Sustained attention assessment of narcoleptic patients: Two case reports

Moraes, Mirleny; Wilson, Barbara A.; Rossini, Sueli; Osternack-Pinto, Kátia; Reimão, Rubens

doi:10.1590/S1980-57642009DN20400020

Abstract

Narcolepsy is a sleep disorder characterized by uncontrollable REM sleep attacks which alter the patients wake state and can lead to difficulties in attention aspects, such as maintaining attention when performing activities or tasks. This study aimed to evaluate sustained attention performance of two narcoleptic patients on the d2 Test, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and Hamilton Rating Scale for Depression (HAM-D). Results showed that the maintenance of attention was associated with a slowing of the target symbols processing function in visual scanning with accuracy in task performance. A high degree of excessive sleepiness was observed, along with mild and moderate degrees of depressive signs and symptoms. One subject also presented with a nocturnal sleep disorder which could represent an important factor affecting attentional and affective capacity.

Key words:
sleep; sleep disorders; excessive daytime sleepiness; narcolepsy; sustained attention; d2 Test; neuropsychology

Resumo

A narcolepsia é um distúrbio do sono caracterizado por ataques diurnos incontroláveis de sono REM, que alteram o estado de vigília dos pacientes, podendo levar a dificuldades na expressão de aspectos da atenção, como a sua manutenção durante a execução de atividades ou tarefas. Este estudo buscou avaliar a atenção sustentada de dois pacientes com narcolepsia através do Teste d2, da Escala de Sonolência Epworth, do Índice de Qualidade de Sono de Pittsburgh (IQSP) e da Escala de Hamilton para Avaliação da Depressão (HAM-D). Os resultados revelaram que a manutenção da atenção mostrou-se associada ao alentecimento no processamento dos símbolos-alvo na sondagem visual, com precisão na execução da tarefa. Houve presença de sonolência excessiva em nível elevado e sinais e sintomas depressivos em grau leve e moderado. Um dos sujeitos apresentou também prejuízo do sono noturno, podendo ser este mais um fator importante na expressão da capacidade atencional e afetiva.

Palavras-chave:
sono; distúrbios do sono; sonolência diurna excessiva; narcolepsia; atenção sustentada; teste d2; neuropsicologia

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References

¹
International Classification of Sleep Disorders, revised edition. Rochester, American Sleep Disorders Association, 2005.
²
Selbach O, Haas H. Hypocretins: the timing of sleep and waking. Chronobiol Int 2006;23:63-70.
³
Rovere R, Rossini S, Reimão R. Quality of life in patients with narcolepsy. Arq Neuropsiquiatr 2008;66:163-167.
⁴
Rovere H, Rossini S, Alcântara C, et al. Avanços na qualidade de vida em portadores de narcolepsia. São Bernardo do Campo: Mudanças, 2007;14:74-78.
⁵
Lefèvre B, Barreto Filho M, Reimão R. Narcolepsia: avaliação neuropsicológica. Neurobiol (Recife) 1990;53:13-24.
⁶
Hood B, Bruck D. Metamemory in narcolepsy. J Sleep Res 1997;6:205-210.
⁷
Aguirre M, Broughton R, Stuss D. Does memory impairment exist in narcolepsy-cataplexy? J Clin Exp Neuropsychol 1985;7:14-24.
⁸
Rogers A, Rosenberg, R. Tests of memory in narcoleptics. Sleep 1990;13:42-52.
⁹
Naumann A, Daum, I. Narcolepsy: pathophysiology and neuropsychological changes. Behav Neurol 2003;14:89-98.
¹⁰
Rieger M, Mayer G, Gauggel S. Attention deficits in patients with narcolepsy. Sleep 2003;26:36-43.
¹¹
Godbout R, Montplaisir J. All-day performance variations in normal and narcoleptic subjects. Sleep 1986;9:200-204.
¹²
Lezak M, Howieson, D, Loring D. Neuropsychological Assessment. 4ª ed., New York: Oxford University Press;2004.
¹³
Manly T. Rehabilitation for disorders of attention. In: Wilson B, editor. Neuropsychological rehabilitation: theory and practice. Swets & Zeitlinger Publischers;2003.
¹⁴
Brickenkamp R. Teste d2: atenção concentrada: manual: instruções, avaliação, interpretação/Rolf Brickenkamp; coordenação Mara Silvia Bolonhezi Bittencourt; tratamento estatístico José Luciano M. Duarte (colaborador); tradução Giselle Müller Roger Welter. São Paulo: Centro Editor de Testes e Pesquisas em Psicologia, 2000.
¹⁵
Spreen O, Strauss E. A compendium of neuropsychological tests. Administration, norms and commentary. New York: Oxford University Press;1998.
¹⁶
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540-545.
¹⁷
Buysse D, Reynolds III, Monk T, Berman S, Kupfer D. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatric Res 1989;28:193-213.
¹⁸
Hamilton M. A Rating Scale for Depression. J Neurol Neurosurg Psychiatry, 1960;23:56-62.
¹⁹
Wilson B. The theory and practice of neuropsychological rehabilitation: an overview. In: Wilson B, editor. Neuropsychological rehabilitation: theory and practice. Swets & Zeitlinger Publish.;2003.
²⁰
Naumann A, Bellebaum C, Daum I. Cognitive deficits in narcolepsy. J Sleep Res 2006;15:329-338.
²¹
Billiard M. Competition between the two types of sleep, and the recuperative function of REM sleep vs NREM sleep in narcoleptics. In: Guilleminault C., Dement WC., Passouant P, editors. Narcolepsy. New York: Spectrum;1976:77-95.
²²
Hood B, Bruck D. Sleepiness and performance in narcolepsy. J Sleep Res 1996;5:128-134.

Publication Dates

Publication in this collection
Oct-Dec 2008

History

Received
07 Oct 2008
Accepted
19 Nov 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
International Classification of Sleep Disorders, revised edition. Rochester, American Sleep Disorders Association, 2005.

[2] ²
Selbach O, Haas H. Hypocretins: the timing of sleep and waking. Chronobiol Int 2006;23:63-70.

[3] ³
Rovere R, Rossini S, Reimão R. Quality of life in patients with narcolepsy. Arq Neuropsiquiatr 2008;66:163-167.

[4] ⁴
Rovere H, Rossini S, Alcântara C, et al. Avanços na qualidade de vida em portadores de narcolepsia. São Bernardo do Campo: Mudanças, 2007;14:74-78.

[5] ⁵
Lefèvre B, Barreto Filho M, Reimão R. Narcolepsia: avaliação neuropsicológica. Neurobiol (Recife) 1990;53:13-24.

[6] ⁶
Hood B, Bruck D. Metamemory in narcolepsy. J Sleep Res 1997;6:205-210.

[7] ⁷
Aguirre M, Broughton R, Stuss D. Does memory impairment exist in narcolepsy-cataplexy? J Clin Exp Neuropsychol 1985;7:14-24.

[8] ⁸
Rogers A, Rosenberg, R. Tests of memory in narcoleptics. Sleep 1990;13:42-52.

[9] ⁹
Naumann A, Daum, I. Narcolepsy: pathophysiology and neuropsychological changes. Behav Neurol 2003;14:89-98.

[10] ¹⁰
Rieger M, Mayer G, Gauggel S. Attention deficits in patients with narcolepsy. Sleep 2003;26:36-43.

[11] ¹¹
Godbout R, Montplaisir J. All-day performance variations in normal and narcoleptic subjects. Sleep 1986;9:200-204.

[12] ¹²
Lezak M, Howieson, D, Loring D. Neuropsychological Assessment. 4ª ed., New York: Oxford University Press;2004.

[13] ¹³
Manly T. Rehabilitation for disorders of attention. In: Wilson B, editor. Neuropsychological rehabilitation: theory and practice. Swets & Zeitlinger Publischers;2003.

[14] ¹⁴
Brickenkamp R. Teste d2: atenção concentrada: manual: instruções, avaliação, interpretação/Rolf Brickenkamp; coordenação Mara Silvia Bolonhezi Bittencourt; tratamento estatístico José Luciano M. Duarte (colaborador); tradução Giselle Müller Roger Welter. São Paulo: Centro Editor de Testes e Pesquisas em Psicologia, 2000.

[15] ¹⁵
Spreen O, Strauss E. A compendium of neuropsychological tests. Administration, norms and commentary. New York: Oxford University Press;1998.

[16] ¹⁶
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540-545.

[17] ¹⁷
Buysse D, Reynolds III, Monk T, Berman S, Kupfer D. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatric Res 1989;28:193-213.

[18] ¹⁸
Hamilton M. A Rating Scale for Depression. J Neurol Neurosurg Psychiatry, 1960;23:56-62.

[19] ¹⁹
Wilson B. The theory and practice of neuropsychological rehabilitation: an overview. In: Wilson B, editor. Neuropsychological rehabilitation: theory and practice. Swets & Zeitlinger Publish.;2003.

[20] ²⁰
Naumann A, Bellebaum C, Daum I. Cognitive deficits in narcolepsy. J Sleep Res 2006;15:329-338.

[21] ²¹
Billiard M. Competition between the two types of sleep, and the recuperative function of REM sleep vs NREM sleep in narcoleptics. In: Guilleminault C., Dement WC., Passouant P, editors. Narcolepsy. New York: Spectrum;1976:77-95.

[22] ²²
Hood B, Bruck D. Sleepiness and performance in narcolepsy. J Sleep Res 1996;5:128-134.

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