Revisiting the Concept of Vigilance

Assessment of Vigilance and Fatigue

This article summarizes the definitions of vigilance, fatigue, and sleepiness, as well as tools used in their assessment. Consideration is given to the strengths and limitations of the different subjective and objective tools. Future directions for research are also discussed, as well as the public health importance of continued investigation in this subject.

Aminoadamantanes: from treatment of Parkinson's and Alzheimer's disease to symptom amelioration of long COVID-19 syndrome?

INTRODUCTION

The aminoadamantanes amantadine and memantine are well known. They mainly act as N-methyl-D-aspartate antagonists.

AREAS COVERED

The antiviral drug amantadine moderately ameliorates impaired motor behavior in patients with Parkinson's disease. Memantine provides beneficial effects on memory function in patients with advanced Alzheimer's disease already treated with acetylcholine esterase inhibitors. Both compounds counteract impaired monoamine neurotransmission with associated symptoms, such as depression. They improve vigilance, lack of attention and concentration, fatigue syndromes according to clinical findings in patients with chronic neurodegenerative processes. Their extrasynaptic N-methyl-D-Aspartate receptor blockade weakens a prolonged influx of Ca²⁺ ions as the main responsible components of neuronal excitotoxicity. This causes neuronal dying and associated functional deficits.

EXPERT OPINION

We suggest aminoadamantanes as future therapies for amelioration of short- and long-term consequences of a COVID 19 infection. Particularly the extended-release amantadine formulations will be suitable. They showed better clinical efficacy compared with the conventional available compounds. Amantadine may particularly be suitable for amelioration of fatigue or chronic exhaustion, memantine for improvement of cognitive deficits. Clinical research in patients, who are affected by the short- and long-term consequences of a COVID 19 infection, is warranted to confirm these still hypothetical putative beneficial effects of aminoadamantanes.

Vigilance described by the time-on-task effect in EEG activity during a cued Go/NoGo task

Vigilance refers to the ability to maintain attention and to remain alert to stimuli in prolonged and monotonous tasks. Vigilance decrement describes the decline in performance in the course of such sustained attention tasks. Time-related alterations in attention have been found to be associated with changes in EEG. We investigated these time-on-task effects on the basis of changes in the conventional EEG spectral bands with the aim of finding a compound measure of vigilance. 148 healthy adults performed a cued Go/NoGo task that lasted approximately 21 min. Behavioural performance was examined by comparing the number of errors in the first and last quarters of the task using paired t-test. EEG data were epoched per trial, and time-on-task effects were modelled by using multiple linear regression, with frequency spectra band power values as independent variables and trial number as the dependent variable. Behavioural performance decreased in terms of omission errors only. Performance of the models, expressed by predicted R-squared, was between 0.10 and 0.27, depending on the particular task condition. The time-on-task EEG spectral changes were characterized by broad changes in the alpha and frontal changes in the beta and gamma bands. We were able to identify a set of EEG spectral features that predict time-on-task. Our output is considered to be a measure of vigilance, reflecting the allocation of mental resources for the maintenance of attention.

Social-ecological considerations informing a universal screening strategy for sleep health in the community

"Poor sleep health" (PSH), defined as reduced amount of sleep and non-restorative sleep, affects cognitive, social and emotional development. Evidence suggests an association of sleep deprivation and mental health problems; however, there are no universal concepts allowing a first-tier screening of PSH at a community level. The focus of this narrative review is to highlight the cultural context of the current medicalized approach to PSH and to suggest social ecological strategies informing new and holistic community-based screening concepts. We present two conceptual screening frameworks; a "medical" and a merged "social emotional wellbeing framework" and combine them utilizing the concept of "ecologies." The first framework proposes the incorporation of "sleep" in the interpretation of "vigilance" and "inappropriate" labeled behaviors. In the first framework, we provide a logic model for screening the myriad of presentations and possible root causes of sleep disturbances as a tool to assess daytime behaviors in context with PSH. In the second framework, we provide evidence that informs screening for "social emotional wellbeing" in the context of predictive factors, perpetuating factors and predispositions through different cultural perspectives. The distinct goals of both frameworks are to overcome training-biased unidirectional thinking and a priori medicalization of challenging, disruptive and/or disobedient behaviors. The latter has been explicitly informed by the critical discourse on colonization and its consequences, spearheaded by First Nations. Our "transcultural, transdisciplinary and transdiagnostic screening framework" may serve as a starting point from which adaptations of medical models could be developed to suit the purposes of holistic screening, diagnosis, and treatment of complex childhood presentations in different cultural contexts.