Differences in brain function between men and women with adult ADHD

Are the brains of women and men with adult ADHD different?
Our research with structural and functional MRI suggests:

1. Men recruit larger neural resources than women to achieve similar behavioral performance during the one- back letter task.

2. Men show less deactivation of a key area of the default mode network, the posterior cingulate gyrus.

In summary, our results provide evidence that cognitive functions are represented differently in men and women with ADHD.

1. Differences in brain function between men and women with adult ADHD Dr. Peter Sörös University of Oldenburg
2. Sex differences
3. Sex differences? www.emma.de accessed 6 March 2017
4. Sex differences?
5. Prevalence of ADHD 0% 3% 6% 9% 0-17 yrs 18-69 yrs 0.3 3.6 0.5 8.4 male female Bachmann CJ, Philipsen A, Hoffmann F: ADHD in Germany: trends in diagnosis and pharmacotherapy—a country- wide analysis of health insurance data on attention-deficit/ hyperactivity disorder (ADHD) in children, adolescents and adults from 2009–2014. Dtsch Arztebl Int 2017; 114: 141–8.
6. MBCT vs. psychoeducation in adult ADHD • 74 adult patients with ADHD included in MRI study • structural and functional MRI before intervention • intervention: 8 weeks of MBCT group therapy vs. 8 weeks of psychoeducation • structural and functional MRI after intervention
7. Structural analysis • 35 women (42±11 years) and 29 men (38±11 years) with adult ADHD • T1-weighted anatomical scan (MPRAGE sequence, Siemens Magnetom Trio at 3 Tesla) • surface-based cortical and volume-based subcortical analysis with Freesurfer
8. Cortical thickness A: The score on the CAARS inattention subscale predicts cortical thickness in a left lateral occipital area in men (Freesurfer surface-based analysis, linear model, p < 0.01, corrected for multiple comparisons). B: Individual mean cortical thickness as a function of inattention score. Regression line and 95% confidence intervals are shown (analysis in R, linear model, (F(1,27) = 26.4, p = 0.000021, adjusted R2 = 0.4756)).
9. Cortical thickness • The lateral occipital cortex is a key region in object and shape processing • Increased cortical thickness in the left lateral occipital cortex may represent a mechanism to compensate for dysfunctional attentional networks in adult ADHD patients
10. Subcortical structures • caudate nucleus • putamen • pallidum • hippocampus • amygdala • accumbens 6 12 18 24 30 1000 1500 2000 2500 volume of left pallidum (mm3) score on the inattention subscale (F(1,33) = 7.25, uncorrected p=0.01105, adjusted R2=0.1553)
11. Working memory • 31 women (42±11 years) and 24 men (37±12 years) with adult ADHD • functional BOLD fMRI during a One-back letter task (Siemens Magnetom Trio at 3 Tesla) • 2 runs, 300 stimuli (89 target, 211 non-target; interstimulus interval: 1 s) each • data analysis with FSL
12. Behavioral data • no significant difference between men and women for • accuracy of responses • latency of correct responses
13. 3.1 5.0 Z x = 34 x = 14 x = 6 x = -28 R R R L R R z = -24 z = -12 z = 0 z = 12 z = 24 z = 36 z = 48 z = 60 PCG PCG SPL SPL LN LN FP FP P P Figure 1. Brain activation map, men > women. Brain regions color-coded in red and yellow show stronger activation in men than in women. Z statistic images are overlaid onto the mean structural T1-weighted image of the participants. The upper two rows show axial images of the brain in radiological convention (the right hemisphere is on the left). The last row shows sagittal images of the right (images 1-3) and left hemisphere (image 4). LN: lentiform nucleus. P: putamen. FP: frontal pole. PCG: posterior cingulate gyrus. SPL: superior parietal lobule. One-back task, men vs. women
14. Working memory, men vs. women Hill AC, Laird AR, Robinson JL. Gender differences in working memory networks: a BrainMap meta-analysis. Biol Psychol. 2014;102:18-29.
15. 2.3 3.8 Z x = 24 x = 4 x = -2 y = 36 R R L R R R z = -24 z = -12 z = 0 z = 12 z = 24 z = 36 z = 48 z = 60 MFG SFG Figure 2. Brain activation map, showing areas inversely correlated with the Conners inattention subscale in men. Z statistic images are overlaid onto the mean structural T1-weighted image of the participants. The upper two rows show axial images of the brain in radiological convention (the right hemisphere is on the left). The last row shows sagittal images of the right (images 1 and 2) and left hemisphere (image 3) as well as one coronal image of the frontal lobe (image 4). MFG: medial frontal gyrus. SFG: superior frontal gyrus. SFG MFG MFG MFG SFG One-back task vs. inattention in men
16. Conclusions • Men recruit larger neural resources than women to achieve similar behavioral performance during the one- back letter task. • Men show less deactivation of a key area of the default mode network, the posterior cingulate gyrus. • In summary, our results provide evidence that cognitive functions are represented differently in men and women with ADHD.
17. References • Poster • Bachmann K. et al. Differences in brain activation after mindfulness training in adults with ADHD - an fMRI study. 6th World Congress on ADHD, Vancouver, Canada, April 2017 • Sörös P. et al. Sex differences in brain activation during a working memory task in adult patients with ADHD. Human Brain Mapping conference, Vancouver, Canada, June 2017 • Paper • Bachmann K. et al. How mindfulness effects working memory function in males and females with ADHD, an fMRI study. in preparation. • Sörös P. et al. Inattention predicts increased thickness of left lateral occipital cortex in men with ADHD. in preparation.
18. elen Dank!