Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Psychol Med. 2013 May;43(5):1093-107. doi: 10.1017/S0033291712001869. Epub 2012 Aug 15.
Attention deficit hyperactivity disorder (ADHD) is recognized as an early-onset neuropsychiatric disorder with executive dysfunctions and neurobiological deficits. The authors compared executive functions and microstructural integrity of the frontostriatal circuit in children with ADHD and typically developing children. Method We assessed 25 children with ADHD and 25 age-, sex-, handedness- and intelligence-matched typically developing children by using psychiatric interviews, the Wechsler Intelligence Scale for Children - third edition, and the tasks involving executive functions in the Cambridge Neuropsychological Test Automated Battery. The frontostriatal tracts were reconstructed by diffusion spectrum imaging tractography and were subdivided into four functionally distinct segments, including dorsolateral, medial prefrontal, orbitofrontal and ventrolateral tracts. Tract-specific and matched case-control analyses were used and generalized fractional anisotropy values were computed.
Children with ADHD had lower generalized fractional anisotropy of all the bilateral frontostriatal fiber tracts and poorer performance in verbal and spatial working memory, set-shifting, sustained attention, cognitive inhibition and visuospatial planning. The symptom severity of ADHD and the executive functioning performance significantly correlated with integrity of the frontostriatal tracts, particularly the left orbitofrontal and ventrolateral tracts. Children with ADHD also demonstrated loss of the leftward asymmetry in the dorsolateral and medial prefrontal tracts that was present in typically developing children.
Our findings demonstrate disturbed structural connectivity of the frontostriatal circuitry in children with ADHD and add new evidence of associations between integrity of the frontostriatal tracts and measures of core symptoms of ADHD and a wide range of executive dysfunctions in both groups.
注意缺陷多动障碍（ADHD）被认为是一种起病于早期的神经精神疾病，存在执行功能障碍和神经生物学缺陷。作者比较了 ADHD 患儿和正常发育儿童的执行功能以及额-纹状体回路的微观结构完整性。
我们通过精神病学访谈、韦氏儿童智力量表第三版和剑桥神经心理学测试自动化电池中的执行功能任务，评估了 25 名 ADHD 患儿和 25 名年龄、性别、利手和智力匹配的正常发育儿童。使用扩散张量成像轨迹重建额-纹状体束，并将其分为四个功能不同的节段，包括背外侧、内侧前额叶、眶额和腹外侧束。采用束特异性和匹配病例对照分析，并计算了广义各向异性分数。
ADHD 患儿双侧额-纹状体纤维束的广义各向异性分数均较低，言语和空间工作记忆、定势转换、持续注意力、认知抑制和视空间规划能力较差。ADHD 的症状严重程度和执行功能表现与额-纹状体束的完整性显著相关，尤其是左侧眶额和腹外侧束。ADHD 患儿还表现出正常发育儿童存在的背外侧和内侧前额叶束的左侧不对称性丧失。
我们的研究结果表明 ADHD 患儿额-纹状体回路的结构连接受损，并为额-纹状体束的完整性与 ADHD 的核心症状以及两组广泛的执行功能障碍之间的相关性提供了新的证据。
