تجربه ای از یک مرکز حافظه فرانسوی در مورد تشخیص اختلال کمتوجهی-بیشفعالی
Abstract
1- Introduction
2- Patients and methods
3- Results
4- Discussion
5- Conclusion
References
Abstract
Introduction
Attention deficit hyperactivity disorder (ADHD) is a frequent neurodevelopmental mental disorder. It can persist in adulthood and be expressed as a cognitive complaint.
Methods
We conducted a descriptive study in a French memory center concerning patients seen over a period of two years. All patients for whom the final diagnosis was ADHD were included. All patients benefited from standard neuropsychological tests and a psychiatric specific consultation.
Results
Thirteen patients were included with an average age of 50.2 ± 19 years. Main complaints related to memory, attention, focusing and organizational functioning. These difficulties had negative social, professional and academic consequences. ADHD history in descendants was noted in 46% of patients. More than 20% of subjects had motor, verbal or mental restlessness. Neuropsychological assessment highlighted impaired performances in executive functions (38%), sustained attention (67%), divided attention (45%), working memory (46%) and information processing speed (75%). A psychiatric history or comorbidities were present in 85% of patients, mostly of the anxio-depressive type. The more prevalent presentations of ADHD were the combined (38%) and inattentive (38%) types.
Discussion
Adult ADHD can masquerade as a cognitive impairment, including a stable cognitive complaint from infancy to old age. Inattentive, hyperactive and impulsive symptoms change with time and become more internalized (such as concentration difficulties or mental restlessness). No neuropsychological pattern has been reported but fluctuating deficits in sustained, divided attention, working memory and information processing speed are frequently observed in adult ADHD. A specific psychiatric expertise is essential in diagnosis and care for ADHD and its commonly associated psychiatric comorbidities.
Introduction
The American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders [1] (DSM-V) defines attention deficit disorder with or without hyperactivity (ADHD) as a syndrome occurring during childhood and which consists of three symptoms: hyperactivity, inattention and impulsivity. In the absence of a specific biomarker, this triad is the sole element for the diagnosis of ADHD. The variable combinations of these symptoms, their educational and social repercussions, are the cause of the different clinical presentations: a predominantly attentional subcategory, a predominantly hyperactive subcategory and finally a mixed subcategory that associates both inattention and hyperactivity symptoms. ADHD is the most frequent neurodevelopmental disorder with an estimated global prevalence in children of between 5 and 6% which has been steadily increasing (an increase of 33% between 1997–1999 and 2006–2008) [2,3]. Historically described as a disorder restricted to the childhood period, its diagnosis in adulthood was long controversial [3]. Many longitudinal studies have now confirmed the chronic nature of ADHD symptoms throughout life, including at an older age [4]. The persistence of the symptoms after adolescence is observed depending on the clinical form considered, in 50% to 80% of the cases [3,5]. Thus, the prevalence of ADHD in adulthood is estimated between 2– 5% and 3–4% worldwide [3,6]. The typical presentation of ADHD in adults meets different criteria from those observed in children. Symptoms associated with hyperactivity/impulsivity decrease and are expressed by disorganization and restlessness (motor or mental), while those associated with an attention deficit persist and now tend to become more prevalent [5,7]. Over time, the target symptoms of ADHD thus become more ‘‘cognitive’’ than ‘‘behavioral’’.