Effects of psychostimulants on alertness and spatial bias in healthy participants

Beyond bias: A registered examination of the validity of using line bisection to measure non-lateralised attention

Line bisection is a task widely used to assess lateral asymmetries of attention, in which participants are asked to mark the midpoint of a horizontal line. The directional bisection error (DBE) from the objective midpoint of the line is the traditional measure of performance. However, an alternative method of studying the bisection behaviour, the endpoint weightings method, has been proposed. This method produces two measures of performance: endpoint weightings bias (EWB) and endpoint weightings sum (EWS). While EWB measures attentional asymmetry, it has been suggested that EWS quantifies the total (non-lateralised) attention allocated to the task. If EWS provides a valid index of non-lateralised attention, then changes in tonic and phasic arousal should systematically affect EWS. In this article, we formally tested this prediction, using time on task to manipulate tonic arousal and unpredictable auditory tones, presented simultaneously with line stimuli, to manipulate phasic arousal. Our registered analyses revealed that neither of our manipulations for tonic or phasic arousal significantly influenced EWS. Therefore, the null hypotheses cannot be rejected. An exploratory analysis of all trials and conditions revealed a significant reduction in EWS with time spent on task. However, the lack of any significant effect of the alerting tone on EWS suggests that EWS may not be a valid measure of generalised attention to the task.

The effects of amphetamines alone and in combination with alcohol on functional neurocognition: A systematic review

Due to their desirable synergistic and/or additive pharmacological effects, amphetamines and alcohol are frequently co-consumed; yet, their combined functional neurocognitive effects remain poorly defined. The PubMed, Scopus, SafetyLit, CINAHL Complete and Medline databases were examined from inception to December 2020. Study selection, data extraction and Cochrane Risk of Bias (RoB2) assessments were conducted according to PRISMA guidelines, and the review was registered on the PROSPERO database (CRD42020189168). A total of 39 full-text articles were included which examined the effects of six amphetamine analogues alone (n = 33) and in combination with alcohol (n = 6) on measures of attention, working memory and reaction time. Amphetamine alone produced limited inverted-U shaped improvement in select behavioural domains, particularly among poor baseline performers. Combined amphetamine and alcohol impaired psychomotor speed and motor control comparable to alcohol alone, and co-consumption with high doses of alcohol (0.08 %BAC) protracted behavioural deficits. Co-consumption of amphetamine with high doses of alcohol impairs response discrimination and psychomotor speed, and their combination is not sufficient to overcome alcohol-induced motor impairment.

Cognitive enhancement effects of stimulants: a randomized controlled trial testing methylphenidate, modafinil, and caffeine

RATIONAL

At all times humans have made attempts to improve their cognitive abilities by different means, among others, with the use of stimulants. Widely available stimulants such as caffeine, but also prescription substances such as methylphenidate and modafinil, are being used by healthy individuals to enhance cognitive performance.

OBJECTIVES

There is a lack of knowledge on the effects of prescription stimulants when taken by healthy individuals (as compared with patients) and especially on the effects of different substances across different cognitive domains.

METHODS

We conducted a pilot study with three arms in which male participants received placebo and one of three stimulants (caffeine, methylphenidate, modafinil) and assessed cognitive performance with a test battery that captures various cognitive domains.

RESULTS

Our study showed some moderate effects of the three stimulants tested. Methylphenidate had positive effects on self-reported fatigue as well as on declarative memory 24 hours after learning; caffeine had a positive effect on sustained attention; there was no significant effect of modafinil in any of the instruments of our test battery. All stimulants were well tolerated, and no trade-off negative effects on other cognitive domains were found.

CONCLUSIONS

The few observed significant positive effects of the tested stimulants were domain-specific and of rather low magnitude. The results can inform the use of stimulants for cognitive enhancement purposes as well as direct further research to investigate the effects of stimulants on specific cognitive domains that seem most promising, possibly by using tasks that are more demanding.

Interactions between spatial attention and alertness in healthy adults: A meta-analysis

Attending to the visuospatial field is paramount for safety. The inability to sufficiently allocate attention in the environment could lead to unfavourable consequences. One's ability to attend quickly to left- and right-sided stimuli can vary depending on the person's level of alertness. A dominant model of this relationship proposes that low alertness is associated with a rightward bias in attention, with increases in alertness shifting attention leftward. The current study sought to synthesise the literature on spatial attention and alertness and identify modulators of this relationship in healthy adults. Nineteen articles meeting inclusion criteria were identified for meta-analysis. A small effect of alertness on spatial bias (d = .302) with no evidence for a systematic publication bias was found. Of the five investigated modulators, namely, the experimental design relative to alertness, direction of alertness manipulation, measurement of alertness, the nature of the spatial task, and handedness, only the latter was identified as a significant modulator of the relationship between alertness and spatial attention. The review's findings tie in with the influential framework by Corbetta and Shulman (2011) and support the idea to increase alertness as a rehabilitation approach to reduce inattention to the left side in neglect patients. Findings also suggest a need for future research to investigate neurological processes that underlie the alertness and spatial attention relationship, and a need to examine the transfer effects of laboratory-based experiments for real-world implications.

Differential Effects of Lowered Arousal on Covert and Overt Shifts of Attention

Based on previous studies demonstrating detrimental effects of reduced alertness on attentional orienting our study seeks to examine covert and overt attentional orienting in different arousal states. We hypothesized an attentional asymmetry with increasing reaction times to stimuli presented to the left visual field in a state of maximally reduced arousal. Eleven healthy participants underwent sleep deprivation and were examined repeatedly every 4 hr over 28 hr in total with two tasks measuring covert and overt orienting of attention. Contrary to our hypothesis, a reduction of arousal did not induce any asymmetry of overt orienting. Even in participants with profound and significant attentional asymmetries in covert orienting no substantial reaction time differences between left- and right-sided targets in the overt orienting task could be observed. This result is not in agreement with assumptions of a tight coupling of covert and overt attentional processes. In conclusion, we found differential effects of lowered arousal induced by sleep deprivation on covert and overt orienting of attention. This pattern of results points to a neuronal non-overlap of brain structures subserving these functions and a differential influence of the norepinephrine system on these modes of spatial attention.

Rehabilitation of spatial neglect

Spatial neglect is a frequent cause of disability associated with high costs and duration of hospital stay, increased family burden, and requirements for skilled chronic care. This condition is disproportionately more frequent with right than left hemispheric injury and it is characterized by perceptual, representational, and behavioral deficits involving or directed towards the left hemispace or the left hemibody. Spatial dysfunction is conceptualized into two major components: the perceptual/representational "where" component that results mainly from injury to posterior brain regions and the premotor/intentional "aiming" component that results mostly from damage to anterior brain regions. Additionally, deficits in arousal, vigilance, affective symptoms, and disorders of emotional communication may compound the clinical manifestations of spatial neglect. Evidence-based sources that evaluate the effectiveness of rehabilitation treatments for neglect are, unfortunately, unable to provide a unified consensus for the efficacy of a given treatment approach. The reasons for this failure are related to internal inconsistencies defining appropriate criteria for treatment success and lack of characterization of neglect mechanisms and considerations of patient characteristics related to treatment failure. In this chapter we advocate the use of visual scanning, limb activation therapy, and "general treatment" because we believe that they are appropriately supported by different sources and they may be useful for experimental trials and standardized clinical care. We advocate an integrative approach that takes advantage of the same rehabilitation strategy or task to treat different perceptual, representational, and premotor components of neglect. A variety of therapies that may be familiar to the rehabilitation team may be useful as long as they are applied in a systematized program and are based on good clinical judgment. Information regarding adjuvant pharmacological therapy is sparse but different agents with aminergic and cholinergic activity may be useful. Medication with sedative, antidopaminergic or anticholinergic properties may interfere with the rehabilitation process and should be avoided.

Effects of modafinil and methylphenidate on visual attention capacity: a TVA-based study

INTRODUCTION

Theory of visual attention (TVA; Bundesen 1990) whole report tasks allow the independent measurement of visual perceptual processing speed and visual short-term memory (vSTM) storage capacity, unconfounded by motor speed. This study investigates how cognitive enhancing effects of psychostimulants depend on baseline performance and individual plasma levels.

MATERIALS AND METHODS

Eighteen healthy volunteers (aged 20-35 years) received single oral doses of either 40 mg methylphenidate, 400 mg modafinil or placebo in a counterbalanced, double-blind crossover design. A whole report of visually presented letter arrays was performed 2.5-3.5 h after drug administration, and blood samples for plasma level analysis were taken.

RESULTS

Methylphenidate and modafinil both enhanced perceptual processing speed in participants with low baseline (placebo) performance. These improvements correlated with subjective alertness. Furthermore, we observed differential plasma level-dependent effects of methylphenidate in lower and higher performing participants: higher plasma levels led to a greater improvement in low-performing participants and to decreasing improvement in high-performing participants. Modafinil enhanced visual short-term memory storage capacity in low-performing participants.

CONCLUSIONS

This is the first pharmacological investigation demonstrating the usefulness of a TVA task for high-resolution and repeated cognitive parameter estimation after cognitive-enhancing medication. Our results confirm previous findings of attentional capacity improvements in low performers and extend the baseline dependency model to methylphenidate. Plasma level-dependent effects of psychostimulants can be modelled on an inverted U-shaped dose-response relationship, which is highly relevant to predict cognitive enhancing and detrimental effects of psychostimulants in patients with cognitive deficits (e.g., attention deficit hyperactivity disorder) and healthy volunteers (e.g., self-medicating academics).