209 Attention Regulation in Narcolepsy Type 1 Time-on-task effect Time-on-task analyses comparing BOLD signals in repetition 1 and 4 between participant groups yielded no significant activation differences. Time-ontask within blocks analyses demonstrated that people with narcolepsy type 1 had significantly less activation than controls in the “late half > early half” contrast combining the two difficulty levels. Post-hoc analyses showed that this effect was driven by the higher difficulty level, as shown in Figure 4 and Table 3. Significantly lower activation was found in people with narcolepsy type 1 in regions including the cingulo-opercular network (bilateral insula and operculum, left anterior cingulate cortex, right middle frontal gyrus, and thalamus), frontoparietal network (bilateral superior frontal gyrus, midcingulate cortex and right inferior frontal gyrus, and angular gyrus), (regulatory) motor areas, and visual regions. Other activated regions were the bilateral temporal lobe and inferior orbitofrontal gyrus and the right angular gyrus. The betweengroup differences were mainly driven by controls upregulating their neural efforts within higher difficulty blocks, whereas people with narcolepsy type 1 maintained stable activation over time. Decreased activation over time was only seen in those with narcolepsy type 1, in the visual cortex and cerebellum. No between-group time-on-task within blocks differences were seen in difficulty level 1. Figure 4. Time-on-task activation clusters within higher difficulty level blocks. Axial slices displaying significant activation clusters that were less activated in people with narcolepsy type 1 than in controls in the “late half > early half” contrast of the higher difficulty level. Analyses were cluster-corrected (p < 0.05), masked for grey matter and a minimum cluster size > 20 voxels was used. 7
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