Effects of total sleep deprivation on components of top-down attentional control using a flexible attentional control task

Sleep deprivation consistently decreases vigilant attention, which can lead to difficulty in performing a variety of cognitive tasks. However, sleep-deprived individuals may be able to compensate for degraded vigilant attention by means of top-down attentional control. We employed a novel task to measure the degree to which individuals overcome impairments in vigilant attention by using top-down attentional control, the Flexible Attentional Control Task (FACT). The FACT is a two-choice task that has trials with valid, invalid, and neutral cues, along with an unexpected switch in the probability of cue validity about halfway in the task. The task provides indices that isolate performance components reflecting vigilant attention and top-down attentional control. Twelve healthy young adults completed an in-laboratory study. After a baseline day, the subjects underwent 39 hours of total sleep deprivation (TSD), followed by a recovery day. The FACT was administered at 03:00, 11:00, and 19:00 during sleep deprivation (TSD condition) and at 11:00 and 19:00 after baseline sleep and at 11:00 after recovery sleep (rested condition). When rested, the subjects demonstrated both facilitation and interference effects on cued trials. While sleep deprived, the subjects showed vigilant attention deficits on neutral cue trials, and an impaired ability to reduce these deficits by using predictive contextual cues. Our results indicate that the FACT can dissociate vigilant attention from top-down attentional control. Furthermore, they show that during sleep deprivation, contextual cues help individuals to compensate partially for impairments in vigilant attention, but the effectiveness of top-down attentional control is diminished.

Temporary amnesia from sleep loss: A framework for understanding consequences of sleep deprivation

Throughout its modern history, sleep research has been concerned with both the benefits of sleep and the deleterious impact of sleep disruption for cognition, behavior, and performance. When more specifically examining the impact of sleep on memory and learning, however, research has overwhelmingly focused on how sleep following learning facilitates memory, with less attention paid to how lack of sleep prior to learning can disrupt subsequent memory. Although this imbalance in research emphasis is being more frequently addressed by current investigators, there is a need for a more organized approach to examining the effect of sleep deprivation before learning. The present review briefly describes the generally accepted approach to analyzing effects of sleep deprivation on subsequent memory and learning by means of its effects on encoding. Then, we suggest an alternative framework with which to understand sleep loss and memory in terms of temporary amnesia from sleep loss (TASL). The review covers the well-characterized properties of amnesia arising from medial temporal lobe lesions and shows how the pattern of preserved and impaired aspects of memory in amnesia may also be appearing during sleep loss. The view of the TASL framework is that amnesia and the amnesia-like deficits observed during sleep deprivation not only affect memory processes but will also be apparent in cognitive processes that rely on those memory processes, such as decision-making. Adoption of the TASL framework encourages movement away from traditional explanations based on narrowly defined domains of memory functioning, such as encoding, and taking instead a more expansive view of how brain structures that support memory, such as the hippocampus, interact with higher structures, such as the prefrontal cortex, to produce complex cognition and behavioral performance, and how this interaction may be compromised by sleep disruption.

Electrodermal Activity Is Sensitive to Sleep Deprivation but Does Not Moderate the Effect of Total Sleep Deprivation on Affect

Emotion is characterized by dimensions of affective valence and arousal, either or both of which may be altered by sleep loss, thereby contributing to impaired regulatory functioning. Controlled laboratory studies of total sleep deprivation (TSD) generally show alterations in physiological arousal and affective state, but the relationship of affect and emotion with physiological arousal during TSD has not been well characterized. Established methods for examining physiological arousal include electrodermal activity (EDA) measures such as non-specific skin conductance responses (NSSCR) and skin conductance level (SCL). These measures are robust physiological markers of sympathetic arousal and have been linked to changes in experienced emotion. To explore the link between physiological arousal and affect during sleep deprivation, we investigated individuals’ EDA under TSD and its relationship to self-reported affect. We also investigated the relationship of EDA to two other measures known to be particularly sensitive to the arousal-decreasing effects of TSD, i.e., self-reported sleepiness and performance on a vigilant attention task. Data were drawn from three previously published laboratory experiments where participants were randomly assigned to either well-rested control (WRC) or 38 h of TSD. In this data set, comprising one of the largest samples ever used in an investigation of TSD and EDA (N = 193 with 74 WRC and 119 TSD), we found the expected impairing effects of TSD on self-reported affect and sleepiness and on vigilant attention. Furthermore, we found that NSSCR, but not SCL, were sensitive to TSD, with significant systematic inter-individual differences. Across individuals, the change in frequency of NSSCR during TSD was not predictive of the effect of TSD on affect, sleepiness, or vigilant attention, nor was it related to these outcomes during the rested baseline. Our findings indicate that while physiological arousal, as measured by EDA, may be useful for assessing TSD-related changes in non-specific arousal at the group level, it is not associated with individuals’ self-reported affect at rest nor their change in affect during TSD. This suggests that an essential aspect of the relationship between physiological arousal and self-reported affect is not well captured by EDA as measured by NSSCR.

Sleep Deprivation Impairs Binding of Information with Its Context

Binding information to its context in long-term memory is critical for many tasks, including memory tasks and decision making. Failure to associate information to its context could be an important aspect of sleep deprivation effects on cognition, but little is known about binding problems from being sleep-deprived at the time of encoding. We studied how sleep deprivation affects binding using a well-established paradigm testing the ability to remember auditorily presented words (items) and their speakers (source context). In a laboratory study, 68 healthy young adults were randomly assigned to total sleep deprivation or a well-rested control condition. Participants completed an affective item and source memory task twice: once after 7h awake during baseline and again 24h later, after nearly 31h awake in the total sleep deprivation condition or 7h awake in the control condition. Participants listened to negative, positive, and neutral words presented by a male or female speaker and were immediately tested for recognition of the words and their respective speakers. Recognition of items declined during sleep deprivation, but even when items were recognized accurately, recognition of their associated sources also declined. Negative items were less bound with their sources than positive or neutral items,but sleep deprivation did not significantly affect this pattern.Our findings indicate that learning while sleep-deprived disrupts the binding of information to its context independent of item valence. Such binding failures may contribute to sleep deprivation effects on tasks requiring the ability to bind new information together in memory.

0125 Sleep Deprivation Impairs the Ability to Overcome Pre-Existing Framing Bias

Introduction

When presented with a choice between sure gains or losses versus gambles, people tend to select sure gains over gambles, but gambles over sure losses. This pre-existing framing bias is embedded in the Framed Gambling Task (FGT), in which subjects choose between a sure option (gain or loss) and a gamble (card from one of two decks). For optimal performance, subjects need to recognize that one deck (‘good deck’) results in better average outcomes than the other deck (‘bad deck’) and select the gamble or sure option depending on the deck (good/bad) rather than the frame (sure loss/gain). A speeded version of the FGT, with 2s response deadlines to induce time pressure, was used in a laboratory total sleep deprivation (TSD) study to determine the impact of sleep loss on the ability to overcome pre-existing framing bias.

Methods

Eight-six subjects (ages 21–38; 47 females) were randomized (2:1 ratio) to a TSD condition (n=56) or control condition (n=30). They completed the speeded FGT at 11:00 on the baseline day (session 1), and again the following day (session 2) after 27h of wakefulness (TSD group) or 3h of wakefulness (control group). Performance accuracy was defined in terms of optimal task performance, i.e., gambling when the good deck was presented and not gambling when the bad deck was presented. Each test bout had 72 trials across three trial blocks.

Results

Accuracy improved across trial blocks (F1,84=20.44, p<0.001). In session 2, the TSD group showed lower accuracy (condition by session interaction: F2,84=4.15, p=0.045) and less improvement across trial blocks (condition by session by trial block interaction: F2,168=3.97, p=0.021) than the control group. Even under TSD, the frequency of response timeouts (RT>2s) was low (<3.5% of trials).

Conclusion

Sleep deprivation degraded FGT performance under time pressure, indicating reduced ability to overcome pre-existing framing bias.

Support

PRMRP award W81XWH-16-1-0319

0301 Different Indices of Vigilant Attention During Sleep Deprivation: Evidence of Multiple Vigilance Constructs?

Introduction

Total sleep deprivation (TSD) causes profound vigilant attention deficits, with large, trait-like individual differences, as evidenced convincingly by response lapses on the psychomotor vigilance test (PVT). There is debate, however, about the role of vigilant attention deficits in the effects of TSD on other speeded performance tasks besides the PVT. We addressed this issue by testing whether PVT response lapses are related to delays in responding to stimuli under strict deadlines in two decision making tasks.

Methods

N=54 healthy adults (aged 21-38y; 31 females) completed an in-laboratory TSD study. Following a 10h baseline sleep opportunity, cognitive testing occurred after 25h and 29h of TSD (09:00 and 13:00). Testing included an AX continuous performance task with switch (AX-CPTs), which is a dynamic decision making task requiring subjects to respond to a frequently occurring cue-probe combination; an identical pairs continuous performance task (CPT-IP), which is a 1-back go/no-go task; and a 10min PVT. Lapses (RTs>500ms) on the PVT and target accuracy on the AX-CPTs and CPT-IP were calculated as indices of vigilant attention. Intraclass correlation coefficients (ICCs) were used to quantify the stability of individual differences, and absolute rank-order correlation (|ρ|) was used to compare the three indices.

Results

The stability of individual differences ranged from fair to substantial (PVT: ICC=0.44; AX-CPTs: ICC=0.73; CPT-IP: ICC=0.31). The rank-order correlation between the AX-CPTs and CPT-IP vigilant attention indices was relatively high (|ρ|=0.44), whereas correlations with PVT lapses were much lower (AX-CPTs: |ρ|=0.14; CPT-IP: |ρ|=0.04).

Conclusion

Individual differences during TSD were moderately stable for each index of vigilant attention, but the relationships between PVT lapses and the other indices were weak. This suggests that any or all of the indices considered here are not pure measures of vigilant attention, or that vigilant attention may constitute multiple, distinct constructs.

Support

CDMRP grant W81XWH-16-1-0319

0121 Effect of Total Sleep Deprivation on Word Recognition of Previously Studied Words with Different Emotional Valence

Introduction

Stimuli with an emotional valence tend to produce better recognition from memory than neutral stimuli. Sleep loss is believed to increase reactivity to negative stimuli, as compared to positive stimuli, which may comparatively enhance subsequent recognition from memory for negative stimuli. We investigated the impact of total sleep deprivation (TSD) on recognition accuracy for words with different emotional valence using the Affective Item Source Memory Task (AISM).

Methods

N=14 adults (ages 21–39; 7 females) completed a 4-day in-laboratory study with 9h baseline sleep (22:00-07:00), 39h acute TSD, and 9h recovery sleep. The AISM was administered at 16:30 during baseline and after 34h TSD. During a 5min study phase, participants heard a list, twice, of 20 positive, 20 negative, and 20 neutral words spoken with a male or female voice. During an immediately subsequent 8min recognition phase, participants heard 120 words (50% new) and judged whether each word had been presented in the study list (item memory). For words judged to have been presented previously, participants indicated whether those were presented by a female or male speaker (source memory).

Results

Mixed-effects ANOVA showed effects of session (p<0.001) and valence (p<0.001) on item memory. At baseline, accuracy was greatest for neutral and positive words compared to negative words. During TSD, accuracy declined for all three valences, and no interaction of session by valence was detected. No effects of TSD or valence on source memory were observed.

Conclusion

Sleep deprivation reduced item memory for words of all valence types. However, there was no comparatively greater impact on item or source memory for negative words nor any differential effect of TSD for different valences. Whether our results would hold with longer time intervals between task phases or an intervening sleep period remains to be determined.

Support

Jazz Pharmaceuticals

Joint effects of stress and chronic cannabis use on prospective memory

RATIONALE

Prospective memory pervades our daily lives and failures can have detrimental consequences. This ability to execute delayed intentions may be impacted by stress, yet few studies have examined these effects. Moreover, as many cannabis users report using cannabis to cope with stress, it is important to understand how stress impacts memory in cannabis users.

OBJECTIVES

We assessed the effects of acute and chronic stress on prospective memory to examine whether stress differentially impacts prospective memory in cannabis users vs. non-users.

METHODS

Forty cannabis users and 42 non-users were assigned an episodic and a habitual prospective memory test before completing either the stress or no stress condition of the Maastricht Acute Stress Test (MAST). Participants were instructed to execute the habitual test during the MAST and the episodic test shortly after the MAST. Chronic stress was measured using the Perceived Stress Scale, and acute stress was measured using subjective ratings and cortisol.

RESULTS

There was a main effect of acute stress indicating that stress detrimentally impacted habitual prospective memory performance. Although there was not a significant stress x cannabis interaction, further planned comparisons indicated the habitual prospective memory impairment was selective to cannabis users. There were also significant negative correlations between (i) episodic prospective memory and both subjective stress as well as chronic stress, and (ii) habitual prospective memory and change in subjective stress.

CONCLUSIONS

This study is the first to reveal detrimental effects of acute stress on prospective memory performance, which may be exacerbated in cannabis users.

Cognitive flexibility: A distinct element of performance impairment due to sleep deprivation

In around-the-clock operations, reduced alertness due to circadian misalignment and sleep loss causes performance impairment, which can lead to catastrophic errors and accidents. There is mounting evidence that performance on different tasks is differentially affected, but the general principles underlying this differentiation are not well understood. One factor that may be particularly relevant is the degree to which tasks require executive control, that is, control over the initiation, monitoring, and termination of actions in order to achieve goals. A key aspect of this is cognitive flexibility, i.e., the deployment of cognitive control resources to adapt to changes in events. Loss of cognitive flexibility due to sleep deprivation has been attributed to "feedback blunting," meaning that feedback on behavioral outcomes has reduced salience - and that feedback is therefore less effective at driving behavior modification under changing circumstances. The cognitive mechanisms underlying feedback blunting are as yet unknown. Here we present data from an experiment that investigated the effects of sleep deprivation on performance after an unexpected reversal of stimulus-response mappings, requiring cognitive flexibility to maintain good performance. Nineteen healthy young adults completed a 4-day in-laboratory study. Subjects were randomized to either a total sleep deprivation condition (n = 11) or a control condition (n = 8). Athree-phase reversal learning decision task was administered at baseline, and again after 30.5 h of sleep deprivation, or matching well-rested control. The task was based on a go/no go task paradigm, in which stimuli were assigned to either a go (response) set or a no go (no response) set. Each phase of the task included four stimuli (two in the go set and two in the no go set). After each stimulus presentation, subjects could make a response within 750 ms or withhold their response. They were then shown feedback on the accuracy of their response. In phase 1 of the task, subjects were explicitly told which stimuli were assigned to the go and no go sets. In phases 2 and 3, new stimuli were used that were different from those used in phase 1. Subjects were not explicitly told the go/no go mappings and were instead required to use accuracy feedback to learn which stimuli were in the go and nogo sets. Phase 3 continued directly from phase 2 and retained the same stimuli as in phase 2, but there was an unannounced reversal of the stimulus-response mappings. Task results confirmed that sleep deprivation resulted in loss of cognitive flexibility through feedback blunting, and that this effect was not produced solely by (1) general performance impairment because of overwhelming sleep drive; (2) reduced working memory resources available to perform the task; (3) incomplete learning of stimulus-response mappings before the unannounced reversal; or (4) interference with stimulus identification through lapses in vigilant attention. Overall, the results suggest that sleep deprivation causes a fundamental problem with dynamic attentional control. This element of performance impairment due to sleep deprivation appears to be distinct from vigilant attention deficits, and represents a particularly significant challenge for fatigue risk management.

Working memory loads differentially influence frame-induced bias and normative choice in risky decision making

Risky decision making can be biased by several types of contextual factors—in particular, framing of outcomes. A popular explanation for outcome framing effects is based on presumed affective reactions that contribute to accepting sure gains and avoiding sure losses. Other theories propose that selective weighting of information about gains and losses contributes to framing bias. Prior research on framing bias has focused on preferences rather than on decisions in which choices can be classified as advantageous (correct) or disadvantageous (incorrect) by a normative criterion. The current study used a novel hypothetical risky decision making task offering choices between a sure option and a gamble option. The gamble was advantageous or disadvantageous on different trials based on the normative criterion of expected value. Results showed risk avoidance with a gain frame and risk seeking with a loss frame, comparable to findings when choices involve preferences. We also examined the impact of working memory loads of either non-affective stimuli, most likely to interfere with acquisition of choice information, or affective stimuli, which might influence affective processes contributing to framing. The results were that non-affective working memory load produced the greatest framing magnitude, while affective load produced changes in framing magnitude across trials that varied by valence. In addition, only the non-affective load decreased advantageous choices and reduced the accuracy of answers to knowledge probe questions about the choices. The findings are consistent with the notion that framing effects may arise from cognitive non-engagement with the task, rather than arising by way of affective processes. Affective loads had a limited influence on framing and no reliable impact on choice accuracy or choice knowledge, suggesting that the affective loads influenced the weighting of choice information.

Trait anxiety impairs cognitive flexibility when overcoming a task acquired response and a preexisting bias

Individuals with high trait anxiety tend to be worse at flexibly adapting goal-directed behavior to meet changing demands relative to those with low trait anxiety. Past research on anxiety and cognitive flexibility has used tasks that involve overcoming a recently acquired rule, strategy, or response pattern after an abrupt change in task requirements (e.g., choice X led to positive outcomes but now leads to negative outcomes). An important limitation of this research is that many decision making situations require overcoming a preexisting bias (e.g., deciding whether to withdraw a historically winning investment that has experienced recent losses). In the present study we examined whether anxiety differences in the ability to overcome an acquired response extend to the ability to overcome a preexisting bias, when the bias produces objectively disadvantageous decisions. High anxiety (n = 78) and low anxiety participants (n = 76) completed a commonly used measure of cognitive flexibility, reversal learning, and a novel Framed Gambling Task that assessed the extent to which they could make advantageous decisions when the normatively correct choice was inconsistent with a preexisting framing bias. High anxiety participants showed the expected diminished reversal learning performance and also had poorer ability to make advantageous choices that were inconsistent with the framing bias. Worse performance in the Framed Gambling Task was not driven by poor knowledge of risk contingencies, because high anxiety participants reported the same explicit knowledge as low anxiety participants. Instead, the results suggest high anxiety is associated with general deficits in resolving interference from prepotent responses.

Total sleep deprivation does not significantly degrade semantic encoding

Sleep deprivation impairs performance on cognitive tasks, but it is unclear which cognitive processes it degrades. We administered a semantic matching task with variable stimulus onset asynchrony (SOA) and both speeded and self-paced trial blocks. The task was administered at the baseline and 24 hours later after 30.8 hours of total sleep deprivation (TSD) or matching well-rested control. After sleep deprivation, the 20% slowest response times (RTs) were significantly increased. However, the semantic encoding time component of the RTs remained at baseline level. Thus, the performance impairment induced by sleep deprivation on this task occurred in cognitive processes downstream of semantic encoding.

Induced Positive Mood and Cognitive Flexibility: Evidence from Task Switching and Reversal Learning

Positive mood often facilitates cognitive functions. Facilitation is hypothesized to be due to an increase in dopamine occurring in positive mood states. However, facilitation has not been consistently found in studies of cognitive flexibility. This inconsistent relationship may reflect the numerous ways cognitive flexibility is measured. Moreover, there is evidence that the role of dopamine in cognitive flexibility performance depends on the type of measure used. In the current study, we employed a probabilistic two-card reversal learning task (n = 129) and a Stroop-like task switching procedure (n = 188) in a college student population. We used a standardized set of mood videos to induce a positive, negative, or neutral mood state. Negative mood states were included to account for possible effects of arousal on performance, which is seen in both positive and negative mood inductions. Based on current theories of positive mood and cognition, we hypothesized that there would be differences in the effects of a positive mood induction on cognitive flexibility as assessed by task switching and reversal learning tasks. The mood induction successfully induced high levels of amusement and increased valence in the positive mood group and high levels of repulsion and decreased valence in the negative mood group. However, there were no differences in cognitive flexibility across any of the mood groups, as assessed by switch costs in task switching and correct choices after the reversal in reversal learning. Overall, these findings do not support the hypothesis that positive mood improves cognitive flexibility.

Altered attentional control strategies but spared executive functioning in chronic cannabis users

BACKGROUND

Cannabis use has increased rapidly in recent decades. The increase in cannabis use makes it important to understand the potential influence of chronic use on attentional control and other executive functions (EFs). Because cannabis is often used to reduce stress, and because stress can constrain attentional control and EFs, the primary goal of this study was to determine the joint effect of acute stress and chronic cannabis use on specific EFs.

METHODS

Thirty-nine cannabis users and 40 non-users were assigned to either a stress or no stress version of the Maastricht Acute Stress Test. Participants then completed two cognitive tasks that involve EFs: (1) task switching, and (2) a novel Flexible Attentional Control Task. These two tasks provided assessments of vigilant attention, inhibitory control, top-down attentional control, and cognitive flexibility. Salivary cortisol was assessed throughout the study.

RESULTS

Reaction time indices showed an interaction between stress and cannabis use on top-down attentional control (p=0.036, n_p²=0.059). Follow-up tests showed that cannabis users relied less on top-down attentional control than did non-users in the no stress version. Despite not relying on top-down control, the cannabis users showed no overall performance deficits on the tasks.

CONCLUSIONS

Chronic cannabis users performed cognitive tasks involving EFs as well as non-users while not employing cognitive control processes that are typical for such tasks. These results indicate alterations in cognitive processing in cannabis users, but such alterations do not necessarily lead to global performance deficits.

Catechol-O-methyltransferase (COMT) genotype affects cognitive control during total sleep deprivation

Adaptive decision making is profoundly impaired by total sleep deprivation (TSD). This suggests that TSD impacts fronto-striatal pathways involved in cognitive control, where dopamine is a key neuromodulator. In the prefrontal cortex (PFC), dopamine is catabolized by the enzyme catechol-O-methyltransferase (COMT). A functional polymorphism (Val158Met) influences COMT's enzymatic activity, resulting in markedly different levels of prefrontal dopamine. We investigated the effect of this polymorphism on adaptive decision making during TSD. Sixty-six healthy young adults participated in one of two in-laboratory studies. After a baseline day, subjects were randomized to either a TSD group (n = 32) with 38 h or 62 h of extended wakefulness or a well-rested control group (n = 34) with 10 h nighttime sleep opportunities. Subjects performed a go/no-go reversal learning (GNGr) task at well-rested baseline and again during TSD or equivalent control. During the task, subjects were required to learn stimulus-response relationships from accuracy feedback. The stimulus-response relationships were reversed halfway through the task, which required subjects to learn the new stimulus-response relationships from accuracy feedback. Performance on the GNGr task was quantified by discriminability (d') between go and no-go stimuli before and after the stimulus-response reversal. GNGr performance did not differ between COMT genotypes when subjects were well-rested. However, TSD exposed a significant vulnerability to adaptive decision making impairment in subjects with the Val allele. Our results indicate that sleep deprivation degrades cognitive control through a fronto-striatal, dopaminergic mechanism.

Sleep Deprivation Diminishes Attentional Control Effectiveness and Impairs Flexible Adaptation to Changing Conditions

Insufficient sleep is a global public health problem resulting in catastrophic accidents, increased mortality, and hundreds of billions of dollars in lost productivity. Yet the effect of sleep deprivation (SD) on decision making and performance is often underestimated by fatigued individuals and is only beginning to be understood by scientists. The deleterious impact of SD is frequently attributed to lapses in vigilant attention, but this account fails to explain many SD-related problems, such as loss of situational awareness and perseveration. Using a laboratory study protocol, we show that SD individuals can maintain information in the focus of attention and anticipate likely correct responses, but their use of such a top-down attentional strategy is less effective at preventing errors caused by competing responses. Moreover, when the task environment requires flexibility, performance under SD suffers dramatically. The impairment in flexible shifting of attentional control we observed is distinct from lapses in vigilant attention, as corroborated by the specificity of the influence of a genetic biomarker, the dopaminergic polymorphism DRD2 C957T. Reduced effectiveness of top-down attentional control under SD, especially when conditions require flexibility, helps to explain maladaptive performance that is not readily explained by lapses in vigilant attention.

Age-differences in cognitive flexibility when overcoming a preexisting bias through feedback

INTRODUCTION

Older adults are often worse than younger adults at adapting to changing situational demands, and this difference is commonly attributed to an age-related decline in acquiring and updating information. Previous research on aging and cognitive flexibility has used measures that require adapting to novel associations learned during a laboratory task (e.g., choice X led to positive outcomes but now leads to negative outcomes). However, in everyday life people must frequently overcome associations based on preexisting beliefs and biases (e.g., you like to eat cake, but your doctor said to limit your sugar intake). The goal of the present study was to examine possible age-differences in overcoming a preexisting bias and determine whether age-related changes in the acquisition and updating of information influence this form of flexibility.

METHOD

Older (n = 20) and younger (n = 20) adults completed a novel task in which repeated choices were made between a sure option (gain or loss) and one of two risky options that were initially ambiguous. Optimal performance required overcoming a framing bias toward being risk seeking to avoid a sure loss and risk averse when offered a sure gain. Probe questions assessed knowledge of choice outcomes, while skin conductance assessed physiological reactions to choices and choice outcomes.

RESULTS

Both older and younger adults demonstrated flexibility by reducing the impact of bias over trials, but younger adults had better performance overall. Age-differences were associated with distinct aspects of processing. Young adults had more precise knowledge of choice outcomes and developed skin conductance responses in anticipation of bad choices that were not apparent in older adults.

CONCLUSIONS

Older adults showed significant improvement over trials in their ability to decrease bias-driven choices, but younger showed greater flexibility. Age-differences in task performance were based on differences in learning and corresponding representations of task-relevant information.

Blunted stress reactivity in chronic cannabis users

RATIONALE

One of the most commonly cited reasons for chronic cannabis use is to cope with stress. Consistent with this, cannabis users have shown reduced emotional arousal and dampened stress reactivity in response to negative imagery.

OBJECTIVES

To our knowledge, the present study represents the first to examine the effects of an acute stress manipulation on subjective stress and salivary cortisol in chronic cannabis users compared to non-users.

METHODS

Forty cannabis users and 42 non-users were randomly assigned to complete either the stress or no stress conditions of the Maastricht Acute Stress Test (MAST). The stress condition of the MAST manipulates both physiological (placing hand in ice bath) and psychosocial stress (performing math under conditions of social evaluation). Participants gave baseline subjective stress ratings before, during, and after the stress manipulation. Cortisol was measured from saliva samples obtained before and after the stress manipulation. Further, cannabis cravings and symptoms of withdrawal were measured.

RESULTS

Subjective stress ratings and cortisol levels were significantly higher in non-users in the stress condition relative to non-users in the no stress condition. In contrast, cannabis users demonstrated blunted stress reactivity; specifically, they showed no increase in cortisol and a significantly smaller increase in subjective stress ratings. The stress manipulation had no impact on cannabis users' self-reported cravings or withdrawal symptoms.

CONCLUSION

Chronic cannabis use is associated with blunted stress reactivity. Future research is needed to determine whether this helps to confer resiliency or vulnerability to stress-related psychopathology as well as the mechanisms underlying this effect.

Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback

STUDY OBJECTIVES

To better understand the sometimes catastrophic effects of sleep loss on naturalistic decision making, we investigated effects of sleep deprivation on decision making in a reversal learning paradigm requiring acquisition and updating of information based on outcome feedback.

DESIGN

Subjects were randomized to a sleep deprivation or control condition, with performance testing at baseline, after 2 nights of total sleep deprivation (or rested control), and following 2 nights of recovery sleep. Subjects performed a decision task involving initial learning of go and no go response sets followed by unannounced reversal of contingencies, requiring use of outcome feedback for decisions. A working memory scanning task and psychomotor vigilance test were also administered.

SETTING

Six consecutive days and nights in a controlled laboratory environment with continuous behavioral monitoring.

SUBJECTS

Twenty-six subjects (22-40 y of age; 10 women).

INTERVENTIONS

Thirteen subjects were randomized to a 62-h total sleep deprivation condition; the others were controls.

MEASUREMENTS AND RESULTS

Unlike controls, sleep deprived subjects had difficulty with initial learning of go and no go stimuli sets and had profound impairment adapting to reversal. Skin conductance responses to outcome feedback were diminished, indicating blunted affective reactions to feedback accompanying sleep deprivation. Working memory scanning performance was not significantly affected by sleep deprivation. And although sleep deprived subjects showed expected attentional lapses, these could not account for impairments in reversal learning decision making.

CONCLUSIONS

Sleep deprivation is particularly problematic for decision making involving uncertainty and unexpected change. Blunted reactions to feedback while sleep deprived underlie failures to adapt to uncertainty and changing contingencies. Thus, an error may register, but with diminished effect because of reduced affective valence of the feedback or because the feedback is not cognitively bound with the choice. This has important implications for understanding and managing sleep loss-induced cognitive impairment in emergency response, disaster management, military operations, and other dynamic real-world settings with uncertain outcomes and imperfect information.

Deconstructing and reconstructing cognitive performance in sleep deprivation

Mitigation of cognitive impairment due to sleep deprivation in operational settings is critical for safety and productivity. Achievements in this area are hampered by limited knowledge about the effects of sleep loss on actual job tasks. Sleep deprivation has different effects on different cognitive performance tasks, but the mechanisms behind this task-specificity are poorly understood. In this context it is important to recognize that cognitive performance is not a unitary process, but involves a number of component processes. There is emerging evidence that these component processes are differentially affected by sleep loss. Experiments have been conducted to decompose sleep-deprived performance into underlying cognitive processes using cognitive-behavioral, neuroimaging and cognitive modeling techniques. Furthermore, computational modeling in cognitive architectures has been employed to simulate sleep-deprived cognitive performance on the basis of the constituent cognitive processes. These efforts are beginning to enable quantitative prediction of the effects of sleep deprivation across different task contexts. This paper reviews a rapidly evolving area of research, and outlines a theoretical framework in which the effects of sleep loss on cognition may be understood from the deficits in the underlying neurobiology to the applied consequences in real-world job tasks.

The role of source memory in gambling task decision making

The role of memory in the Iowa Gambling Task (IGT) was tested in two experiments that dissociated item memory (memory for losses obtained) from source memory (the deck that produced a given loss). In Experiment 1, participants observed 75 choices that had been made by controls or patients in previous research, followed by memory tests, and then 25 active choices from the participant. In Experiment 2, participants made choices for 75 trials, performed the memory tests, and then made 25 final choices. The data show that item and source memory can diverge within the IGT, and that source memory makes a significant contribution to IGT performance.

Optimal choice

We present a classification and theoretical analysis of discrete-trial and free-operant choice procedures in which reinforcement is assigned to one alternative only, or independently to both, is either always available or conditionally available, and is either "held" or not from trial to trial. Momentary-maximizing and (globally) optimal choice sequences are defined in terms of initializing and marker events. Free-operant choice is analyzed in terms of a clock space whose axes are the times since the last A and B choices. The analysis shows that most molar matching data are derivable from momentary maximizing, and that the momentary-maximizing hypothesis has not been adequately tested in either discrete-trial or free-operant situations.

Matching, maximizing, and hill-climbing

In simple situations, animals consistently choose the better of two alternatives. On concurrent variable-interval variable-interval and variable-interval variable-ratio schedules, they approximately match aggregate choice and reinforcement ratios. The matching law attempts to explain the latter result but does not address the former. Hill-climbing rules such as momentary maximizing can account for both. We show that momentary maximizing constrains molar choice to approximate matching; that molar choice covaries with pigeons' momentary-maximizing estimate; and that the "generalized matching law" follows from almost any hill-climbing rule.

Hill-climbing by pigeons

Pigeons were exposed to two types of concurrent operant-reinforcement schedules in order to determine what choice rules determine behavior on these schedules. In the first set of experiments, concurrent variable-interval, variable-interval schedules, key-peck responses to either of two alternative schedules produced food reinforcement after a random time interval. The frequency of food-reinforcement availability for the two schedules was varied over different ranges for different birds. In the second series of experiments, concurrent variable-ratio, variable-interval schedules, key-peck responses to one schedule produced food reinforcement after a random time interval, whereas food reinforcement occurred for an alternative schedule only after a random number of responses. Results from both experiments showed that pigeons consistently follow a behavioral strategy in which the alternative schedule chosen at any time is the one which offers the highest momentary reinforcement probability (momentary maximizing). The quality of momentary maximizing was somewhat higher and more consistent when both alternative reinforcement schedules were time-based than when one schedule was time-based and the alternative response-count based. Previous attempts to provide evidence for the existence of momentary maximizing were shown to be based upon faulty assumptions about the behavior implied by momentary maximizing and resultant inappropriate measures of behavior.

Effects of component length and of the transitions among components in multiple schedules

Pigeons received equal variable-interval reinforcement during presentations of two line-orientation stimuli while five other orientations appeared in extinction. Component duration was 30 seconds for all orientations and the sequence was arranged so that each orientation preceded itself and each other orientation equally often. The duration of one component (0 degrees ) was shortened to 10 seconds and the other (90 degrees ) was lengthened to 50 seconds. All animals showed large increases in response rate in the shortened component and this increase was recoverable after an interpolated condition in which all components were again 30 seconds in duration. This effect was replicated in a second experiment in which component duration was changed from 150 seconds to 50 seconds and 250 seconds. An examination of local contrast effects during the first experiment showed that the shortened component produced local contrast during subsequent presentations of the lengthened component, just as would a component associated with more frequent reinforcement. When the presentation sequence was changed so that the lengthened component was always followed by the shortened component, response rates generally increased during the lengthened component. When the sequence was arranged so that the shortened component always preceded the longer component, response rate decreased in the former. These effects, as well as the increases in response rate following change in component length, seem not to be the product of local contrast effects among components.

Effects of sleep deprivation on dissociated components of executive functioning

STUDY OBJECTIVES

We studied the effects of sleep deprivation on executive functions using a task battery which included a modified Sternberg task, a probed recall task, and a phonemic verbal fluency task. These tasks were selected because they allow dissociation of some important executive processes from non-executive components of cognition.

DESIGN

Subjects were randomized to a total sleep deprivation condition or a control condition. Performance on the executive functions task battery was assessed at baseline, after 51 h of total sleep deprivation (or no sleep deprivation in the control group), and following 2 nights of recovery sleep, at fixed time of day (11:00). Performance was also measured repeatedly throughout the experiment on a control task battery, for which the effects of total sleep deprivation had been documented in previously published studies.

SETTING

Six consecutive days and nights in a controlled laboratory environment with continuous behavioral monitoring.

PARTICIPANTS

Twenty-three healthy adults (age range 22-38 y; 11 women). Twelve subjects were randomized to the sleep deprivation condition; the others were controls.

RESULTS

Performance on the control task battery was considerably degraded during sleep deprivation. Overall performance on the modified Sternberg task also showed impairment during sleep deprivation, as compared to baseline and recovery and compared to controls. However, two dissociated components of executive functioning on this task--working memory scanning efficiency and resistance to proactive interference--were maintained at levels equivalent to baseline. On the probed recall task, resistance to proactive interference was also preserved. Executive aspects of performance on the phonemic verbal fluency task showed improvement during sleep deprivation, as did overall performance on this task.

CONCLUSION

Sleep deprivation affected distinct components of cognitive processing differentially. Dissociated non-executive components of cognition in executive functions tasks were degraded by sleep deprivation, as was control task performance. However, the executive functions of working memory scanning efficiency and resistance to proactive interference were not significantly affected by sleep deprivation, nor were dissociated executive processes of phonemic verbal fluency performance. These results challenge the prevailing view that executive functions are especially vulnerable to sleep loss. Our findings also question the idea that impairment due to sleep deprivation is generic to cognitive processes subserved by attention.

Measurement of cognition in studies of sleep deprivation

Controlled laboratory studies of the effects of sleep deprivation on cognition have the potential to further our understanding of why some complex tasks are more affected by lack of sleep than other tasks. However, apparently simple cognitive tasks reflect multiple cognitive processes at once. Some of the component processes involved in a task may be more affected by sleep deprivation than others. Thus, interpreting measures of overall performance without consideration of the specific task requirements can lead to misleading conclusions. Using examples from studies of attention, working memory and executive functioning, we demonstrate the importance of analysing how different task components contribute to performance and how the nature of the stimulus content can influence outcomes of sleep deprivation studies. Recent developments in cognitive neuropsychology may help sleep researchers conduct more precise tests of fatigue effects on cognition. In turn, studies of sleep and cognition hold promise as a strategy for the development of better general models of how the cognitive system adjusts dynamically to impairments in processing.

Somatic responses in behavioral inhibition

In the present study, skin conductance responses (SCRs) were measured postdecision and prefeedback in a go/no-go (GNG) task in which participants used response feedback to learn when to respond or not to respond to numeric stimuli. Like somatic markers in gambling tasks and somatic reactions to error monitoring in choice reaction time tasks, SCR patterns distinguished between correct and incorrect trials over time. These somatic reactions were disrupted by a reversal of GNG contingencies, and they were facilitated by pretraining of the stimulus-response mappings. In all cases, however, the somatic reactions appeared to be a product of competent decision making rather than a contributor to performance. Differential somatic responses to good and bad choices appear to be a robust and fairly general phenomenon, but researchers should be cautious in assuming that the somatic responses contribute to performance.

Affective biasing of choices in gambling task decision making

The proponents of the somatic marker hypothesis presume that rational decision making is guided by emotional reactions that are developed from prior experience. Supporting evidence for the hypothesis comes almost exclusively from the short-term affective reactions that are learned during the course of a hypothetical decision-making task--the gambling task (GT). We examined GT performance and affective reactions to choices when those choices were biased by words that had preexisting affective value. In one experiment, affectively valued words directly signaled good and bad choices. A congruent relation between affective value of word and choice outcome improved GT performance, whereas an incongruent relation greatly interfered with performance. In another experiment, affectively valued words were maintained as a working memory (WM) load between GT choices. A WM load with affectively positive words somewhat improved GT performance, whereas affectively negative words interfered with performance. Somatic markers-indicated by differential anticipatory skin conductance response (SCR) amplitude for good and bad choices-appeared at a point in the GT session when choice performance was superior. However, differential SCR developed during the session after good choice performance was already established. These results indicate that preexisting affective biases can influence GT decision making. In addition, the somatic markers that are regular accompaniments of GT decision making appeared to be temporally lagging indicators of choice performance.

Components of working memory and somatic markers in decision making

According to Damasio's somatic marker hypothesis, affective reactions ordinarily guide and simplify decision making. In an earlier study, we used a modified version of the gambling task developed by Bechara and colleagues so that we could explore the relations among decision making, working memory (WM) load, and formation of somatic markers. This prior work found that an increased WM load produced by secondary tasks interfered with the development of somatic markers and led to poorer gambling task performance. In the present study, we tested whether secondary tasks affect the executive functions of WM, verbal buffering, or both. Our findings indicate that verbal buffering alone does not interfere with gambling task performance or the development of somatic markers. Interference with the executive functions of WM is necessary to disrupt gambling performance and somatic markers.

Impulsive decision making and working memory

Decision making that favors short-term over long-term consequences of action, defined as impulsive or temporally myopic, may be related to individual differences in the executive functions of working memory (WM). In the first 2 experiments, participants made delay discounting (DD) judgments under different WM load conditions. In a 3rd experiment, participants high or low on standardized measures of imupulsiveness and dysexecutive function were asked to make DD judgments. A final experiment examined WM load effects on DD when monetary rewards were real rather than hypothetical. The results showed that higher WM load led to greater discounting of delayed monetary rewards. Further, a strong direct relation was found between measures of impulsiveness, dysexecutive function,and discounting of delayed rewards. Thus, limits on WM function, either intrinsic or extrinsic, are predictive of a more impulsive decision-making style.

Somatic markers, working memory, and decision making

The somatic marker hypothesis formulated by Damasio (e.g., 1994; Damasio, Tranel, & Damasio, 1991) argues that affective reactions ordinarily guide and simplify decision making. Although originally intended to explain decision-making deficits in people with specific frontal lobe damage, the hypothesis also applies to decision-making problems in populations without brain injury. Subsequently, the gambling task was developed by Bechara (Bechara, Damasio, Damasio, & Anderson, 1994) as a diagnostic test of decision-making deficit in neurological populations. More recently, the gambling task has been used to explore implications of the somatic marker hypothesis, as well as to study suboptimal decision making in a variety of domains. We examined relations among gambling task decision making, working memory (WM) load, and somatic markers in a modified version of the gambling task. Increased WM load produced by secondary tasks led to poorer gambling performance. Declines in gambling performance were associated with the absence of the affective reactions that anticipate choice outcomes and guide future decision making. Our experiments provide evidence that WM processes contribute to the development of somatic markers. If WM functioning is taxed, somatic markers may not develop, and decision making may thereby suffer.

Zanamivir in the prevention of influenza among healthy adults: a randomized controlled trial

CONTEXT

The neuraminidase inhibitor zanamivir, a sialic acid analog administered directly to the respiratory tract, has been demonstrated in clinical studies to be effective in treatment of type A and B influenza. It has also been shown to prevent influenza infection and disease in an experimental model.

OBJECTIVE

To examine the efficacy of zanamivir, administered once daily, in the prevention of influenza infection and disease.

DESIGN

Double-blind, randomized, placebo-controlled trial.

SETTING

Two midwestern university communities.

PARTICIPANTS

A total of 1107 healthy adults (mean age [range], 29 [18-69] years) were recruited in November 1997, before the influenza season.

INTERVENTION

At the start of the influenza outbreak, 554 subjects were randomized to receive placebo and 553 to receive zanamivir. The drug, 10 mg once per day, or identical placebo was administered by oral inhalation for a 4-week period.

MAIN OUTCOME MEASURES

Illness occurrence was recorded by participants daily and records were evaluated weekly. Specimens were collected for viral isolation when symptoms were reported within 3 days of illness onset. Infection was also identified by testing paired serum samples for rise in antibody titer against the circulating influenza viruses.

RESULTS

Zanamivir was 67% efficacious (95% confidence interval [CI], 39%-83%; P<.001) in preventing laboratory-confirmed clinical influenza meeting the case definition and 84% efficacious (95% CI, 55%-94%; P=.001) in preventing laboratory-confirmed illnesses with fever. All influenza infections occurring during the season, with or without symptoms, were prevented with an efficacy of 31% (95% CI, 4%-50%; P=.03). The nature and incidence of adverse events in the zanamivir group did not differ from placebo. Compliance with the once-daily dosage was high.

CONCLUSIONS

Zanamivir administered once daily is efficacious and well tolerated in the prevention of influenza for a 4-week period in healthy adults.

Range effects and dimensional organization in visual discrimination

Pigeons were trained to discriminate two types of visual forms that could vary in two orthogonal dimensions. One set of stimuli was designed to have relatively integral dimensions, while the other set of stimuli was intended to have relatively separable dimensions, for the pigeon. A first experiment provided evidence that the dimensions of our two stimulus sets differed in the degree of separability. The second experiment examined the effect of increased stimulus range on discrimination of the two stimulus sets. Results from this experiment indicated that increases in range in either relevant or irrelevant dimensions reduced discrimination for the integral stimulus set. For the separable stimulus dimensions, however, performance declined only with increased stimulus range along a relevant dimension. In the third experiment, stimulus range was increased along either one or two dimensions of the stimulus. Correlated changes in stimulus range along two dimensions had an impact only for integral stimuli. In summary, these experiments demonstrate that the organizational structure of stimulus dimensions determines the impact of increases in stimulus range, probably due to the attentional properties of different stimulus forms.

The effects of transtracheal gas delivery on central inspiratory neuromuscular drive

Previous studies have shown transtracheal delivery of low-flow oxygen (TTO) decreases inspired minute ventilation (Veinsp) and have postulated that this would result in a decrease in the work of breathing (WOB). We hypothesized that a fall in central inspiratory neuromuscular drive (CIND) with TTO would reflect a fall in WOB. We measured resting ventilatory parameters (RVP) and CIND by the mouth occlusion pressure technique (MOP) at different gas flow rates through the catheter in 21 subjects (13 men, 8 women; mean age, 60 +/- 10.6 years) with severe COPD with a mature intratracheal oxygen catheter (ITOC). We also constructed a lung/chest wall analog (LCA) to determine if flow through the catheter would alter pressure changes during inspiration. Inspiratory tidal volume (Vtinsp) and minute ventilation (Veinsp) decreased proportionally to the gas flow rate through the catheter. However, with increasing flow through the catheter, P0.1 increased in the LCA, presumably due to the Bernoulli effect. The lack of a similar change in the subject group suggests that CIND does, in fact, fall, and that possibly there is a decrease in WOB. This effect may be of benefit to patients with severe COPD.

Dobutamine, but not dopamine, augments the normal chronotropic response to acute hypoxemia

Infusion of exogenous dopamine has been shown to alter both the hypoxic and the hypercapnic ventilatory response, but its effects on the hypoxic and the hypercapnic cardiac response have not been reported. The purpose of this study was to determine if cardiac responses to hypoxemia and hypercapnia are altered by infusion of either dopamine (DOP) or its analog dobutamine (DBT). Baseline mean arterial blood pressure (MAP) and heart rate (HR) were measured in 7 normal male subjects while normal saline was infused intravenously (NS1) for 30 min. Each subject then underwent both a eucapnic hypoxemic challenge (EHC), and a hyperoxic hypercapnic challenge (HHC). In a double-blinded randomized fashion either DOP1 or DBT1 was selected and infused at 5 micrograms/kg/min for 30 min. EHC and HHC were again performed. This sequence was then repeated following a second NS infusion (NS2) and the alternate vasopressor. On a second study day, the dose of dopamine (DOP2) selected was that sufficient to induce a similar rise in MAP as seen with DBT1. Following NS and DOP1 there was a reproducible significant linear increase in HR with progressive hypoxemia seen in all subjects. This response was significantly augmented following infusion of DBT1 (p < 0.03), but no such augmentation was noted with DOP2. No significant change in HR was noted during HHC. The mechanisms responsible for this augmentation of hypoxemic response during dobutamine infusion are unclear, and do not appear to be related to a rise in MAP. We speculate that it is due to an effect of dobutamine on beta 1-receptor activity.

Patterns of responding within sessions

Rates of responding changed systematically across sessions for rats pressing levers and keys and for pigeons pressing treadles and pecking keys. A bitonic function in which response rates increased and then decreased across sessions was the most common finding, although an increase in responding also occurred alone. The change in response rate was usually large. The function relating responding to time in session had the following general characteristics: It appeared early in training, and further experience moved and reduced its peak; it was flatter for longer sessions; and it was flatter, more symmetrical, and peaked later for lower than for higher rates of reinforcement. Factors related to reinforcement exerted more control over the location of the peak rate of responding and the steepness of the decline in response rates than did factors related to responding. These within-session changes in response rates have fundamental theoretical and methodological implications.

Strut fixation of an extensive flail chest

The indications for and preferred approaches to operative stabilization of posttraumatic chest wall instability are uncertain. We suggest this simple, rapid, and effective approach to surgical stabilization by Luque rod strutting of the flail segment when operation is required.

Discrete and continuous measures of dimensional stimulus control

In two sets of experiments, we examined dimensional stimulus control of pigeons' responses to a visual flicker-rate continuum. In the first experiment, responses to a single key were reinforced periodically during stimuli from one half of the stimulus continuum, and responses during other stimuli were extinguished. In the second experiment, two response keys were simultaneously available, with reinforcement for each response alternative associated with different halves of the stimulus continuum. Conditions of the second experiment involved either free-operant or discrete-trial stimulus presentations. Results from these experiments show that positive dimensional contrast appeared in discrimination tasks with one or two response alternatives, but only with free-operant procedures. In addition, discrimination between stimulus classes established by differential reinforcement was assessed as accurately by continuous rate measures as by discrete response choice in the two-alternative situation. The general implication of these experiments is that response rate measures, when properly applied, may reveal sources of variation within stimulus classes, such as dimensional contrast, that are not evident with discrete measures.

Massed and spaced stimulus sequences in dimensional discrimination

In two experiments, pigeons' responding to a visual flicker-rate continuum was established by a maintained generalization procedure. For both experiments, variable-interval reinforcement was available for responses during stimuli from one half of the stimulus continuum while responses during other stimuli were extinguished. The first experiment compared gradients of dimensional stimulus control produced by randomly presented positive and negative stimuli with gradients produced by massed positive and negative stimuli. The second experiment alternated the order of massed stimulus sequences. In both cases, massing of stimulus sequences diminished positive dimensional contrast effects, without seriously disturbing discrimination between positive and negative stimuli. The results indicate that stimulus sequences can have an important role in the production of dimensional contrast effects.