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用于治疗注意力缺陷多动障碍的神经元烟碱受体激动剂:聚焦于认知

Neuronal nicotinic receptor agonists for the treatment of attention-deficit/hyperactivity disorder: focus on cognition.

作者信息

Wilens Timothy E, Decker Michael W

机构信息

Massachusetts General Hospital, Pediatric Psychopharmacology Research Unit, Yawkey Center for Outpatient Care-YAW 6A, Boston, MA 02114, USA.

出版信息

Biochem Pharmacol. 2007 Oct 15;74(8):1212-23. doi: 10.1016/j.bcp.2007.07.002. Epub 2007 Jul 7.

Abstract

Attention deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed neurobehavioral disorder in children and adolescents, and in about half of these patients, significant symptomology continues into adulthood. Although impulsivity and hyperactivity are the most salient features of ADHD, cognitive deficits, particularly impairments in attention and executive function, are an important component, particularly in adolescents and adults, with over 90% of adults seeking treatment for ADHD manifesting cognitive dysfunction. Currently available medications treat the core ADHD symptoms but typically do not adequately address cognitive aspects of ADHD, underscoring the need for new therapeutics. Dopamine and norepinephrine are hypothesized to be particularly important in ADHD, but there is emerging evidence that cholinergic neurotransmission, particularly involving neuronal nicotinic acetylcholine receptors (nAChRs), may play a role in the pathophysiology of ADHD. Nicotine has demonstrated procognitive effects in both humans and experimental animals and has produced signals of efficacy in small proof-of-concept adult ADHD trials. Although adverse effects associated with nicotine preclude its development as a therapeutic, a number of novel nAChR agonists with improved safety/tolerability profiles have been discovered. Of these, ABT-418 and ABT-089 have both demonstrated signals of efficacy in adults with ADHD. Notably, tolerability issues that might be expected of a nAChR agonist, such as nausea and emesis, were not observed at efficacious doses of ABT-089. Further understanding of the effects of novel neuronal nAChR agonists on specific aspects of cognitive functioning in ADHD is required to assess the full potential of this approach.

摘要

注意缺陷多动障碍(ADHD)是儿童和青少年中最常被诊断出的神经行为障碍,约半数患者的显著症状会持续到成年期。尽管冲动和多动是ADHD最突出的特征,但认知缺陷,尤其是注意力和执行功能受损,是一个重要组成部分,在青少年和成年人中尤为如此,超过90%寻求ADHD治疗的成年人存在认知功能障碍。目前可用的药物治疗ADHD的核心症状,但通常不能充分解决ADHD的认知方面问题,这凸显了对新疗法的需求。多巴胺和去甲肾上腺素被认为在ADHD中尤为重要,但越来越多的证据表明,胆碱能神经传递,特别是涉及神经元烟碱型乙酰胆碱受体(nAChRs),可能在ADHD的病理生理学中起作用。尼古丁在人类和实验动物中均显示出促认知作用,并且在小型概念验证性成人ADHD试验中产生了疗效信号。尽管与尼古丁相关的不良反应使其无法作为一种治疗药物进行开发,但已发现了一些安全性/耐受性有所改善的新型nAChR激动剂。其中,ABT - 418和ABT - 089在患有ADHD的成年人中均显示出疗效信号。值得注意的是,在ABT - 089的有效剂量下未观察到nAChR激动剂可能出现的耐受性问题,如恶心和呕吐。需要进一步了解新型神经元nAChR激动剂对ADHD认知功能特定方面的影响,以评估这种方法的全部潜力。

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