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1 The Effects of Stimulant Countermeasures on Executive Functioning and Decision- Making During Sleep Deprivation Walter Reed Army Institute of Research (WRAIR) McLean Hospital, Harvard Medical School McLean Hospital, Harvard Medical School William D. S. Killgore, Ph.D.

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Reduced metabolic activity will lead to deficits in executive functioning including planning, judgment, and decision-making Modified from Thomas et al. (2000) 2 Hypotheses

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Reduced metabolic activity will lead to deficits in executive functioning including planning, judgment, and decision-making Stimulants may activate these areas and reverse these deficits Modified from Thomas et al. (2000) 3 Hypotheses

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Reduced metabolic activity will lead to deficits in executive functioning including planning, judgment, and decision-making Stimulants may activate other areas involved in alertness, while leaving prefrontal areas and associated executive functions degraded or Stimulants may activate these areas and reverse these deficits Modified from Thomas et al. (2000) 4 Hypotheses

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Wed Thursday FridaySaturday Sunday 24002400 2400 2400 1200120012001200 Training Sleep 5 In-Residence Sleep Deprivation Studies General Study Design

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Wed Thursday FridaySaturday Sunday 24002400 2400 2400 1200120012001200 Training Sleep Dorsolateral Prefrontal Cortex Killgore et al., Journal of Sleep Research (2008) 6 Executive Function Test Battery 44 HOURS Caffeine 600 mg D-AMPH 20 mg Modafinil 400 mg Placebo 3:00 AM

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7 Match each card to the appropriate key card: Concept Formation, Set Shifting, & Mental Flexibility WRONG! RIGHT! Wisconsin Card Sorting Test

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8 Perseverative Errors (T-Score) Killgore et al., Sleep (2009) Better Worse Modafinil significantly improved WCST performance (i.e., reduced perseveration during sleep deprivation) relative to other stimulants or placebo. Age Norm Wisconsin Card Sorting Test

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9 Planning & Sequencing Number of Moves Time to Solve Tower of Hanoi

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10 Number of Moves beyond Optimal Time Before Each Move Total Time Planning & Sequencing Goal Your Tower Tower of London

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11 Total Moves Mean Pickup Time p