Proal Erika, Reiss Philip T, Klein Rachel G, Mannuzza Salvatore, Gotimer Kristin, Ramos-Olazagasti Maria A, Lerch Jason P, He Yong, Zijdenbos Alex, Kelly Clare, Milham Michael P, Castellanos F Xavier
Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center, New York University Langone School of Medicine, USA.
Arch Gen Psychiatry. 2011 Nov;68(11):1122-34. doi: 10.1001/archgenpsychiatry.2011.117.
Volumetric studies have reported relatively decreased cortical thickness and gray matter volumes in adults with attention-deficit/hyperactivity disorder (ADHD) whose childhood status was retrospectively recalled. We present, to our knowledge, the first prospective study combining cortical thickness and voxel-based morphometry in adults diagnosed as having ADHD in childhood.
To test whether adults with combined-type childhood ADHD exhibit cortical thinning and decreased gray matter in regions hypothesized to be related to ADHD and to test whether anatomic differences are associated with a current ADHD diagnosis, including persistent vs remitting ADHD.
Cross-sectional analysis embedded in a 33-year prospective follow-up at a mean age of 41.2 years.
Research outpatient center.
We recruited probands with ADHD from a cohort of 207 white boys aged 6 to 12 years. Male comparison participants (n = 178) were free of ADHD in childhood. We obtained magnetic resonance images in 59 probands and 80 comparison participants (28.5% and 44.9% of the original samples, respectively).
Whole-brain voxel-based morphometry and vertexwise cortical thickness analyses.
The cortex was significantly thinner in ADHD probands than in comparison participants in the dorsal attentional network and limbic areas (false discovery rate < 0.05, corrected). In addition, gray matter was significantly decreased in probands in the right caudate, right thalamus, and bilateral cerebellar hemispheres. Probands with persistent ADHD (n = 17) did not differ significantly from those with remitting ADHD (n = 26) (false discovery rate < 0.05). At uncorrected P < .05, individuals with remitting ADHD had thicker cortex relative to those with persistent ADHD in the medial occipital cortex, insula, parahippocampus, and prefrontal regions.
Anatomic gray matter reductions are observable in adults with childhood ADHD, regardless of the current diagnosis. The most affected regions underpin top-down control of attention and regulation of emotion and motivation. Exploratory analyses suggest that diagnostic remission may result from compensatory maturation of prefrontal, cerebellar, and thalamic circuitry.
容积研究报告称，那些童年时期情况是通过回顾性回忆得出的注意力缺陷多动障碍（ADHD）成年患者，其皮质厚度和灰质体积相对减少。据我们所知，我们开展了第一项前瞻性研究，结合了童年被诊断为患有ADHD的成年患者的皮质厚度和基于体素的形态测量学。
测试童年患有复合型ADHD的成年人在假设与ADHD相关的区域是否存在皮质变薄和灰质减少，并测试解剖学差异是否与当前的ADHD诊断相关，包括持续性ADHD与缓解性ADHD。
在平均年龄41.2岁时进行的33年前瞻性随访中的横断面分析。
研究门诊中心。
我们从一组207名6至12岁的白人男孩中招募了患有ADHD的先证者。男性对照参与者（n = 178）童年时未患ADHD。我们获取了59名先证者和80名对照参与者的磁共振图像（分别占原始样本的28.5%和44.9%）。
全脑基于体素的形态测量学和逐顶点皮质厚度分析。
在背侧注意力网络和边缘区域，ADHD先证者的皮质明显比对照参与者薄（错误发现率<0.05，校正后）。此外，先证者右侧尾状核、右侧丘脑和双侧小脑半球的灰质明显减少。持续性ADHD的先证者（n = 17）与缓解性ADHD的先证者（n = 26）之间无显著差异（错误发现率<0.05）。在未校正的P<0.05时，缓解性ADHD患者相对于持续性ADHD患者，在内侧枕叶皮质、岛叶、海马旁回和前额叶区域的皮质更厚。
童年患有ADHD的成年人中可观察到解剖学上的灰质减少，无论当前诊断如何。受影响最严重的区域是注意力自上而下控制以及情绪和动机调节的基础。探索性分析表明，诊断缓解可能是前额叶、小脑和丘脑回路代偿性成熟的结果。
