Ohnishi Takashi, Toda Wataru, Itagaki Shuntaro, Sato Aya, Matsumoto Junya, Ito Hiroshi, Ishii Shiro, Miura Itaru, Yabe Hirooki
Medical Affairs Division, Janssen Pharmaceutical K.K., Tokyo, Japan.
Department of Neuropsychiatry, Fukushima Medical University, Fukushima, Japan.
Front Psychiatry. 2023 Mar 16;14:1093522. doi: 10.3389/fpsyt.2023.1093522. eCollection 2023.
Attention-deficit/hyperactivity disorder (ADHD) is a neuropsychiatric disorder whose primary symptoms are hyperactivity, impulsivity, and inattention. Historically, ADHD was recognized as a disease of childhood and adolescence. However, many patients are known to have persistent symptoms into adulthood. Many researchers consider the neuropathology of ADHD to be based on abnormalities in multiple parallel and intersecting pathways rather than a single anatomical area, but such alterations remain to be clarified.
Using diffusion tensor imaging, we investigated differences in the global network metrics estimated by graph theory and the degree of connectivity between adjacent voxels within a white matter (WM) fascicle defined by the density of the diffusing spins (connectometry) between 19 drug-naive Japanese patients with adult ADHD and 19 matched healthy controls (HCs). In adult patients with ADHD, we examined the relationships between the symptomatology of ADHD and global network metrics and WM abnormalities.
Compared with HCs, adult patients with ADHD showed a reduced rich-club coefficient and decreased connectivity in widely distributed WMs such as the corpus callosum, the forceps, and the cingulum bundle. Correlational analyses demonstrated that the general severity of ADHD symptoms was associated with several global network metrics, such as lower global efficiency, clustering coefficient, small worldness, and longer characteristic path length. The connectometry revealed that the severity of hyperactive/impulsive symptoms was associated with overconnectivity in the corticostriatal, corticospinal, and corticopontine tracts, the inferior fronto-occipital fasciculus, and the extreme capsule but dysconnectivity in the cerebellum. The severity of inattentive symptoms was associated with dysconnectivity in the intracerebellar circuit and some other fibers.
The results of the present study indicated that patients with treatment-naive adult ADHD showed disrupted structural connectivity, which contributes to less efficient information transfer in the ADHD brain and pathophysiology of ADHD.
UMIN Clinical Trials Registry (UMIN-CTR) UMIN000025183, Registered: 5 January 2017.
注意力缺陷多动障碍（ADHD）是一种神经精神障碍，其主要症状为多动、冲动和注意力不集中。历史上，ADHD被认为是一种儿童和青少年疾病。然而，众所周知，许多患者成年后仍有持续症状。许多研究人员认为ADHD的神经病理学基于多个平行和交叉通路的异常，而非单一解剖区域，但此类改变仍有待阐明。
我们使用扩散张量成像，研究了19名未服用过药物的成年ADHD日本患者与19名匹配的健康对照（HC）之间，通过图论估计的全局网络指标差异，以及由扩散自旋密度定义的白质（WM）束内相邻体素之间的连接程度（连接计量学）。在成年ADHD患者中，我们研究了ADHD症状学与全局网络指标及WM异常之间的关系。
与HC相比，成年ADHD患者的富俱乐部系数降低，胼胝体、钳状束和扣带束等广泛分布的WM中的连接性降低。相关性分析表明，ADHD症状的总体严重程度与多个全局网络指标相关，如较低的全局效率、聚类系数、小世界特性和较长的特征路径长度。连接计量学显示，多动/冲动症状的严重程度与皮质纹状体、皮质脊髓和皮质脑桥束、额枕下束及外囊的连接过度有关，但与小脑的连接中断有关。注意力不集中症状的严重程度与小脑内回路及其他一些纤维的连接中断有关。
本研究结果表明，未接受过治疗的成年ADHD患者存在结构连接中断，这导致ADHD大脑中的信息传递效率降低及ADHD的病理生理学改变。
UMIN临床试验注册中心（UMIN-CTR）UMIN000025183，注册时间：2017年1月5日。
