Department of Psychiatry,National Taiwan University Hospital, and College of Medicine,Taipei,Taiwan.
Systems Neuroscience Group,QIMR Berghofer Medical Research Institute,Brisbane, Queensland,Australia.
Psychol Med. 2018 Oct;48(14):2399-2408. doi: 10.1017/S0033291718000028. Epub 2018 Feb 7.
Childhood-onset attention-deficit hyperactivity disorder (ADHD) in adults is clinically heterogeneous and commonly presents with different patterns of cognitive deficits. It is unclear if this clinical heterogeneity expresses a dimensional or categorical difference in ADHD.
We first studied differences in functional connectivity in multi-echo resting-state functional magnetic resonance imaging (rs-fMRI) acquired from 80 medication-naïve adults with ADHD and 123 matched healthy controls. We then used canonical correlation analysis (CCA) to identify latent relationships between symptoms and patterns of altered functional connectivity (dimensional biotype) in patients. Clustering methods were implemented to test if the individual associations between resting-state brain connectivity and symptoms reflected a non-overlapping categorical biotype.
Adults with ADHD showed stronger functional connectivity compared to healthy controls, predominantly between the default-mode, cingulo-opercular and subcortical networks. CCA identified a single mode of brain-symptom co-variation, corresponding to an ADHD dimensional biotype. This dimensional biotype is characterized by a unique combination of altered connectivity correlating with symptoms of hyperactivity-impulsivity, inattention, and intelligence. Clustering analyses did not support the existence of distinct categorical biotypes of adult ADHD.
Overall, our data advance a novel finding that the reduced functional segregation between default-mode and cognitive control networks supports a clinically important dimensional biotype of childhood-onset adult ADHD. Despite the heterogeneity of its presentation, our work suggests that childhood-onset adult ADHD is a single disorder characterized by dimensional brain-symptom mediators.
成人起病的注意缺陷多动障碍（ADHD）在临床上表现出异质性，且常伴有不同认知缺陷模式。目前尚不清楚这种临床异质性是否代表 ADHD 在维度或类别上的差异。
我们首先研究了 80 名未用药的 ADHD 成年患者和 123 名匹配的健康对照者多回波静息态功能磁共振成像（rs-fMRI）中功能连接的差异。然后，我们使用典型相关分析（CCA）来识别患者症状和改变的功能连接模式（维度生物型）之间的潜在关系。聚类方法用于检验静息态脑连接与症状之间的个体关联是否反映出非重叠的类别生物型。
与健康对照组相比，ADHD 成人表现出更强的功能连接，主要是在默认模式、扣带前回-脑岛和皮质下网络之间。CCA 确定了一种单一的脑-症状共同变化模式，对应于 ADHD 的维度生物型。这种维度生物型的特点是与多动-冲动、注意力不集中和智力相关的改变连接具有独特的组合。聚类分析不支持成人 ADHD 存在明显的类别生物型。
总体而言，我们的数据提供了一个新的发现，即默认模式和认知控制网络之间功能连接的减少支持了儿童起病的成人 ADHD 的一个重要临床维度生物型。尽管其表现存在异质性，但我们的工作表明，儿童起病的成人 ADHD 是一种单一的障碍，其特征是具有维度的脑-症状介导物。
