- 學位論文
注意力不足過動症成人患者之大腦白質完整性變化:全腦徑束自動分析之擴散頻譜造影研究
Alteration of White Matter Tract Integrity Property in Adults with Attention-Deficit Hyperactivity Disorder: A Diffusion Spectrum Imaging Study Using Whole Brain Tract-Based Automatic Analysis
摘要
研究目的：兒童期常見的注意力不足過動症（Attention Deficit/Hyperactivity Disorder, ADHD）常會持續到成人期，目前已有顯著證據顯示ADHD會伴隨廣泛的大腦結構異常。擴散造影(diffusion imaging)對ADHD大腦白質微結構完整性的研究發現:前額紋狀路徑、扣帶束、上縱束、下縱束等結構可能是異常所在。本研究為第一個以擴散頻譜造影(diffusion spectrum imaging, DSI)探討成人ADHD全腦白質微結構完整性之研究，並檢視ADHD成人與對照組白質徑束之不同。 研究方法：六十四位成人ADHD個案，年齡28.7歲(平均年齡 ± 標準差, 28.7歲 ± 7.9歲; 男性佔54.7%)及八十一位對照組，年齡28.4歲(28.4歲 ± 7.9歲; 男性佔55.6%)，均接受完整精神評估及DSI掃描，獲得影像後則以全腦徑束自動分析(tract-based automatic analysis, TBAA)來重建全腦神經徑束，後續以threshold free cluster weighted (TFCW) 分數進行組間分析。參加者亦須完成成人ADHD臨床症狀自陳量表、柯能式持續表現測驗(Conners’ continuous performance test, CCPT)、快速視覺資訊處理測驗(rapid visual information processing test)以評估其臨床症狀及注意力表現。資料以關聯性分析及迴歸進行統計。 研究成果：影像分析結果發現ADHD成人與對照組差異最大的十五條徑束主要存在於額葉-紋狀體-視丘-皮質迴路、右側下縱束、右側上縱束I、左側上縱束II、以及胼胝體的頂葉、顳葉及枕葉部分。兩組神經徑束完整性與注意力表現測驗的關聯性亦不同:在成人ADHD個案中，CCPT相關參數與額葉-紋狀體路徑完整性有關；而在對照組中，CCPT相關參數則與視丘及胼胝體相關路徑完整性有關。此外，在ADHD組中，右側上縱束I及背外側前額皮質至紋狀體路徑 (dorsolateral prefrontal cortex- striatum tract)完整性越高，臨床之過動/衝動症狀則會越低。 研究結論：以新發展的TBAA，可發現成人ADHD個案在額葉-紋狀體-視丘-皮質迴路、注意力網絡(attention network)、感覺運動系統(sensorimotor system)以及語言系統(linguistic system)存在白質微結構的損害，實驗結果亦可提供上述系統白質連結性的證據。此外，兩組在進行注意力測驗時，可能會運用不同腦區；成人ADHD個案的注意力表現與額葉-紋狀體路徑完整性有相關，對照組的注意力表現則傾向與視丘及胼胝體相關路徑有關。
並列摘要
Objective: Attention deficit/hyperactivity disorder (ADHD) lasts to adulthood with the evidence of widespread brain abnormalities. Diffusion imaging studies reveal disturbed white matter microstructure integrity in several brain regions in ADHD, such as the frontostriatal circuit, cingulum, superior longitudinal fasciculus, inferior longitudinal fasciculus, etc. As the first study to examine the microstructure integrity using diffusion spectrum imaging (DSI) in adults with ADHD, this study aimed to identify the fiber tracts which can distinguish adults with ADHD and healthy adults. Method: Sixty-four adults with ADHD aged 28.7 (mean ± standard deviation, SD, 28.7 ± 7.9; male, 54.7%) and eighty-one healthy adults aged 28.4 (28.4 ± 7.9; male, 55.6%), received psychiatric and DSI assessments. After acquisition of the DSI, whole brain tractography was reconstructed by a novel tract-based automatic analysis (TBAA). The participants also reported on ADHD clinical symptoms and received the Conners’ continuous performance test and rapid visual information processing test for the assessment of attention performance. Correlation and regression analyses were conducted. Results: The most significantly different clusters between healthy adults and adults with ADHD were determined in 15 tracts, located in the fronto-striato-thalamo-cortical circuit, right inferior longitudinal fasciculus (ILF), right superior longitudinal fasciculus (SLF) I, left SLF II, and corpus callosum (parietal, temporal and occipital parts). There were different patterns of the associations of the fiber tracts integrity with CCPT performance between adults with ADHD and healthy adults. In summary, the CCPT indexes were correlated with the integrity of fronto-striatal tracts in adults with ADHD, while the CCPT indexes exhibited correlation with the integrity of thalamus and corpus callosum related tracts in healthy adults. Moreover, higher integrity of the right SLF I and the dorsolateral prefrontal cortex to striatum were associated with less hyperactivity/impulsivity symptoms in adults with ADHD. Conclusions: Using the whole brain TBAA method, we found the tracts with altered white matter microstructure property in adults with ADHD are involved in the fronto-striato-thalamo-cortical circuit, attention network, sensorimotor system, and linguistic system. Moreover, when undertaken attention performance test, different neural correlates were employed. In the ADHD group, the associations existed in the fronto-stiatal tracts, while in healthy adults, the association was uncovered in the thalamus and corpus callosum related tracts.