The executive control network and symptomatic improvement in attention-deficit/hyperactivity disorder
The executive control network and symptomatic improvement in attention-deficit/hyperactivity disorder
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DOI：
10.1016/j.cortex.2015.08.012
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发表时间：
2015-12-01
期刊：
影响因子：
3.6
通讯作者：
Mennes, Maarten
中科院分区：
文献类型：
--
作者：
Francx, Winke;Oldehinkel, Marianne;Mennes, Maarten
背景资料：一种神经发育理论假设注意力缺陷/多动障碍（ADHD）的缓解是由于改善了前额叶自上而下的控制，而ADHD，独立于目前的诊断，其特征是稳定的非皮质缺陷（Halperin & Schulz，2006）。我们测试了这一理论，使用静息状态功能磁共振成像（fMRI）数据在一个大样本的青少年与缓解型ADHD，持续性ADHD，和健康controls.Methods：在这项后续研究的参与者是100名健康对照组和129名青少年ADHD合并型在基线（平均年龄在基线11.8年，在后续17.5年）。两次收集诊断信息，并在随访时进行磁共振成像（MRI）扫描。我们使用执行控制网络的静息状态功能连接（RSFC）来研究是否改善前额叶自上而下的控制与ADHD症状的发展减少有关。此外，我们测试了非皮质RSFC，即，小脑和纹状体RSFC，是异常的持续性和/或缓解性ADHD相比controls.Results：更高的连接额区（前扣带皮层）的执行控制网络与减少ADHD症状。这种关联是由多动/冲动症状的变化驱动的，而不是由注意力不集中的变化驱动的。在这个网络中，缓解型ADHD的参与者表现出比对照组更强的RSFC，而持续性ADHD病例表现出RSFC强度介于缓解型ADHD病例和对照组之间。小脑和皮质下RSFC没有不同的参与者与ADHD和controls.Conclusions：在符合神经发育理论，ADHD症状恢复有关的执行控制网络中的前额叶区域更强的整合。缓解性ADHD、持续性ADHD和健康对照的RSFC强度模式可能反映了有助于症状缓解的代偿性神经机制的存在。(C)2015爱思唯尔有限公司版权所有。
Background: One neurodevelopmental theory hypothesizes remission of attention-deficit/hyperactivity disorder (ADHD) to result from improved prefrontal top-down control, while ADHD, independent of the current diagnosis, is characterized by stable non-cortical deficits (Halperin & Schulz, 2006). We tested this theory using resting state functional MRI (fMRI) data in a large sample of adolescents with remitting ADHD, persistent ADHD, and healthy controls.Methods: Participants in this follow-up study were 100 healthy controls and 129 adolescents with ADHD combined type at baseline (mean age at baseline 11.8 years; at follow-up 17.5 years). Diagnostic information was collected twice and augmented with magnetic resonance imaging (MRI) scanning at follow-up. We used resting state functional connectivity (RSFC) of the executive control network to investigate whether improved prefrontal top-down control was related to a developmental decrease in ADHD symptoms. In addition, we tested whether non-cortical RSFC, i.e., cerebellar and striatal RSFC, was aberrant in persistent and/or remittent ADHD compared to controls.Results: Higher connectivity within frontal regions (anterior cingulate cortex) of the executive control network was related to decreases in ADHD symptoms. This association was driven by change in hyperactive/impulsive symptoms and not by change in inattention. Participants with remitting ADHD showed stronger RSFC than controls within this network, while persistent ADHD cases exhibited RSFC strengths intermediate to remittent ADHD cases and controls. Cerebellar and subcortical RSFC did not differ between participants with ADHD and controls.Conclusions: In line with the neurodevelopmental theory, symptom recovery in ADHD was related to stronger integration of prefrontal regions in the executive control network. The pattern of RSFC strength across remittent ADHD, persistent ADHD, and healthy controls potentially reflects the presence of compensatory neural mechanisms that aid symptomatic remission. (C) 2015 Elsevier Ltd. All rights reserved.