Schulz Kurt P, Li Xiaobo, Clerkin Suzanne M, Fan Jin, Berwid Olga G, Newcorn Jeffrey H, Halperin Jeffrey M
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA.
Cortex. 2017 May;90:1-11. doi: 10.1016/j.cortex.2017.01.019. Epub 2017 Feb 20.
The protracted and highly variable development of prefrontal cortex regions that support cognitive control has been purported to shape the adult outcome of attention-deficit/hyperactivity disorder (ADHD). This neurodevelopmental model was tested in a prospectively followed sample of 27 adult probands who were diagnosed with ADHD in childhood and 28 carefully matched comparison subjects aged 21-28 years. Probands were classified with persistent ADHD or remitted ADHD. Behavioral and neural responses to the Stimulus and Response Conflict Task (SRCT) performed during functional magnetic resonance imaging (fMRI) were compared in probands and comparison subjects and in probands with persistent and remitted ADHD. Response speed and accuracy for stimulus, response, and combined conflicts did not differ across groups. Orbitofrontal, inferior frontal and parietal activation was lower in probands than comparison subjects, but only for combined conflicts, when demand for cognitive control was highest. Reduced activation for combined conflicts in probands was almost wholly attributable to the persistence of ADHD; orbitofrontal, inferior frontal, anterior cingulate and parietal activation was lower in probands with persistent ADHD than both probands with remitted ADHD and comparison subjects, but did not differ between probands with remitted ADHD and comparison subjects. These data provide the first evidence that prefrontal and parietal activation during cognitive control parallels the adult outcome of ADHD diagnosed in childhood, with persistence of symptoms linked to reduced activation and symptom recovery associated with activation indistinguishable from adults with no history of ADHD.
支持认知控制的前额叶皮质区域发育过程漫长且高度可变，这被认为塑造了注意力缺陷多动障碍（ADHD）的成人后果。在一个前瞻性随访样本中对这一神经发育模型进行了测试，该样本包括27名童年期被诊断为ADHD的成年先证者以及28名年龄在21至28岁之间、经过仔细匹配的对照受试者。先证者被分为持续性ADHD或缓解性ADHD。在功能磁共振成像（fMRI）期间，对先证者和对照受试者以及持续性和缓解性ADHD的先证者进行了刺激与反应冲突任务（SRCT）的行为和神经反应比较。不同组在刺激、反应和综合冲突方面的反应速度和准确性没有差异。在前额叶眶部、额下回和顶叶的激活方面，先证者低于对照受试者，但仅在综合冲突时如此，此时对认知控制的需求最高。先证者在综合冲突时激活减少几乎完全归因于ADHD的持续性；持续性ADHD的先证者在前额叶眶部、额下回、前扣带回和顶叶的激活低于缓解性ADHD的先证者和对照受试者，但缓解性ADHD的先证者与对照受试者之间没有差异。这些数据首次证明，认知控制过程中前额叶和顶叶的激活与童年期诊断的ADHD的成人后果平行，症状的持续性与激活减少相关，而症状恢复与激活情况有关，这种激活情况与无ADHD病史的成年人难以区分。
