Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation.
Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation.
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DOI：
10.3389/fnhum.2018.00100
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发表时间：
2018
影响因子：
2.9
通讯作者：
Rubia K
中科院分区：
文献类型：
--
作者：
Rubia K
本综述重点关注基于功能磁共振成像 (fMRI) 研究的注意力缺陷多动障碍 (ADHD) 的认知神经科学，以及最近的临床相关应用，例如基于 fMRI 的诊断分类或通过神经反馈 (NF) 或脑刺激针对 fMRI 缺陷的神经调节疗法。对执行功能 (EF) 功能磁共振成像研究的荟萃分析表明，ADHD 患者在多个左右半球背侧、腹侧和内侧额-扣带-纹状体-丘脑和额顶-小脑网络中存在认知域分离的复杂多系统损伤，这些网络介导认知控制、注意力、时间安排和工作记忆 (WM)。此外，还有新的证据表明，调节动机和情绪控制的眼眶和腹内侧前额叶和边缘区域存在异常。此外，默认模式网络（DMN）的停用不良表明低参与度任务积极网络和“关闭”不良的过度参与任务消极网络之间存在异常相互关系，这两者都与认知受损有关。 ADHD 的转化认知神经科学仍处于起步阶段。模式识别分析试图使用 fMRI 数据提供 ADHD 的诊断分类，分类准确率超过 80%。然而，必要的复制研究仍然悬而未决。脑刺激已在针对 ADHD 关键额叶功能障碍的异构设计、少量概念验证研究中进行了测试。根据一些研究，经颅直流电刺激 (tDCS) 似乎有望改善 ADHD 症状和认知功能，但需要进行更大规模的重复刺激（有或没有认知训练）的临床试验，以测试临床疗效和非目标功能的潜在成本。只有三项研究使用功能磁共振成像或近红外光谱对 ADHD 中基于功能磁共振成像的额叶功能障碍进行了试点，其中两项较大的研究发现认知和症状有所改善，但并不优于主动对照条件，这表明潜在的安慰剂效应。神经治疗似乎对多动症很有吸引力，因为它们的安全性和潜在的长期神经塑性作用是药物无法提供的。然而，需要对它们的短期和长期临床和认知功效及其个体化治疗的潜力进行彻底测试。
This review focuses on the cognitive neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) based on functional magnetic resonance imaging (fMRI) studies and on recent clinically relevant applications such as fMRI-based diagnostic classification or neuromodulation therapies targeting fMRI deficits with neurofeedback (NF) or brain stimulation. Meta-analyses of fMRI studies of executive functions (EFs) show that ADHD patients have cognitive-domain dissociated complex multisystem impairments in several right and left hemispheric dorsal, ventral and medial fronto-cingulo-striato-thalamic and fronto-parieto-cerebellar networks that mediate cognitive control, attention, timing and working memory (WM). There is furthermore emerging evidence for abnormalities in orbital and ventromedial prefrontal and limbic areas that mediate motivation and emotion control. In addition, poor deactivation of the default mode network (DMN) suggests an abnormal interrelationship between hypo-engaged task-positive and poorly “switched off” hyper-engaged task-negative networks, both of which are related to impaired cognition. Translational cognitive neuroscience in ADHD is still in its infancy. Pattern recognition analyses have attempted to provide diagnostic classification of ADHD using fMRI data with respectable classification accuracies of over 80%. Necessary replication studies, however, are still outstanding. Brain stimulation has been tested in heterogeneously designed, small numbered proof of concept studies targeting key frontal functional impairments in ADHD. Transcranial direct current stimulation (tDCS) appears to be promising to improve ADHD symptoms and cognitive functions based on some studies, but larger clinical trials of repeated stimulation with and without cognitive training are needed to test clinical efficacy and potential costs on non-targeted functions. Only three studies have piloted NF of fMRI-based frontal dysfunctions in ADHD using fMRI or near-infrared spectroscopy, with the two larger ones finding some improvements in cognition and symptoms, which, however, were not superior to the active control conditions, suggesting potential placebo effects. Neurotherapeutics seems attractive for ADHD due to their safety and potential longer-term neuroplastic effects, which drugs cannot offer. However, they need to be thoroughly tested for short- and longer-term clinical and cognitive efficacy and their potential for individualized treatment.
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