Section on Neurobehavioral and Clinical Research, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892.
Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892.
Proc Natl Acad Sci U S A. 2017 Oct 31;114(44):11787-11792. doi: 10.1073/pnas.1705229114. Epub 2017 Oct 16.
We have a limited understanding of why many children with attention deficit hyperactivity disorder do not outgrow the disorder by adulthood. Around 20-30% retain the full syndrome as young adults, and about 50% show partial, rather than complete, remission. Here, to delineate the neurobiology of this variable outcome, we ask if the persistence of childhood symptoms into adulthood impacts on the brain's functional connectivity. We studied 205 participants followed clinically since childhood. In early adulthood, participants underwent magnetoencephalography (MEG) to measure neuronal activity directly and functional MRI (fMRI) to measure hemodynamic activity during a task-free period (the "resting state"). We found that symptoms of inattention persisting into adulthood were associated with disrupted patterns of typical functional connectivity in both MEG and fMRI. Specifically, those with persistent inattention lost the typical balance of connections within the default mode network (DMN; prominent during introspective thought) and connections between this network and those supporting attention and cognitive control. By contrast, adults whose childhood inattentive symptoms had resolved did not differ significantly from their never-affected peers, both hemodynamically and electrophysiologically. The anomalies in functional connectivity tied to clinically significant inattention centered on midline regions of the DMN in both MEG and fMRI, boosting confidence in a possible pathophysiological role. The findings suggest that the clinical course of this common childhood onset disorder impacts the functional connectivity of the adult brain.
我们对为什么许多患有注意力缺陷多动障碍的儿童到成年后不会痊愈的原因了解有限。大约 20-30%的人在成年后仍保留完整的综合征，而大约 50%的人表现出部分而非完全缓解。在这里，为了描绘这种可变结果的神经生物学，我们询问儿童期症状持续到成年是否会影响大脑的功能连接。我们研究了 205 名自童年起就接受临床随访的参与者。在成年早期，参与者接受了脑磁图（MEG）测量直接的神经元活动和功能磁共振成像（fMRI）测量任务期间的血液动力学活动（“静息状态”）。我们发现，成年后持续存在的注意力不集中症状与 MEG 和 fMRI 中典型功能连接模式的中断有关。具体来说，那些持续存在注意力不集中的人失去了默认模式网络（DMN；在内省思考时活跃）内连接的典型平衡，以及该网络与支持注意力和认知控制的网络之间的连接。相比之下，那些童年注意力不集中症状已经缓解的成年人在血液动力学和电生理方面与从未受影响的同龄人没有显著差异。与临床上显著的注意力不集中相关的功能连接异常集中在 DMN 的中线区域，在 MEG 和 fMRI 中均如此，这增强了对可能的病理生理作用的信心。研究结果表明，这种常见的儿童期发病障碍的临床病程会影响成年人大脑的功能连接。
