Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center of the NYU Langone Medical Center, New York, USA.
Am J Psychiatry. 2012 Oct;169(10):1038-55. doi: 10.1176/appi.ajp.2012.11101521.
The authors performed a comprehensive meta-analysis of task-based functional MRI studies of attention deficit hyperactivity disorder (ADHD).
The authors searched PubMed, Ovid, EMBASE, Web of Science, ERIC, CINAHAL, and NeuroSynth for studies published through June 30, 2011. Significant differences in brain region activation between individuals with ADHD and comparison subjects were detected using activation likelihood estimation meta-analysis. Dysfunctional regions in ADHD were related to seven reference neuronal systems. The authors performed a set of meta-analyses focused on age groups (children and adults), clinical characteristics (history of stimulant treatment and presence of psychiatric comorbidities), and specific neuropsychological tasks (inhibition, working memory, and vigilance/attention).
Fifty-five studies were included (39 for children and 16 for adults). In children, hypoactivation in ADHD relative to comparison subjects was observed mostly in systems involved in executive function (frontoparietal network) and attention (ventral attentional network). Significant hyperactivation in ADHD relative to comparison subjects was observed predominantly in the default, ventral attention, and somatomotor networks. In adults, ADHD-related hypoactivation was predominant in the frontoparietal system, while ADHD-related hyperactivation was present in the visual, dorsal attention, and default networks. Significant ADHD-related dysfunction largely reflected task features and was detected even in the absence of comorbid mental disorders or a history of stimulant treatment.
A growing literature provides evidence of ADHD-related dysfunction in multiple neuronal systems involved in higher-level cognitive functions but also in sensorimotor processes, including the visual system, and in the default network. This meta-analytic evidence extends early models of ADHD pathophysiology that were focused on prefrontal-striatal circuits.
作者对注意缺陷多动障碍（ADHD）的基于任务的功能磁共振成像研究进行了综合荟萃分析。
作者检索了PubMed、Ovid、EMBASE、Web of Science、ERIC、CINAHAL 和 NeuroSynth，检索截至 2011 年 6 月 30 日发表的研究。使用激活似然估计荟萃分析检测 ADHD 患者和对照受试者之间大脑区域激活的显著差异。ADHD 中的功能障碍区域与七个参考神经元系统相关。作者进行了一组元分析，重点关注年龄组（儿童和成人）、临床特征（兴奋剂治疗史和精神共病存在）以及特定的神经心理学任务（抑制、工作记忆和警觉/注意力）。
共纳入 55 项研究（39 项针对儿童，16 项针对成人）。在儿童中，与对照受试者相比，ADHD 患者的激活不足主要发生在执行功能（额顶网络）和注意力（腹侧注意力网络）相关系统中。与对照受试者相比，ADHD 患者的过度激活主要发生在默认、腹侧注意力和躯体运动网络中。在成人中，与 ADHD 相关的激活不足主要发生在前额顶叶系统中，而与 ADHD 相关的过度激活则发生在视觉、背侧注意力和默认网络中。与 ADHD 相关的功能障碍主要反映了任务特征，即使在没有共病精神障碍或兴奋剂治疗史的情况下也能检测到。
越来越多的文献提供了证据表明，与 ADHD 相关的功能障碍涉及多个涉及高级认知功能的神经元系统，还涉及感觉运动过程，包括视觉系统和默认网络。这种元分析证据扩展了早期专注于前额叶-纹状体回路的 ADHD 病理生理学模型。
