持續型與非持續型注意力不足過動症青少年之神經心理功能表現

Abstract

目的:注意力不足過動症(Attention-Deficit/Hyperactivity Disorder, ADHD)患者在的不同年齡層皆被發現會有神經心理功能的缺損，但尚無單一的缺損可以解釋注意力不足過動症的全貌。兒童與青少年患者的注意力不足過動症症狀可能會隨著年紀而減輕，並且有一半的患者長大後症狀將不再符合診斷的標準。兒童與青少年的神經心理功能表現會隨著年齡增長而有所改變，而注意力不足過動症的疾病狀態與神經心理功能表現的相關性至今則尚未有一致的發現。本研究的目的為評估持續型與非持續型注意力不足過動症的神經心理功能表現。 方法:共有459位11-19歲患有注意力不足過動症的青少年完成本研究的測驗，這些青少年皆在本研究進行之前約4-5年被臨床診斷為注意力不足過動症，另外有280位沒有注意力不足過動症診斷的青少年作為控制組。所有參加本研究的青少年皆接受中文版Kidde－情感性疾患與精神分裂症目錄－流行病學版(K-SADS-E)的診斷性會談，以確認他們過去與現在注意力不足過動症的狀態以及是否有其他精神科疾患，並且接受包括智商(intelligence quotient, IQ)以及劍橋電腦化神經心理測驗組套(Cambridge Neuropsychological testing automated battery, CANTAB)的測驗。持續型注意力不足過動症的定義為收案時仍符合注意力不足過動症的診斷準則，而非持續型注意力不足過動症的定義為過去有注意力不足過動症的診斷，但收案時已經不符合注意力不足過動症的診斷準則。 結果:持續型注意力不足過動症組(68.6%)較非持續注意力不足過動症組(31.4%)以及控制組年齡稍小一些。控制組的青少年較兩組過去有注意力不足過動症的青少年有較高的全智商，也可逆背較多數字。單變項分析顯示，不管是持續型或非持續型注意力不足過動症之青少年，大多數的神經心理功能表現都比控制組差，並且由好到壞呈現控制組－非持續型注意力不足過動症－持續型注意力不足過動症的線性趨勢。在控制年齡、性別、全智商以及精神疾患後，不管是持續型或非持續型注意力不足過動症組都在空間短期記憶(spatial span)、空間工作記憶、視覺辨識記憶、反應時間與訊號偵測度上皆較控制組差。注意力不足過動症與控制組在模組轉換(set-shifting)能力的表現沒有顯著差異。不管是在注意力不足過動症組或控制組，較年長青少年的神經心理功能表現較年輕者佳。 結論:注意力不足過動症的青少年長大持續會有神經心理功能缺損，某些缺損長大後即消失，少數則會持續。本研究顯示，在青少年，不管是持續型或非持續型注意力不足過動症，空間工作記憶缺損是注意力不足過動症一個穩定的特性。

Objective: ADHD has been found to have various neuropsychological deficits across life span and no single deficit was found to explain the whole picture of ADHD. Children and adolescents with ADHD may have age-dependent decline in symptoms and half of them will not meet the diagnostic criteria as they grow up. There was no consistent finding in the relationship between the disease status of ADHD and neuropsychological functions, which change with age during childhood and adolescence. Our study aimed to evaluate the neuropsychological functions in adolescents with persistent and non-persistent ADHD. Methods: We recruited 459 adolescents, aged 11-19, who were clinically diagnosed with ADHD 4 to 5 years before the implementation of this study and 280 comparison adolescents without ADHD. All participants were interviewed by the Chinese K-SADS-E to confirm their previous and current ADHD status and other psychiatric diagnoses, and received neuropsychological tests including intelligent quotient (IQ) and Cambridge Neuropsychological testing automated battery (CANTAB). ADHD was considered persistent if the adolescents with childhood diagnosis of ADHD met full diagnostic criteria for DSM-IV ADHD at ascertainment and non-persistent if the adolescents with childhood diagnosis of ADHD no longer met the full diagnostic criteria. Results: Adolescents with persistent ADHD (68.6%) were slightly younger than patients without persistent ADHD (31.4%) and the controls. The controls had higher full-scale IQ and more digits recalled backward than the two ADHD groups. The univariate analyses revealed that both persistent and non-persistent ADHD groups performed significantly worse than the controls in most modalities of the CANTAB and showed a linear trend in the order of persistent ADHD, non-persistent ADHD, and the controls. After adjusting for age, sex, full-scale IQ and any psychiatric comorbidity, regardless of current ADHD diagnosis, the adolescents with ADHD performed worse in spatial span, spatial working memory, visual recognition memory, reaction time and signal detectability than the controls. Set-shifting was not impaired in neither persistent nor persistent ADHD. Response inhibition and the EF tasks with lower difficulties were only impaired in current ADHD. Older adolescents had better performance than younger ones in all three groups in majority of neuropsychological tasks. Conclusion: The findings suggest that adolescents with ADHD continue to suffer from neuropsychological deficits when they grow up, and some deficits may disappear with symptoms and age while several may persist. Our study provides strong evidence that spatial working memory is a stable trait of ADHD regardless of the ADHD status throughout adolescence.