Subcortico-Cortical Dysconnectivity in ADHD: A Voxel-Wise Mega-Analysis Across Multiple Cohorts.

IF 15.1 1区 医学 Q1 PSYCHIATRY American Journal of Psychiatry Pub Date : 2024-06-01 Epub Date: 2024-03-13 DOI:10.1176/appi.ajp.20230026
Luke J Norman, Gustavo Sudre, Jolie Price, Philip Shaw
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Abstract

Objective: A large body of functional MRI research has examined a potential role for subcortico-cortical loops in the pathogenesis of attention deficit hyperactivity disorder (ADHD), but has produced inconsistent findings. The authors performed a mega-analysis of six neuroimaging data sets to examine associations between ADHD diagnosis and traits and subcortico-cortical connectivity.

Methods: Group differences were examined in the functional connectivity of four subcortical seeds in 1,696 youths with ADHD diagnoses (66.39% males; mean age, 10.83 years [SD=2.17]) and 6,737 unaffected control subjects (47.05% males; mean age, 10.33 years [SD=1.30]). The authors examined associations between functional connectivity and ADHD traits (total N=9,890; 50.3% males; mean age, 10.77 years [SD=1.96]). Sensitivity analyses were used to examine specificity relative to commonly comorbid internalizing and non-ADHD externalizing problems. The authors further examined results within motion-matched subsamples, and after adjusting for estimated intelligence.

Results: In the group comparison, youths with ADHD showed greater connectivity between striatal seeds and temporal, fronto-insular, and supplementary motor regions, as well as between the amygdala and dorsal anterior cingulate cortex, compared with control subjects. Similar findings emerged when ADHD traits were considered and when alternative seed definitions were adopted. Dominant associations centered on the connectivity of the caudate bilaterally. Findings were not driven by in-scanner motion and were not shared with commonly comorbid internalizing and externalizing problems. Effect sizes were small (largest peak d, 0.15).

Conclusions: The findings from this large-scale mega-analysis support established links with subcortico-cortical circuits, which were robust to potential confounders. However, effect sizes were small, and it seems likely that resting-state subcortico-cortical connectivity can capture only a fraction of the complex pathophysiology of ADHD.

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多动症的皮层下连接障碍:跨越多个队列的体素全分析。
研究目的大量功能性核磁共振成像研究探讨了皮层下-皮层环路在注意力缺陷多动障碍(ADHD)发病机制中的潜在作用,但研究结果并不一致。作者对六个神经影像数据集进行了大规模分析,以研究ADHD诊断和特质与皮层下连接之间的关联:研究人员对1,696名诊断为ADHD的青少年(66.39%为男性;平均年龄为10.83岁[SD=2.17])和6,737名未受影响的对照组受试者(47.05%为男性;平均年龄为10.33岁[SD=1.30])的四个皮层下种子的功能连接性进行了群体差异分析。作者研究了功能连通性与多动症特征之间的关联(总人数=9890;50.3%为男性;平均年龄为10.77岁[SD=1.96])。灵敏度分析用于检查与常见合并内化和非多动症外化问题相关的特异性。作者还进一步研究了运动匹配子样本的结果,并对估计智力进行了调整:在分组比较中,与对照组受试者相比,患有多动症的青少年在纹状体种子与颞叶、前内侧和辅助运动区之间,以及杏仁核与背侧前扣带回皮层之间表现出更大的连通性。在考虑多动症特质和采用其他种子定义时,也出现了类似的发现。主要的关联集中在双侧尾状核的连通性上。研究结果不受扫描仪内运动的影响,也不与通常合并的内化和外化问题相同。效应大小较小(最大峰值d为0.15):这项大规模的大型分析结果支持与皮层下-皮层环路的既定联系,这些联系对潜在的混杂因素具有稳健性。然而,效应大小较小,静息态皮层下-皮层连通性似乎只能捕捉到多动症复杂病理生理学的一部分。
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来源期刊
American Journal of Psychiatry
American Journal of Psychiatry 医学-精神病学
CiteScore
22.30
自引率
2.80%
发文量
157
审稿时长
4-8 weeks
期刊介绍: The American Journal of Psychiatry, dedicated to keeping psychiatry vibrant and relevant, publishes the latest advances in the diagnosis and treatment of mental illness. The journal covers the full spectrum of issues related to mental health diagnoses and treatment, presenting original articles on new developments in diagnosis, treatment, neuroscience, and patient populations.
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