注意缺陷多动障碍中的感觉-认知皮层通路

Sensation-to-cognition cortical streams in attention-deficit/hyperactivity disorder.

作者信息

Carmona Susana, Hoekzema Elseline, Castellanos Francisco X, García-García David, Lage-Castellanos Agustín, Van Dijk Koene R A, Navas-Sánchez Francisco J, Martínez Kenia, Desco Manuel, Sepulcre Jorge

机构信息

Department of Psychology, Harvard University, Center for Brain Science, Cambridge, Massachusetts.

Unidad de Medicina y Cirugía Experimental, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.

出版信息

Hum Brain Mapp. 2015 Jul;36(7):2544-57. doi: 10.1002/hbm.22790. Epub 2015 Mar 28.

Abstract

We sought to determine whether functional connectivity streams that link sensory, attentional, and higher-order cognitive circuits are atypical in attention-deficit/hyperactivity disorder (ADHD). We applied a graph-theory method to the resting-state functional magnetic resonance imaging data of 120 children with ADHD and 120 age-matched typically developing children (TDC). Starting in unimodal primary cortex-visual, auditory, and somatosensory-we used stepwise functional connectivity to calculate functional connectivity paths at discrete numbers of relay stations (or link-step distances). First, we characterized the functional connectivity streams that link sensory, attentional, and higher-order cognitive circuits in TDC and found that systems do not reach the level of integration achieved by adults. Second, we searched for stepwise functional connectivity differences between children with ADHD and TDC. We found that, at the initial steps of sensory functional connectivity streams, patients display significant enhancements of connectivity degree within neighboring areas of primary cortex, while connectivity to attention-regulatory areas is reduced. Third, at subsequent link-step distances from primary sensory cortex, children with ADHD show decreased connectivity to executive processing areas and increased degree of connections to default mode regions. Fourth, in examining medication histories in children with ADHD, we found that children medicated with psychostimulants present functional connectivity streams with higher degree of connectivity to regions subserving attentional and executive processes compared to medication-naïve children. We conclude that predominance of local sensory processing and lesser influx of information to attentional and executive regions may reduce the ability to organize and control the balance between external and internal sources of information in ADHD.

摘要

我们试图确定,在注意力缺陷多动障碍(ADHD)中,连接感觉、注意力和高阶认知回路的功能连接流是否存在异常。我们将一种图论方法应用于120名患有ADHD的儿童和120名年龄匹配的发育正常儿童(TDC)的静息态功能磁共振成像数据。从单峰初级皮层——视觉、听觉和躯体感觉皮层开始,我们使用逐步功能连接来计算在离散数量的中继站(或连接步长距离)处的功能连接路径。首先,我们对TDC中连接感觉、注意力和高阶认知回路的功能连接流进行了特征描述,发现这些系统尚未达到成年人所实现的整合水平。其次,我们寻找了ADHD儿童和TDC儿童之间的逐步功能连接差异。我们发现,在感觉功能连接流的初始步骤中,患者在初级皮层相邻区域内的连接程度显著增强,而与注意力调节区域的连接减少。第三,在距初级感觉皮层后续的连接步长距离上,ADHD儿童与执行加工区域的连接减少,与默认模式区域的连接程度增加。第四,在检查ADHD儿童的用药史时,我们发现,与未用药儿童相比,使用精神兴奋剂治疗的儿童的功能连接流与支持注意力和执行过程的区域具有更高的连接程度。我们得出结论,局部感觉加工占主导以及向注意力和执行区域的信息流入较少,可能会降低ADHD患者组织和控制内外信息源之间平衡的能力。

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