Neural correlates of alerting and orienting impairment in multiple sclerosis patients

Manuel Vázquez-Marrufo, Alejandro Galvao-Carmona, Javier J González-Rosa, Antonio R Hidalgo-Muñoz, Mónica Borges, Juan Luis Ruiz-Peña, Guillermo Izquierdo, Manuel Vázquez-Marrufo, Alejandro Galvao-Carmona, Javier J González-Rosa, Antonio R Hidalgo-Muñoz, Mónica Borges, Juan Luis Ruiz-Peña, Guillermo Izquierdo

Abstract

Background: A considerable percentage of multiple sclerosis patients have attentional impairment, but understanding its neurophysiological basis remains a challenge. The Attention Network Test allows 3 attentional networks to be studied. Previous behavioural studies using this test have shown that the alerting network is impaired in multiple sclerosis. The aim of this study was to identify neurophysiological indexes of the attention impairment in relapsing-remitting multiple sclerosis patients using this test.

Results: After general slowing had been removed in patients group to isolate the effects of each condition, some behavioral differences between them were obtained. About Contingent Negative Variation, a statistically significant decrement were found in the amplitude for Central and Spatial Cue Conditions for patient group (p<0.05). ANOVAs showed for the patient group a significant latency delay for P1 and N1 components (p<0.05) and a decrease of P3 amplitude for congruent and incongruent stimuli (p<0.01). With regard to correlation analysis, PASAT-3s and SDMT showed significant correlations with behavioral measures of the Attention Network Test (p<0.01) and an ERP parameter (CNV amplitude).

Conclusions: Behavioral data are highly correlated with the neuropsychological scores and show that the alerting and orienting mechanisms in the patient group were impaired. Reduced amplitude for the Contingent Negative Variation in the patient group suggests that this component could be a physiological marker related to the alerting and orienting impairment in relapsing-remitting multiple sclerosis. P1 and N1 delayed latencies are evidence of the demyelination process that causes impairment in the first steps of the visual sensory processing. Lastly, P3 amplitude shows a general decrease for the pathological group probably indexing a more central impairment. These results suggest that the Attention Network Test give evidence of multiple levels of attention impairment, which could help in the assessment and treatment of relapsing-remitting multiple sclerosis patients.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Experimental procedure.
Figure 1. Experimental procedure.
The possible combinations for sets of cues and targets were six: No cue congruent (NC-C), No cue incongruent (NC-I), Central cue congruent (CC-C), Central cue incongruent (CC-I), Spatial cue congruent (SC-C) and Spatial cue incongruent (SC-I).
Figure 2. 58 scalp electrodes recorded and…
Figure 2. 58 scalp electrodes recorded and sets of electrodes analyzed for each ERP (CNV, P1, N1 and P3) studied.
Figure 3. Contingent Negative Variation modulations at…
Figure 3. Contingent Negative Variation modulations at Cz electrode and topographic maps.
Figure 4. P3 component modulations at Pz…
Figure 4. P3 component modulations at Pz electrode and topographic maps.
Figure 5. Correlation analyses.
Figure 5. Correlation analyses.
Neuropsychological score (PASAT-3s) and mean reaction time (upper panel); Accuracy in the Attention Network Test and SDMT score (middle panel), and CNV amplitude and SDMT score (lower panel).

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