with the disorder.

Ocular motor signatures of cognitive dysfunction in multiple sclerosis

The anatomical and functional overlap between ocular motor command circuitry and the higher-order networks that form the scaffolding for cognition makes for a compelling hypothesis that measures of ocular motility could provide a means to sensitively interrogate cognitive dysfunction in people with multiple sclerosis (MS). Such an approach may ultimately provide objective and reproducible measures of cognitive dysfunction that offer an innovative capability to refine diagnosis, improve prognostication, and more accurately codify disease burden. A further dividend may be the validation and application of biomarkers that can be used in studies aimed at identifying and monitoring preventative, protective and even restorative properties of novel neurotherapeutics in MS. This Review discusses the utility of ocular motor measures in patients with MS to characterize disruption to wide-ranging networks that support cognitive function.

Dissociating Two Stages of Preparation in the Stop Signal Task Using fMRI

Often we must balance being prepared to act quickly with being prepared to suddenly stop. The stop signal task (SST) is widely used to study inhibitory control, and provides a measure of the speed of the stop process that is robust to changes in subjects' response strategy. Previous studies have shown that preparation affects inhibition. We used fMRI to separate activity that occurs after a brief (500 ms) warning stimulus (warning-phase) from activity that occurs during responses that follow (response-phase). Both of these phases could contribute to the preparedness to stop because they both precede stop signals. Warning stimuli activated posterior networks that signal the need for top-down control, whereas response phases engaged prefrontal and subcortical networks that implement top-down control. Regression analyses revealed that both of these phases affect inhibitory control in different ways. Warning-phase activity in the cerebellum and posterior cingulate predicted stop latency and accuracy, respectively. By contrast, response-phase activity in fronto-temporal areas and left striatum predicted go speed and stop accuracy, in pre-supplementary motor area affected stop accuracy, and in right striatum predicted stop latency and accuracy. The ability to separate hidden contributions to inhibitory control during warning-phases from those during response-phases can aid in the study of models of preparation and inhibitory control, and of disorders marked by poor top-down control.

Anticipating conflict: Neural correlates of a Bayesian belief and its motor consequence

Previous studies have examined the neural correlates of proactive control using a variety of behavioral paradigms; however, the neural network relating the control process to its behavioral consequence remains unclear. Here, we applied a dynamic Bayesian model to a large fMRI data set of the stop signal task to address this issue. By estimating the probability of the stop signal - p(Stop) - trial by trial, we showed that higher p(Stop) is associated with prolonged go trial reaction time (RT), indicating proactive control of motor response. In modeling fMRI signals at trial and target onsets, we distinguished activities of proactive control, prediction error, and RT slowing. We showed that the anterior pre-supplementary motor area (pre-SMA) responds specifically to increased stop signal likelihood, and its activity is correlated with activations of the posterior pre-SMA and bilateral anterior insula during prolonged response times. This directional link is also supported by Granger causality analysis. Furthermore, proactive control, prediction error, and time-on-task are each mapped to distinct areas in the medial prefrontal cortex. Together, these findings dissect regional functions of the medial prefrontal cortex in cognitive control and provide system level evidence associating conflict anticipation with its motor consequence.

Cognitive deterioration and functional compensation in ALS measured with fMRI using an inhibitory task

Amyotrophic lateral sclerosis (ALS) is characterized by degeneration of upper and lower motor neurons, resulting in progressive weakness and muscle atrophy. Recent studies suggest that nondemented ALS patients can show selective cognitive impairments, predominantly executive dysfunction, but little is known about the neural basis of these impairments. Oculomotor studies in ALS have described deficits in antisaccade execution, which requires the implementation of a task set that includes inhibition of automatic responses followed by generation of a voluntary action. It has been suggested that the dorsolateral prefrontal cortex (DLPFC) contributes in this process. Thus, we investigated whether deterioration of executive functions in ALS patients, such as the ability to implement flexible behavior during the antisaccade task, is related to DLPFC dysfunction. While undergoing an fMRI scan, 12 ALS patients and 12 age-matched controls performed an antisaccade task with concurrent eye tracking. We hypothesized that DLPFC deficits would appear during the antisaccade preparation stage, when the task set is being established. ALS patients made more antisaccade direction errors and showed significant reductions in DLPFC activation. In contrast, regions, such as supplementary eye fields and frontal eye fields, showed increased activation that was anticorrelated with the number of errors. The ALS group also showed reduced saccadic latencies that correlated with increased activation across the oculomotor saccade system. These findings suggest that ALS results in deficits in the inhibition of automatic responses that are related to impaired DLPFC activation. However, they also suggest that ALS patients undergo functional changes that partially compensate the neurological impairment.

Developmental improvements in voluntary control of behavior: effect of preparation in the fronto-parietal network?

The ability to prepare for an action improves the speed and accuracy of its performance. While many studies indicate that behavior performance continues to improve throughout childhood and adolescence, it remains unclear whether or how preparatory processes change with development. Here, we used a rapid event-related fMRI design in three age groups (8-12, 13-17, 18-25years) who were instructed to execute either a prosaccade (look toward peripheral target) or an antisaccade (look away from target) task. We compared brain activity within the core fronto-parietal network involved in saccade control at two epochs of saccade generation: saccade preparation related to task instruction versus saccade execution related to target appearance. The inclusion of catch trials containing only task instruction and no target or saccade response allowed us to isolate saccade preparation from saccade execution. Five regions of interest were selected: the frontal, supplementary, parietal eye fields which are consistently recruited during saccade generation, and two regions involved in top down executive control: the dorsolateral prefrontal and anterior cingulate cortices. Our results showed strong evidence that developmental improvements in saccade performance were related to better saccade preparation rather than saccade execution. These developmental differences were mostly attributable to children who showed reduced fronto-parietal activity during prosaccade and antisaccade preparation, along with longer saccade reaction times and more incorrect responses, compared to adolescents and adults. The dorsolateral prefrontal cortex was engaged similarly across age groups, suggesting a general role in maintaining task instructions through the whole experiment. Overall, these findings suggest that developmental improvements in behavioral control are supported by improvements in effectively presetting goal-appropriate brain systems.

Fixational saccades reflect volitional action preparation

Human volitional actions are preceded by preparatory processes, a critical mental process of cognitive control for future behavior. Volitional action preparation is regulated by large-scale neural circuits including the cerebral cortex and the basal ganglia. Because volitional action preparation is a covert process, the network dynamics of such neural circuits have been examined by neuroimaging and recording event-related potentials. Here, we examined whether such covert processes can be measured by the overt responses of fixational saccades (including microsaccades), the largest miniature eye movements that occur during eye fixation. We analyzed fixational saccades while adult humans maintained fixation on a central visual stimulus as they prepared to generate a volitional saccade in response to peripheral stimulus appearance. We used the antisaccade paradigm, in which subjects generate a saccade toward the opposite direction of a peripheral stimulus. Appropriate antisaccade performance requires the following two aspects of volitional control: 1) facilitation of saccades away from the stimulus and 2) suppression of inappropriate saccades toward the stimulus. We found that fixational saccades that occurred before stimulus appearance reflected the dual preparatory states of saccade facilitation and suppression and correlated with behavioral outcome (i.e., whether subjects succeeded or failed to cancel inappropriate saccades toward the stimulus). Moreover, fixational saccades explained a large proportion of individual differences in behavioral performance (poor/excellent) across subjects. These results suggest that fixational saccades predict the outcome of future volitional actions and may be used as a potential biomarker to detect people with difficulties in volitional action preparation.