Parameter-Based Evaluation of Attentional Impairments in Schizophrenia and Their Modulation by Prefrontal Transcranial Direct Current Stimulation.

BACKGROUND: Attentional dysfunctions constitute core cognitive symptoms in schizophrenia, but the precise underlying neurocognitive mechanisms remain to be elucidated. METHODS: In this randomized, double-blind, sham-controlled study, we applied, for the first time, a theoretically grounded modeling approach based on Bundesen's Theory of Visual Attention (TVA) to (i) identify specific visual attentional parameters affected in schizophrenia and (ii) assess, as a proof of concept, the potential of single-dose anodal transcranial direct current stimulation (tDCS; 20 min, 2 mA) to the left dorsolateral prefrontal cortex to modulate these attentional parameters. To that end, attentional parameters were measured before (baseline), immediately after, and 24 h after the tDCS intervention in 20 schizophrenia patients and 20 healthy controls. RESULTS: At baseline, analyses revealed significantly reduced visual processing speed and visual short-term memory storage capacity in schizophrenia. A significant stimulation condition × time point interaction in the schizophrenia patient group indicated improved processing speed at the follow-up session only in the sham condition (a practice effect), whereas performance remained stable across the three time points in patients receiving verum stimulation. In healthy controls, anodal tDCS did not result in a significant change in attentional performance. CONCLUSION: With regard to question (i) above, these findings are indicative of a processing speed and short-term memory deficit as primary sources of attentional deficits in schizophrenia. With regard to question (ii), the efficacy of single-dose anodal tDCS for improving (speed aspects of visual) cognition, it appears that prefrontal tDCS (at the settings used in the present study), rather than ameliorating the processing speed deficit in schizophrenia, actually may interfere with practice-dependent improvements in the rate of visual information uptake. Such potentially unexpected effects of tDCS ought to be taken into consideration when discussing its applicability in psychiatric populations. The study was registered at http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00011665.

Single-session transcranial direct current stimulation induces enduring enhancement of visual processing speed in patients with major depression.

Attentional deficits are considered key cognitive symptoms in major depressive disorder (MDD) arising from abnormal activation patterns within dorsolateral prefrontal cortex (dlPFC) alertness networks. Altering these activity patterns with transcranial direct current stimulation (tDCS) might thus ameliorate alertness-dependent cognitive deficits in MDD patients. In a double-blind, randomized, sham-controlled study, we investigated the effect of a single session of anodal tDCS (2 mA) applied to the left dlPFC on different parameters of visual attention based on Bundesen's theory of visual attention (Psychol Rev 97(4):523-547, 1990) in a group of 20 patients with MDD and a control group of 20 healthy participants. The parametric attention assessment took place before, immediately after and 24 h after tDCS intervention. It revealed a selective impairment in visual processing speed as a primary functional deficit in MDD at baseline assessment. Furthermore, a significant stimulation condition × time point interaction showed that verum tDCS over the left dlPFC resulted in a processing speed enhancement 24 h post-stimulation in MDD patients. In healthy control participants, we did not find similar tDCS-induced effects. Our results suggest that even a single session of tDCS over the dlPFC can induce enduring neurocognitive benefits that indicate an amelioration of cortical under-arousal in MDD patients in a time frame beyond that of immediate, excitability increases that are directly induced by the current.

Object integration requires attention: Visual search for Kanizsa figures in parietal extinction.

The contribution of selective attention to object integration is a topic of debate: integration of parts into coherent wholes, such as in Kanizsa figures, is thought to arise either from pre-attentive, automatic coding processes or from higher-order processes involving selective attention. Previous studies have attempted to examine the role of selective attention in object integration either by employing visual search paradigms or by studying patients with unilateral deficits in selective attention. Here, we combined these two approaches to investigate object integration in visual search in a group of five patients with left-sided parietal extinction. Our search paradigm was designed to assess the effect of left- and right-grouped nontargets on detecting a Kanizsa target square. The results revealed comparable reaction time (RT) performance in patients and controls when they were presented with displays consisting of a single to-be-grouped item that had to be classified as target vs. nontarget. However, when display size increased to two items, patients showed an extinction-specific pattern of enhanced RT costs for nontargets that induced a partial shape grouping on the right, i.e., in the attended hemifield (relative to the ungrouped baseline). Together, these findings demonstrate a competitive advantage for right-grouped objects, which in turn indicates that in parietal extinction, attentional competition between objects particularly limits integration processes in the contralesional, i.e., left hemifield. These findings imply a crucial contribution of selective attentional resources to visual object integration.