COGNITIVE DEFICITS IN NARCOLEPTICS: POSSIBLE CAUSES, SIMILARITIES TO ADHD, AND CLASSROOM ACCOMMODATIONS
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Narcolepsy is a sleep disorder affecting more than 1 in 2,000 Americans. It is characterized by excessive daytime sleepiness, a fast transition into REM sleep, and is often accompanied by cataplexy (a symptom involving involuntary loss of muscle tone in awake patients). In most cases the disorder is autoimmune, the immune system targets and destroys hypocretin ( orexin) producing neurons in the hypothalamus. Narcolepsy is permanent and irreversible. Treatments consist primarily of neurostimulant pharmaceuticals designed to keep patients awake during daytime hours; they do not restore the hypocretin pathway. This pathway is implicated in maintaining wakefulness, metabolism, and is also a reward pathway that could factor into complex memory and executive function tasks. Additionally, narcoleptics have altered sleep stage cycles that are key for memory processing and consolidation. It is not yet known if or how narcoleptics process memories differently, however, it is known that narcoleptics exhibit cognitive and attentional deficits. These deficits appear to show similarities to symptoms of attention deficit hyperactivity disorder (ADHD), which is a far more common learning disorder. Little is known about appropriate accommodations for narcoleptic students in classroom settings. Current recommendations are vague and focus only on preventing sleep attacks, not on the cognitive impairments associated with the disorder. In addition to synthesizing known narcoleptic deficiencies and discussing their possible classroom implications. For this project, I performed a clinical review of relevant literature on cognition in narcoleptics. I found no obvious pattern in task performances between the disorders, but narcoleptic literature was scarce, so pattern detection was difficult. Furthermore, the results vary widely in the narcoleptic studies making observed deficits controversial. In addition, I choose two tasks (Alternating Reactions, and the Dual Task) in which ADHD and narcolepsy seemed to show similar results and quantitatively compared them. I found supported similarity only in narcoleptic and ADHD-I and ADHD-H subtypes reaction times. Error rates were not significantly different on these two tasks either, but when narcoleptics were compared to ADHD controls, no difference was observed, indicating little support for similarity claims. Overall more research is needed into the topic and attention must be paid to replicating previous study finding and reporting hypocretin levels alongside them. It is difficult to say exactly how much accommodation is needed for narcoleptics in academic settings, but I feel that executive function support programs that are used to help ADHD students stay on track should be offered to narcoleptics as well. I hope to encourage further thought into the status of this underrepresented group; this project aims to improve the information available on classroom implications of all aspects of narcolepsy, not just the primary sleep symptoms.