Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa utca 6, Budapest, 1083, Hungary.
Molecular Psychiatry and In Vitro Disease Modeling Research Group, Semmelweis University, Budapest, Hungary.
Eur Arch Psychiatry Clin Neurosci. 2024 Oct;274(7):1741-1758. doi: 10.1007/s00406-023-01702-x. Epub 2023 Nov 18.
Adult attention-deficit/hyperactivity disorder (aADHD) represents a heterogeneous entity incorporating different subgroups in terms of symptomatology, course, and neurocognition. Although neurocognitive dysfunction is generally associated with aADHD, its severity, association with self-reported symptoms, and differences between subtypes remain unclear. We investigated 61 outpatients (65.6% male, mean age 31.5 ± 9.5) diagnosed using DSM-5 criteria together with age-, sex-, and education-matched healthy controls (HC) (n = 58, 63.8% male, mean age 32.3 ± 9.6). Neurocognitive alterations were assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and compared between groups using the generalized linear model (GLM) method. Multivariate effects were tested by principal component analysis combined with multivariate pattern analysis. Self-reported symptom severity was tested for correlations with neurocognitive performance. GLM analyses revealed nominally significant differences between the aADHD and HC groups in several domains, however, only the Rapid Visual Information Processing measures survived correction, indicating impaired sustained attention and response inhibition in the aADHD group. Comparison of the predominantly inattentive and the hyperactive-impulsive/combined subtypes yielded nominally significant differences with higher levels of dysfunction in the inattentive group. In the stepwise discriminant analysis aADHD and HC groups were best separated with 2 factors representing sustained attention and reaction time. We found only weak correlations between symptom severity and CANTAB factors. aADHD patients are neuropsychologically heterogeneous and subtypes show different neurocognitive profiles. Differences between the aADHD and HC groups were driven primarily by the inattentive subtype. Sustained attention and its factor derivative showed the most significant alterations in aADHD patients.
成人注意缺陷多动障碍（aADHD）是一种异质实体，在症状、病程和神经认知方面包含不同亚组。尽管神经认知功能障碍通常与 aADHD 相关，但其严重程度、与自我报告症状的关联以及亚型之间的差异仍不清楚。我们调查了 61 名门诊患者（65.6%为男性，平均年龄 31.5±9.5），他们使用 DSM-5 标准诊断，同时还包括年龄、性别和教育匹配的健康对照组（HC）（n=58，63.8%为男性，平均年龄 32.3±9.6）。使用剑桥神经心理学测试自动化电池（CANTAB）评估神经认知改变，并使用广义线性模型（GLM）方法比较组间差异。通过主成分分析与多元模式分析相结合测试多变量效应。测试自我报告症状严重程度与神经认知表现之间的相关性。GLM 分析显示，在几个领域，aADHD 组和 HC 组之间存在名义上的显著差异，但只有快速视觉信息处理测量值在纠正后仍然存在，这表明 aADHD 组的持续注意力和反应抑制受损。对主要注意力不集中和多动冲动/混合亚型的比较显示，注意力不集中组的功能障碍水平更高，存在名义上的显著差异。在逐步判别分析中，aADHD 和 HC 组最好用代表持续注意力和反应时间的 2 个因素来区分。我们只发现症状严重程度和 CANTAB 因素之间存在微弱的相关性。aADHD 患者神经认知异质性大，亚型表现出不同的神经认知特征。aADHD 组和 HC 组之间的差异主要由注意力不集中型驱动。持续注意力及其因子衍生表现出 aADHD 患者最显著的改变。
