Mostert Jeanette C, Onnink A Marten H, Klein Marieke, Dammers Janneke, Harneit Anais, Schulten Theresa, van Hulzen Kimm J E, Kan Cornelis C, Slaats-Willemse Dorine, Buitelaar Jan K, Franke Barbara, Hoogman Martine
Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands.
Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.
Eur Neuropsychopharmacol. 2015 Nov;25(11):2062-2074. doi: 10.1016/j.euroneuro.2015.08.010. Epub 2015 Aug 21.
Attention Deficit/Hyperactivity Disorder (ADHD) in childhood is associated with impaired functioning in multiple cognitive domains: executive functioning (EF), reward and timing. Similar impairments have been described for adults with persistent ADHD, but an extensive investigation of neuropsychological functioning in a large sample of adult patients is currently lacking. We systematically examined neuropsychological performance on tasks measuring EF, delay discounting, time estimation and response variability using univariate ANCOVA's comparing patients with persistent ADHD (N=133, 42% male, mean age 36) and healthy adults (N=132, 40% male, mean age 36). In addition, we tested which combination of variables provided the highest accuracy in predicting ADHD diagnosis. We also estimated for each individual the severity of neuropsychological dysfunctioning. Lastly, we investigated potential effects of stimulant medication and a history of comorbid major depressive disorder (MDD) on performance. Compared to healthy adults, patients with ADHD showed impaired EF, were more impulsive, and more variable in responding. However, effect sizes were small to moderate (range: 0.05-0.70) and 11% of patients did not show neuropsychological dysfunctioning. The best fitting model predicting ADHD included measures from distinct cognitive domains (82.1% specificity, 64.9% sensitivity). Furthermore, patients receiving stimulant medication or with a history of MDD were not distinctively impaired. To conclude, while adults with ADHD as a group are impaired on several cognitive domains, the results confirm that adult ADHD is neuropsychologically heterogeneous. This provides a starting point to investigate individual differences in terms of impaired cognitive pathways.
儿童注意力缺陷多动障碍（ADHD）与多个认知领域的功能受损有关：执行功能（EF）、奖励和时间感知。持续性ADHD的成年患者也存在类似的功能受损情况，但目前缺乏对大量成年患者神经心理功能的广泛调查。我们使用单变量协方差分析，系统地检查了持续性ADHD患者（N = 133，42%为男性，平均年龄36岁）和健康成年人（N = 132，40%为男性，平均年龄36岁）在测量EF、延迟折扣、时间估计和反应变异性任务上的神经心理表现。此外，我们测试了哪些变量组合在预测ADHD诊断方面具有最高的准确性。我们还为每个个体估计了神经心理功能障碍的严重程度。最后，我们研究了兴奋剂药物和共病的重度抑郁症（MDD）病史对表现的潜在影响。与健康成年人相比，ADHD患者的EF受损，更冲动，反应更具变异性。然而，效应大小为小到中等（范围：0.05 - 0.70），11%的患者未表现出神经心理功能障碍。预测ADHD的最佳拟合模型包括来自不同认知领域的测量指标（特异性82.1%，敏感性64.9%）。此外，接受兴奋剂药物治疗或有MDD病史的患者没有明显受损。总之，虽然ADHD成年患者作为一个群体在几个认知领域存在功能受损，但结果证实成年ADHD在神经心理学上具有异质性。这为研究认知途径受损方面的个体差异提供了一个起点。
