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Semin Speech Lang 2002; 23(2): 139-150
DOI: 10.1055/s-2002-24990
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

The Effect of Attentional Dysfunction in Alzheimer's Disease: Theoretical and Practical Implications

Nancy S. Foldi1, 2, 3 , Jacqueline J. Lobosco2 , Lynn A. Schaefer1
  • 1Department of Psychology, Queens College-City University of New York, Flushing, New York
  • 2Department of Psychology, The Graduate Center-City University of New York, New York, NY
  • 3Division of Geriatrics, Department of Medicine, Winthrop-University Hospital, Stony Brook School of Medicine, Mineola, New York
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Publication History

Publication Date:
11 April 2002 (online)

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ABSTRACT

Attention may be one of the earliest cognitive abilities to change in Alzheimer's disease (AD), although its role has received belated recognition. This article discusses different aspects of attention and how these are differentially affected in AD. Of the various attention functions, divided and selective attention are particularly vulnerable. The etiology of attentional deficits in AD arises from damage to areas of frontal and parietal association cortex, disconnection between the anterior and posterior attentional networks, and decreased cholinergic function. Severity of illness is associated with attentional deterioration. Complexity or increased load of a task may further disrupt attentional function. Knowledge of attentional changes in AD is important to the understanding of disease-related changes in other cognitive domains such as memory, visuospatial functions, and language.

KEYWORD

Alzheimer's disease - attention

REFERENCES

  • 1 McKhann G, Drachman D, Folstein M F. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group, Department of Health and Human Services Task Force on Alzheimer's Disease.  Neurology . 1984;  34 939-944
    CrossrefPubMedGoogle Scholar
  • 2 Perry R J, Hodges J R. Attention and executive deficits in Alzheimer's disease: a critical review.  Brain . 1999;  122 383-404
    CrossrefPubMedGoogle Scholar
  • 3 Haxby J V, Horowitz B, Ungerleider L G. The functional organization of human extrastriate cortex: a PET-rCBF study of selective attention to faces and locations.  J Neurosci . 1994;  14 6336-6353
    CrossrefPubMedGoogle Scholar
  • 4 Johannsen P, Jakobsen J, Bruhn P, Gjedde A. Cortical responses to sustained and divided attention in Alzheimer's disease.  Neuroimage . 1999;  10 269-281
    CrossrefPubMedGoogle Scholar
  • 5 Almkvist O. Functional brain imaging as a looking-glass into the degraded brain: reviewing evidence from Alzheimer disease in relation to normal aging.  Acta Psychologica . 2000;  105 255-277
    CrossrefPubMedGoogle Scholar
  • 6 Haxby J V, Grady C L, Duara R. Neocortical metabolic abnormalities precede nonmemory cognitive defects in early Alzheimer's-type dementia.  Arch Neurol . 1986;  43 882-885
    PubMedGoogle Scholar
  • 7 Parasuraman R, Greenwood P M. Selective attention in aging and dementia. In: Parasuraman R, ed. The Attentive Brain Cambridge, MA: The MIT Press 1998: 461-487
    Google Scholar
  • 8 Parasuraman R, Haxby J V. Attention and brain function in Alzheimer's disease: a review.  Neuropsychology . 1993;  7 242-272
    CrossrefPubMedGoogle Scholar
  • 9 Perry R J, Watson P, Hodges J R. The nature and staging of attention dysfunction in early (minimal and mild) Alzheimer's disease: relationship to episodic and semantic memory impairment.  Neuropsychologia . 2000;  38 252-271
    CrossrefPubMedGoogle Scholar
  • 10 Kastner S, Ungerleider L G. Mechanisms of visual attention in the human cortex.  Annu Rev Neurosci . 2000;  23 315-341
    CrossrefPubMedGoogle Scholar
  • 11 Wolfe J M. Guided search 2.0: a revised model of visual search.  Psychonomic Bulletin and Review . 1994;  1 202-238
    PubMedGoogle Scholar
  • 12 Cherry E C. Some experiments on the recognition of speech, with one and with two ears.  J Acoust Soc Am . 1953;  26 975-979
    PubMedGoogle Scholar
  • 13 Posner M I, Petersen S E. The attention system of the human brain.  Annu Rev Neurosci . 1990;  13 25-42
    CrossrefPubMedGoogle Scholar
  • 14 Mesulam M-M. Principles of Behavioral and Cognitive Neurology, 2nd ed. New York: Oxford University Press; 2000 . 
    Google Scholar
  • 15 Nebes R D, Brady C B. Phasic and tonic alertness in Alzheimer's disease.  Cortex . 1993;  29 77-90
    PubMedGoogle Scholar
  • 16 Parasuraman R, Nestor P G. Preserved cognitive operations in early Alzheimer's disease. In: Cerella J, Rybash J, Hoyer W, Commons ML, eds. Adult Information Processing: Limits on Loss San Diego: Academic Press 1993: 77-111
    Google Scholar
  • 17 Connors C K. Multi-Health Systems Staff.  Connors' Continuous Performance Test. Toronto: Multi-Health Systems 1995
    Google Scholar
  • 18 Lines C R, Dawson C, Preston G C. Memory and attention in patients with senile dementia of the Alzheimer type and in normal elderly subjects.  J Clin Exp Neuropsychol . 1991;  13 691-702
    PubMedGoogle Scholar
  • 19 Sano M, Rosen W, Stern Y, Rosen J, Mayeux R. Simple reaction time as a measure of global attention in Alzheimer's disease.  J Int Neuropsychol Soc . 2001;  1 56-61
    PubMedGoogle Scholar
  • 20 Brazzelli M, Cocchini G, Della Salla S, Spinnler H. Alzheimer patients show a sensitivity decrement over time on a tonic alertness task.  J Clin Exp Neuropsychol . 1994;  16 851-860
    PubMedGoogle Scholar
  • 21 Davies D R, Jones D M, Taylor A. Selective and sustained-attention tasks: individual and group differences. In: Parasuraman R, Davies DR, eds. Varieties of Attention San Diego: Academic Press 1984: 395-447
    Google Scholar
  • 22 Robertson I H, Ward T, Ridgeway V, Nimmo-Smith I. Tests of Everyday Attention.  Bury St. Edmunds, UK: Thames Valley Test Company 1994
    Google Scholar
  • 23 Wechsler D. Wechsler Adult Intelligence Scale-Revised. New York: The Psychological Corporation . 1981
    Google Scholar
  • 24 Bäckman L, Small B J, Fratiglioni L. Stability of the preclinical episodic memory deficit in Alzheimer's disease.  Brain . 2001;  124 96-102
    CrossrefPubMedGoogle Scholar
  • 25 Rizzo M, Anderson S W, Dawson J, Myers R, Ball K. Visual attention impairments in Alzheimer's disease.  Neurology . 2000;  54 1954-1959
    PubMedGoogle Scholar
  • 26 Perry R J, Hodges J R. Fate of patients with questionable (very mild) Alzheimer's disease: longitudinal profiles of individual subjects' decline.  Dementia and Geriatric Cognitive Disorders . 2000;  11 342-349
    CrossrefPubMedGoogle Scholar
  • 27 Gainotti G, Marra C, Villa G. A double dissociation between accuracy and time of execution on attentional tasks in Alzheimer's disease and multi-infarct dementia.  Brain . 2001;  124 731-738
    CrossrefPubMedGoogle Scholar
  • 28 Posner M I. Orienting of attention.  Q J Exp Psychol . 1980;  32 3-25
    PubMedGoogle Scholar
  • 29 Parasuraman R, Greenwood P M, Haxby J V, Grady C L. Visuospatial attention in dementia of the Alzheimer type.  Brain . 1992;  115 711-733
    PubMedGoogle Scholar
  • 30 Greenwood P M, Parasuraman R, Haxby J V. Visuospatial attention across the adult life span.  Neuropsychologia . 1993;  31 471-485
    CrossrefPubMedGoogle Scholar
  • 31 Oken B S, Kishiyama S S, Kaye J A, Howieson D B. Attention deficit in Alzheimer's disease is not simulated by an anticholinergic/antihistaminergic drug and is distinct from deficits in healthy aging.  Neurology . 1994;  44 657-662
    PubMedGoogle Scholar
  • 32 Corbetta M, Miezin F M, Shulman G L, Petersen S E. A PET study of visuospatial attention.  J Neurosci . 1993;  13 1202-1226
    PubMedGoogle Scholar
  • 33 Greenwood P, Parasuraman R, Alexander G E. Controlling the focus of spatial attention during visual search: effects of advanced aging and Alzheimer disease.  Neuropsychology . 1997;  11 3-12
    CrossrefPubMedGoogle Scholar
  • 34 Daffner K R, Mesulam M-M, Scinto L FM. The central role of the prefrontal cortex in directing attention to novel events.  Brain . 2000;  123 927-939
    CrossrefPubMedGoogle Scholar
  • 35 Knight R T, Scabini D. Anatomic bases of event-related potential and their relationship to novelty detection in humans.  J Clin Neurophysiol . 1998;  15 3-13
    PubMedGoogle Scholar
  • 36 Cummings J L. The neuropsychiatric inventory: assessing psychopathology in dementia patients.  Neurology . 1997;  48(Suppl 6) S10-S16
    PubMedGoogle Scholar
  • 37 Miranda M I, Ramirez-Lugo L, Bermudez-Rattoni F. Cortical cholinergic activity is related to the novelty of the stimulus.  Brain Res . 2000;  882 230-235
    CrossrefPubMedGoogle Scholar
  • 38 Daffner K R, Rentz D M, Scinto L FM. Pathophysiology underlying diminished attention to novel events in patients with early AD.  Neurology . 2001;  56 1377-1383
    PubMedGoogle Scholar
  • 39 LaBar K S, Mesulam M-M, Gitelman D R, Weintraub S. Emotional curiosity: modulation of visuospatial attention by arousal is preserved in aging and early-stage Alzheimer's disease.  Neuropsychologia . 2000;  38 1734-1740
    CrossrefPubMedGoogle Scholar
  • 40 Heilman K M, Valenstein E, Watson R T. Neglect and related disorders.  Semin Neurol . 1984;  2000 20:463-470
    PubMedGoogle Scholar
  • 41 Ishiai S, Koyama Y, Seki K. Unilateral spatial neglect in AD: significance of line bisection performance.  Neurology . 2000;  55 364-370
    PubMedGoogle Scholar
  • 42 Nestor P G, Parasuraman R, Haxby J V, Grady C L. Divided attention and metabolic brain dysfunction in mild dementia of the Alzheimer's type.  Neuropsychologia . 2001;  29 379-387
    PubMedGoogle Scholar
  • 43 Baddeley A D, Baddeley H D, Bucks R S, Wilcock G K. Attentional control in Alzheimer's disease.  Brain . 2001;  124 1492-1508
    CrossrefPubMedGoogle Scholar
  • 44 Foldi N S, Jutagir R, Davidoff D, Gould T. Selective attention skills in Alzheimer's disease: performance on graded cancellation tests varying in density and complexity.  Journal of Gerontology - Psychological Sciences . 1992;  47 P146-P153
    PubMedGoogle Scholar
  • 45 Parasuraman R, Greenwood P M, Alexander G E. Selective impairment of spatial attention during visual search in Alzheimer's disease.  Neuroreport . 1995;  6 1861-1864
    PubMedGoogle Scholar
  • 46 Caputo G, Guerra S. Attentional selection by distractor suppression.  Vision Res . 1998;  38 669-689
    CrossrefPubMedGoogle Scholar
  • 47 Foster J K. Selective attention in Alzheimer's disease.  Frontiers in Bioscience . 2001;  6 D135-D153
    PubMedGoogle Scholar
  • 48 Treisman A, Gelade G A. A feature integration theory of attention.  Cogn Psychol . 1980;  12 97-136
    CrossrefPubMedGoogle Scholar
  • 49 Plude D J, Doussard-Roosevelt J A. Aging, selective attention, and feature integration.  Psychol Aging . 1989;  4 98-105
    CrossrefPubMedGoogle Scholar
  • 50 Duncan J, Humphreys G W. Visual search and stimulus similarity.  Psychol Rev . 1989;  96 433-458
    PubMedGoogle Scholar
  • 51 Nebes R D, Brady C B. Focused and divided attention in Alzheimer's disease.  Cortex . 1989;  25 305-315
    PubMedGoogle Scholar
  • 52 Foster J K, Behrmann M, Stuss D T. Visual attention deficits in Alzheimer's disease: simple versus conjoined feature search.  Neuropsychology . 1999;  13 223-245
    CrossrefPubMedGoogle Scholar
  • 53 Lavie N, Tsal Y. Perceptual load as a major determinant of locus of selection in visual attention.  Perception and Psychophysics . 1994;  56 183-197
    PubMedGoogle Scholar
  • 54 Cossa F M, Della Salla S, Spinnler H. Selective visual attention in Alzheimer's and Parkinson's patients: memory- and data-driven control.  Neuropsychologia . 1989;  27 887-892
    CrossrefPubMedGoogle Scholar
  • 55 Albert M S, Moss M B, Tanzi R, Jones K. Preclinical prediction of AD using neuropsychological tests.  J Int Neuropsychol Soc . 2001;  7 631-639
    CrossrefPubMedGoogle Scholar
  • 56 Killiany R J, Gomez-Isla T, Moss M. Use of structural magnetic resonance imaging to predict who will get Alzheimer's disease.  Ann Neurol . 2000;  47 430-439
    CrossrefPubMedGoogle Scholar
  • 57 McKeith I G, Galasko D, Kosaka K. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium of DLB international workshop.  Neurology . 1996;  47 1113-1124
    CrossrefPubMedGoogle Scholar
  • 58 Hansen L, Salmon D, Galasko D. The Lewy body variant of Alzheimer's disease: a clinical and pathologic entity.  Neurology . 1990;  40 1-8
    PubMedGoogle Scholar
  • 59 Calderon J, Perry R J, Erzinclioglu S W. Perception, attention, and working memory are disproportionately impaired in dementia with Lewy bodies compared with Alzheimer's disease.  J Neurol Neurosurg Psychiatry . 2001;  70 157-164
    CrossrefPubMedGoogle Scholar
  • 60 Ballard C, O'Brien J, Gray A. Attention and fluctuating attention in patients with dementia with Lewy bodies and Alzheimer disease.  Arch Neurol . 2001;  58 977-982
    CrossrefPubMedGoogle Scholar
  • 61 Desimone R, Duncan J. Neural mechanisms of selective visual attention.  Annu Rev Neurosci . 1995;  18 193-222
    CrossrefPubMedGoogle Scholar
  • 62 Reynolds J H, Pasternak T, Desimone R. Attention increases sensitivity of V4 neurons.  Neuron . 2000;  26 703-714
    CrossrefPubMedGoogle Scholar
  • 63 Stuss D T, Shallice T, Alexander M P, Picton T W. A multidisciplinary approach to anterior attentional functions.  Ann N Y Acad Sci . 1995;  769 191-211
    CrossrefPubMedGoogle Scholar
  • 64 Kastner S, Pinsk M A, De Weerd P, Desimone R, Ungerleider L G. Increased activity in human visual cortex during directed attention in the absence of visual stimulation.  Neuron . 1999;  22 751-761
    CrossrefPubMedGoogle Scholar
  • 65 Stuss D T, Toth J P, Franchi D P. Dissociation of attentional processes in patients with focal frontal and posterior lesions.  Neuropsychologia . 1999;  37 1005-1027
    CrossrefPubMedGoogle Scholar
  • 66 Davies P, Maloney A JF. Selective loss of central cholinergic neurons in Alzheimer's disease.  Lancet . 1976;  2 1403
    PubMedGoogle Scholar
  • 67 Davidson M C, Marrocco R T. Local infusion of scopolamine into intraparietal cortex slows covert orienting in rhesus monkeys.  J Neurophysiol . 2000;  83 1536-1549
    PubMedGoogle Scholar
  • 68 Levy J A, Parasuraman R, Greenwood P M, Dukoff R, Sunderland T. Acetylcholine affects the spatial scale of attention: evidence from Alzheimer's disease.  Neuropsychology . 2000;  14 288-298
    CrossrefPubMedGoogle Scholar
  • 69 Rogers S L, Friedhoff L T. The efficacy and safety of donepezil in patients with Alzheimer's disease.  Dementia . 1996;  7 293-303
    PubMedGoogle Scholar
  • 70 Rösler M, Anand R, Cincin-Sain A. Efficacy and safety of rivastigmine in patients with Alzheimer's disease: international randomised controlled trial.  BMJ . 2000;  318 633-638
    PubMedGoogle Scholar
  • 71 Bentham P, Gray R, Sellwood E, Raftery J. Effectiveness of rivastigmine in Alzheimer's disease. Improvements in functional ability remain unestablished.  BMJ . 1999;  319 640-641
    PubMedGoogle Scholar
  • 72 Mirza R N, Stolerman P I. The role of nicotinic and muscarinic acetylcholine receptors in attention.  Psychopharmacology . 2000;  148 243-250
    CrossrefPubMedGoogle Scholar
  • 73 Stryker M P. Drums keep pounding a rhythm in the brain.  Science . 2001;  291 1506-1507
    CrossrefPubMedGoogle Scholar
  • 74 Wolfe J M, Friedman-Hill S R, Steward M I, O'Connel K M. The role of categorization in visual search for orientation.  J Exp Psychol Hum Percept Perform . 1992;  18 34-39
    CrossrefPubMedGoogle Scholar
  • 75 Monsch A, Bondi M, Butters N. Comparisons of verbal fluency tasks in the detection of dementia of the Alzheimer type.  Arch Neurol . 1992;  49 1253-1258
    PubMedGoogle Scholar
  • 76 Rizzo M, Reinach S, McGehee D V, Dawson J. Simulated car crashes and crash predictors in drivers with Alzheimer disease.  Arch Neurol . 1997;  54 545-553
    PubMedGoogle Scholar
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