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J Neural Transm (Vienna). 2017 Mar;124(3):335-345. doi: 10.1007/s00702-016-1637-z. Epub 2016 Oct 25.

Attention in Parkinson's disease with fatigue: evidence from the attention network test.

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Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy.
Vaclav Vojta Rehabilitation Center, Via Pincherle 186, 00146, Rome, Italy.
Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy.
Academic Neurologic Unit, A. Fiorini Hospital, Sapienza University of Rome, Terracina, LT, Italy.
Department of Neurosciences Rehabilitation Ophthalmology Genetics Maternal and Child Health (DiNOGMI), Institute of Neurology, University of Genova, Largo Daneo 3, 16132, Genova, Italy.
Neurology and Neurophysiopathology Unit, Sandro Pertini Hospital, Rome, Italy.


Fatigue is a non-specific symptom that is common in chronic diseases and represents one of the most disabling symptoms in Parkinson's disease. PD patients often experience cognitive deficits related above all to executive functions. The relationship between cognitive changes and fatigue in PD patients has not been explored in depth. The Attention Network Test (ANT) is a rapid, widely used test to measure the efficiency of three attentional networks, i.e., alerting, orienting, and executive, by evaluating reaction times (RTs) in response to visual stimuli. To assess the association between fatigue and the efficiency of the attentional networks, according to the Posnerian view, ANT was administered to 15 parkinsonian patients with fatigue (PFS-16 > 2.95), 17 parkinsonian patients without fatigue, and 37 age- and sex-matched healthy controls. Anxiety, depression, quality of sleep, and quality of life were also assessed. Parkinsonian patients displayed significantly longer RTs and lower executive network efficiency than controls. Patients with fatigue displayed significantly lower executive network efficiency than patients without fatigue. Moreover, patients with fatigue exhibited a lower accuracy than either patients without fatigue or controls. Finally, patients without fatigue displayed a more efficient alerting network than either patients with fatigue or controls. Although the pathogenesis of fatigue is multifactorial, our results indicate that fatigue may be closely related to an alteration of the striato-thalamo-cortical loop connecting the neostriatum to the prefrontal cortex, which is also responsible for the executive dysfunction that is typical of Parkinson's disease.


Attention; Attention network test; Fatigue; Parkinson’s disease; Reaction time

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