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Global life expectancy is increasing dramatically with a corresponding rise in the prevalence of pathological ageing conditions such as dementia and stroke. Maintaining high levels of cognitive function in the face of dementia-related neuropathology or following acquired brain damage is of pressing societal importance. The ability to maintain endogenous levels of attentional engagement is a domain-general process underlying many higher-order cognitive capabilities. Deficits in this capacity are evident across a range of neurodegenerative diseases, interfere with functional recovery following right hemisphere stroke, and are associated with an increased likelihood of falling in older adults. In healthy ageing, superior levels of attentional engagement have been proposed to promote plasticity processes contributing to ‘cognitive reserve’: Older adults with more cognitively stimulating environments, achieved through education, complex professions, or social engagements, present with less clinical symptomatology in a range of conditions, such as dementia, given the degree of disease-related neuropathology.

Sustained attention is postulated to contribute to cognitive reserve such that high levels of attention, necessitated by cognitively demanding environments, lead to greater environmental enrichment. This encourages plasticity processes that, in turn, contribute to a neuroprotective effect against disease. The neural underpinnings of this effect have recently been proposed to result from the continuous engagement of the right lateralised fronto-parietal networks (FPN) and the repeated activation of the neurotransmitter noradrenaline …