title: Detecting effects of donepezil on visual selective attention using signal detection parameters in Alzheimer's disease.
abstract: BACKGROUND
  Attentional function is impaired in Alzheimer's disease (AD). Moreover, attention is mediated by acetylcholine. But, despite the widespread use of acetylcholinesterase inhibitors (AChE-I) to augment available acetylcholine in AD, measures of attentional function have not been used to assess the drug response.
  
  
  OBJECTIVE
  We hypothesized that as cholinergic augmentation impacts directly on the attentional system, higher-order measures of visual selective attention would be sensitive to effects of treatment using an AChE-I (donepezil hydrochloride). We also sought to determine whether these attentional measures were more sensitive to treatment than other measures of cognitive function.
  
  
  METHODS
  Seventeen patients with AD (8 untreated, 9 treated with donepezil) were contrasted on performance of a selective cancellation task. Two signal detection parameters were used as outcome measures: decision strategy (beta, beta) and discriminability (d-prime, d'). Standard screening and cognitive domain measures of vigilance, language, memory, and executive function were also contrasted.
  
  
  RESULTS
  Treated patients judged stimuli more conservatively (p = 0.29) by correctly endorsing targets and rejecting false alarms. They also discriminated targets from distractors more easily (p = 0.58). The screening and neuropsychological measures failed to differentiate the groups.
  
  
  CONCLUSIONS
  Higher-order attentional measures captured the effects of donepezil treatment in small groups of patients with AD. The results suggest that cholinergic availability may directly affect the attentional system, and that these selective attention measures are sensitive markers to detect treatment response.
authors.affiliation: Department of Psychology, Queens College & the Doctoral Subprogram in Neuropsychology, The Graduate Center of the City University of New York, NY 11367, USA. nsfoldi@qc.edu
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Foldi
authors.forename: Richard E C
authors.initials: RE
authors.lastname: White
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Schaefer
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000523:psychology; D001288:Attention / Q000187:drug effects*; D002800:Cholinesterase Inhibitors / Q000494:pharmacology*; D003071:Cognition / Q000187:drug effects; D003657:Decision Making / Q000187:drug effects; D004192:Discrimination, Psychological / Q000187:drug effects; D000077265:Donepezil; D005260:Female; D006801:Humans; D007189:Indans / Q000494:pharmacology*; D008297:Male; D009483:Neuropsychological Tests; D010364:Pattern Recognition, Visual / Q000187:drug effects; D010775:Photic Stimulation / Q000379:methods; D010880:Piperidines / Q000494:pharmacology*; D017603:Signal Detection, Psychological / Q000187:drug effects*
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil