注意缺陷多动障碍患者与强迫症患者在干扰抑制和注意力分配过程中特定于疾病的功能障碍。
Disorder-specific dysfunctions in patients with attention-deficit/hyperactivity disorder compared to patients with obsessive-compulsive disorder during interference inhibition and attention allocation.
机构信息
Department of Child Psychiatry, Institute of Psychiatry, King's College London, London, UK.
出版信息
Hum Brain Mapp. 2011 Apr;32(4):601-11. doi: 10.1002/hbm.21048.
BACKGROUND
Abnormalities in inhibitory control and underlying fronto-striatal networks is common to both attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive-disorder (OCD). The aim of this study was to investigate disorder-specific abnormalities in neural networks mediating interference inhibition and selective attention.
METHOD
Event-related functional magnetic resonance imaging (fMRI) was used to compare brain activation of boys with ADHD (18), with OCD (10), and healthy boys during (20) during a Simon task that measures interference inhibition and controls for and therefore comeasures attention allocation.
RESULTS
During interference inhibition, both patient groups shared mesial frontal dysfunction compared to controls. Disorder-specific dysfunctions were observed in OCD patients in dorsolateral prefrontal cortex during the oddball condition and in ADHD patients in inferior parietal lobe during interference inhibition and in caudate and posterior cingulate during the simpler oddball condition. The decreased activation in caudate and cingulate in ADHD was furthermore negatively correlated with ADHD symptoms and positively with OCD behavioral traits.
CONCLUSIONS
The study shows that ADHD and OCD patients have shared but also disorder-specific brain dysfunctions during interference inhibition and attention allocation. Both disorders shared dysfunction in mesial frontal cortex. Disorder-specific dysfunctions, however, were observed in dorsolateral prefrontal cortex in OCD patients and in caudate, cingulate, and parietal brain regions in ADHD patients. The disorder-specific dissociation of striato-cingulate activation that was increased in OCD compared to ADHD patients, was furthermore inversely related to the symptomatology of the two disorders, and may potentially reflect differential dopamine modulation of striatal brain regions.
背景
注意缺陷多动障碍（ADHD）和强迫症（OCD）都存在抑制控制和相关额纹状体网络的异常。本研究旨在探讨介导干扰抑制和选择性注意的神经网络中特定于疾病的异常。
方法
采用事件相关功能磁共振成像（fMRI）比较了 ADHD（18 例）男孩、OCD（10 例）男孩和健康男孩在 Simon 任务中的大脑激活情况，该任务用于测量干扰抑制和注意力分配。
结果
在干扰抑制过程中，与对照组相比，两组患者均存在内侧额叶功能障碍。在Oddball 条件下，OCD 患者在背外侧前额叶皮层存在特定于疾病的功能障碍，在干扰抑制过程中，ADHD 患者在顶下小叶和尾状核以及在更简单的 Oddball 条件下在后扣带回存在功能障碍。ADHD 患者尾状核和扣带回的激活减少与 ADHD 症状呈负相关，与 OCD 行为特征呈正相关。
结论
本研究表明，ADHD 和 OCD 患者在干扰抑制和注意力分配过程中既有共同的也有特定于疾病的脑功能障碍。两种疾病都存在内侧额叶皮层功能障碍。然而，在 OCD 患者的背外侧前额叶皮层和 ADHD 患者的尾状核、扣带回和顶叶脑区观察到特定于疾病的功能障碍。与 ADHD 患者相比，OCD 患者纹状体-扣带回的激活增加存在特定于疾病的分离，并且与两种疾病的症状学呈负相关，这可能潜在地反映了纹状体脑区多巴胺的差异调节。
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