Left insular cortical thinning differentiates the inattentive and combined subtype of adult attention-deficit/hyperactivity disorder

Simon Maier; Alexandra Philipsen; Evgeniy Perlov; Kimon Runge; Swantje Matthies; Dieter Ebert; Dominique Endres; Katharina Domschke; Ludger Tebartz van Elst; Kathrin Nickel

doi:10.1016/j.jpsychires.2023.01.030

Left insular cortical thinning differentiates the inattentive and combined subtype of adult attention-deficit/hyperactivity disorder

J Psychiatr Res. 2023 Mar:159:196-204. doi: 10.1016/j.jpsychires.2023.01.030. Epub 2023 Jan 28.

Authors

Affiliations

¹ Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: simon.maier@uniklinik-freiburg.de.
² Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany. Electronic address: Alexandra.Philipsen@ukbonn.de.
³ Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Clinic for Psychiatry Luzern, St. Urban, St. Urban, Switzerland. Electronic address: evgeniy.perlov@lups.ch.
⁴ Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: kimon.runge@uniklinik-freiburg.de.
⁵ Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: swantje.matthies@uniklinik-freiburg.de.
⁶ Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: dieter.ebert@uniklinik-freiburg.de.
⁷ Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: dominique.endres@uniklinik-freiburg.de.
⁸ Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: katharina.domschke@uniklinik-freiburg.de.
⁹ Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: tebartzvanelst@uniklinik-freiburg.de.
¹⁰ Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: kathrin.nickel@uniklinik-freiburg.de.

PMID: 36739847
DOI: 10.1016/j.jpsychires.2023.01.030

Abstract

Background: Neuroimaging studies in attention-deficit/hyperactivity disorder (ADHD) demonstrated decreased global gray matter volume. In terms of surface parameters, most investigations focused on cortical thickness with a multi-center MEGA-analysis indicating cortical thinning in children, but not in adults with ADHD. In this single-scanner study, for the first time in adult ADHD, we additionally examined metrics beyond cortical thickness and surface area, namely sulcal depth and fractal dimension as measures of cortical alteration and complexity. Unlike most previous studies, ADHD subtypes were considered.

Methods: As part of the Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS), surface parameters were analyzed in 131 adults with ADHD (66 combined, 60 inattentive and 5 hyperactive/impulsive subtype) and 95 healthy controls with the Computational Anatomy Toolbox (CAT12) using Statistical Parametric Mapping Software (SPM).

Results: Neither at the vertex- nor at the region of interest-level, the ADHD and control group differed significantly with regard to cortical thickness, gyrification index, sulcal depth or fractal dimension. Contrasting the combined and the inattentive subtype, patients of the combined subtype showed a significant thinning of the left anterior insular cortex. Thinner left pars opercularis cortical thickness was associated with symptoms of hyperactivity/restlessness.

Conclusions: Resembling previous findings of a correlation of the left anterior insular gray matter volume with oppositional symptoms in adolescents with ADHD, we detected left anterior insular cortical thinning in the ADHD combined subtype. Left insular cortical thickness could represent a potential marker to distinguish the predominantly inattentive and the combined ADHD subtype in adulthood.

Keywords: ADHD; Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study; Cortical thickness; Gyrification index; Sulcal depth; attention-deficit/hyperactivity disorder.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Attention Deficit Disorder with Hyperactivity* / diagnosis
Cerebral Cortex
Cerebral Cortical Thinning
Child
Humans
Insular Cortex
Magnetic Resonance Imaging / methods