Measuring the attention networks and quantitative-electroencephalography correlates of attention in depression

Depression is a mental disorder that globally impacts over 264 million individuals of all ages (World Health Organization, 2020). Previous reports suggest that depression originates from multifaceted disruptions in the interconnected neural circuitry in several cortical (e.g., prefrontal cortex, cingulate cortex) and subcortical brain regions associated with reward processing and self-preservation (Drevets et al., 2008; Furman et al., 2011; Johansen-Berg et al., 2008; Zhao et al., 2017). These disruptions in neural circuitry may be responsible for the functional outcomes in individuals with MDD. Specifically, McIntyre et al. (2013) indicate that functional outcomes are associated with, and can be mediated by, cognitive disturbances; these may include deficits in cognitive domains such as attention, concentration, and executive functioning (see Cambridge et al., 2018; McClintock et al., 2010 for full review).

The Combined Attention Systems Task (CAST; (Lawrence, 2018) was developed to assess these attention networks, while simultaneously addressing the main concerns of engagement and ease of use identified in previous tasks such as the Attention Network Task (Fan et al., 2001; 2002) and its variations (Callejas et al., 2005). Unlike other network attention tasks, the CAST separates endogenous and exogenous trials to distinctly measure these aspects of attention and using warning tones as alerting cues, instead of the visual stimuli, thus, avoiding confounding the alerting and orienting networks (see supplemental material for full description of the changes made to the ANT and why the CAST was chosen for this study).

While the only published research with the CAST administered it to a sample of children (Johnson et al., 2019), the paradigm shows great promise for use within clinical and adult samples (de Souza Almeida et al., 2021). Specifically, the CAST may help to better understand some of the attentional deficits identified for individuals with clinical depression using the ANT. Prior work shows individuals with depression exhibit reduced reaction times to the conflict monitoring aspects of the ANT, however, orienting and alerting generally remain intact (Sommerfeldt et al., 2016). While deficits in executive functioning in individuals with depression are a trend in the literature (Bellaera & von Mühlenen, 2017; Cotrena et al., 2016; Elliott, 1998; Goodall et al., 2018; Liu et al., 2020; Paelecke-Habermann et al., 2005), other studies report no differences (Crews et al., 1999; Huang et al., 2017; Preiss et al., 2010; Shi et al., 2020). Individuals with MDD may have a cortical inefficiency related to executive control (Krompinger & Simons, 2011; Wagner et al., 2006), suggesting they are recruiting more cognitive resources to complete conflict monitoring tasks at the same capacity as healthy controls. These attentional deficits may be linked to the severity of depression, whereby those experiencing chronic or severe depression are more impacted than those with mild or subclinical symptoms (Bellaera & von Mühlenen, 2017; Crews et al., 1999; Huang et al., 2017; Shi et al., 2020; Yang & Ling, 2019). Bellaera and von Mühlenen (2017) found those with minor/moderate depression (indexed with an 18-item depression scale) outperformed those with possible minor depression and healthy controls on measures of reaction time (ANT-I). Thus, there may be a difference in how state vs. trait depression impacts attention networks.

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