Department of Child Psychiatry, Institute of Psychiatry, King's College, London SE5 8AF, UK.
J Psychiatr Res. 2010 Jul;44(10):629-39. doi: 10.1016/j.jpsychires.2009.11.016. Epub 2010 Jan 13.
Attention-Deficit Hyperactivity Disorder (ADHD) in children has been associated with fronto-striatal functional abnormalities during tasks of inhibitory control. In adults with ADHD, however, hardly any functional magnetic resonance imaging (fMRI) studies have investigated the neurofunctional correlates of the most compromised cognitive functions of motor response inhibition and no study has investigated cognitive flexibility. In this study we used fMRI to compare brain function and task-relevant inter-regional functional connectivity between 11 medication-naïve adults with persistent inattentive/hyperactive behaviours, followed up from childhood when they had been diagnosed with ADHD, and 14 age-matched healthy controls during a Stop and a cognitive Switch tasks. Whole-brain regression MR analyses were conducted within patients to correlate symptoms with brain activation. Despite comparable task performance, adults with childhood ADHD showed reduced activation compared to controls in bilateral inferior prefrontal cortex, caudate and thalamus during both tasks, as well as in left parietal lobe during the Switch task. Within patients, the severity of the behavioural symptoms was negatively correlated with more extensive activation of similar regions in fronto-striatal, parietal and cerebellar brain areas. In the Stop task, patients showed reduced inter-regional functional connectivity between right inferior fronto-frontal, fronto-striatal and fronto-parietal neural networks. The findings demonstrate that adults with childhood ADHD and persisting behavioural symptoms show strikingly similar patterns of fronto-striatal and parietal dysfunction to those observed in childhood ADHD during the same tasks of inhibitory control. This suggests that neuro-functional abnormalities in ADHD patients are likely to continue between childhood and early adulthood.
儿童注意缺陷多动障碍（ADHD）与抑制控制任务期间额-纹状体功能异常有关。然而，在患有 ADHD 的成年人中，几乎没有任何功能磁共振成像（fMRI）研究调查运动反应抑制中最受影响的认知功能的神经功能相关性，也没有研究调查认知灵活性。在这项研究中，我们使用 fMRI 比较了 11 名未服用药物的成年人和 14 名年龄匹配的健康对照者在停止和认知转换任务中的脑功能和与任务相关的区域间功能连接，这些成年人在儿童时期被诊断患有 ADHD 后一直存在注意力不集中/多动行为。在患者中进行了全脑回归 MR 分析，以将症状与大脑激活相关联。尽管任务表现相当，患有儿童 ADHD 的成年人在执行两个任务时双侧额下回皮质、尾状核和丘脑的激活明显低于对照组，在执行转换任务时左侧顶叶也存在这种情况。在患者中，行为症状的严重程度与额-纹状体、顶叶和小脑脑区相似区域的更广泛激活呈负相关。在停止任务中，患者的右额下回-额前、额纹状体和额顶叶神经回路之间的区域间功能连接减少。研究结果表明，患有儿童 ADHD 和持续行为症状的成年人在执行相同的抑制控制任务时，表现出与儿童 ADHD 相似的额-纹状体和顶叶功能障碍模式。这表明 ADHD 患者的神经功能异常可能在儿童期和成年早期之间持续存在。
