Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Biol Psychiatry. 2017 Nov 1;82(9):642-650. doi: 10.1016/j.biopsych.2017.07.008. Epub 2017 Jul 21.
Attention-deficit/hyperactivity disorder (ADHD) is associated with structural abnormalities in total gray matter, basal ganglia, and cerebellum. Findings of structural abnormalities in frontal and temporal lobes, amygdala, and insula are less consistent. Remarkably, the impact of comorbid oppositional defiant disorder (ODD) (comorbidity rates up to 60%) on these neuroanatomical differences is scarcely studied, while ODD (in combination with conduct disorder) has been associated with structural abnormalities of the frontal lobe, amygdala, and insula. The aim of this study was to investigate the effect of comorbid ODD on cerebral volume and cortical thickness in ADHD.
Three groups, 16 ± 3.5 years of age (mean ± SD; range 7-29 years), were studied on volumetric and cortical thickness characteristics using structural magnetic resonance imaging (surface-based morphometry): ADHD+ODD (n = 67), ADHD-only (n = 243), and control subjects (n = 233). Analyses included the moderators age, gender, IQ, and scan site.
ADHD+ODD and ADHD-only showed volumetric reductions in total gray matter and (mainly) frontal brain areas. Stepwise volumetric reductions (ADHD+ODD < ADHD-only < control subjects) were found for mainly frontal regions, and ADHD+ODD was uniquely associated with reductions in several structures (e.g., the precuneus). In general, findings remained significant after accounting for ADHD symptom severity. There were no group differences in cortical thickness. Exploratory voxelwise analyses showed no group differences.
ADHD+ODD and ADHD-only were associated with volumetric reductions in brain areas crucial for attention, (working) memory, and decision-making. Volumetric reductions of frontal lobes were largest in the ADHD+ODD group, possibly underlying observed larger impairments in neurocognitive functions. Previously reported striatal abnormalities in ADHD may be caused by comorbid conduct disorder rather than ODD.
注意力缺陷多动障碍（ADHD）与总灰质、基底神经节和小脑的结构异常有关。额叶、颞叶、杏仁核和岛叶结构异常的发现则不太一致。值得注意的是，对立违抗性障碍（ODD）（合并率高达 60%）对这些神经解剖差异的影响几乎没有研究，而 ODD（与品行障碍合并）与额叶、杏仁核和岛叶的结构异常有关。本研究旨在探讨合并 ODD 对 ADHD 患者脑体积和皮质厚度的影响。
使用结构磁共振成像（基于表面的形态测量学）研究三组（16±3.5 岁，均值±标准差；范围 7-29 岁）的脑体积和皮质厚度特征：ADHD+ODD（n=67）、ADHD 仅（n=243）和对照组（n=233）。分析包括年龄、性别、智商和扫描部位等调节因素。
ADHD+ODD 和 ADHD 仅组表现出总灰质和（主要是）额叶脑区的体积减少。主要是额叶区域的体积逐渐减少（ADHD+ODD<ADHD 仅<对照组），并且 ADHD+ODD 与多个结构的减少（例如，楔前叶）具有独特的相关性。一般来说，在考虑到 ADHD 症状严重程度后，这些发现仍然具有统计学意义。皮质厚度没有组间差异。探索性体素分析没有显示出组间差异。
ADHD+ODD 和 ADHD 仅组与注意力、（工作）记忆和决策相关的脑区体积减少有关。ADHD+ODD 组额叶体积减少最大，可能导致神经认知功能的观察到的更大损伤。先前报道的 ADHD 纹状体异常可能是由合并的品行障碍而不是 ODD 引起的。
