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Yıl:2014; Cilt: 15; Sayı: 4>> Özet
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Anadolu Psikiyatri Dergisi; 2014;15(4):318-327
Erişkin dikkat eksikliği ve hiperaktivite bozukluğunda silik nörolojik belirtiler ve nöropsikolojik işlev düzeyleri
ANİ Kenar, H Herken
Denizli Devlet Hastanesi, Denizli
Amaç: Dikkat eksikliği hiperaktivite bozukluğu (DEHB), nöropsikiyatrik bir bozukluk olup etiyopatogenezinde fronto-striyatal döngü üzerinde durulmaktadır. Psikiyatrik bozukluklardaki beyin işlev bozukluklarının araştırılmasında kullanılan silik nörolojik belirtiler daha çok çocukluk çağı DEHB’de araştırılmıştır. Bu çalışmada, DEHB’li erişkinlerin frontal bölge işlevlerine duyarlı nöropsikolojik test performansları ve silik nörolojik belirtilerin düzeylerinin araştırılması hedeflenmiştir. Yöntem: Çalışmaya DEHB tanısı konmuş olan 18-60 yaşları arasında 60 olgu ve 60 sağlıklı kontrol alındı. Olgu grubunda eş tanı varlığına bakılmamıştır. Her iki gruba Nörolojik Değerlendirme Ölçeği ve nöropsikolojik testler (Sayı dizileri, sözel bellek, Stroop ve Wisconsin Kart Eşleme Testi (WKET)) uygulandı. Elli dokuz olgu ve 46 kontrol bireyinin nöropsikolojik testleri ve nörolojik değerlendirmesi geçerli kabul edilmiş ve istatistiksel değerlendirmeye alınmıştır. Sonuç: Olguların yaş ortalaması 28.93±8.08, kontrol grubunun 32.07±8.11’di. Olguların %59.3’ü kadın, %40.7’si erkek; kontrol grubunun %63.0’ı kadın, %37.0’ı erkektir. DEHB’li erişkin grubunda sayı dizileri, sözel bellek ve stroop testlerinde kontrol grubuna göre anlamlı düzeyde düşük performans saptandı. WKET’de DEHB’li erişkinler ile kontrol grubu arasında farklılık bulunmadı. Silik nörolojik belirtilerde DEHB’li erişkinlerde motor koordinasyon ve alt test maddelerinden başparmak opozisyonunda kontrol grubuna göre anlamlı düzeyde düşük performans saptanmıştır. DEHB’li erişkinlerde duyusal bütünleştirme alt testinde ve alt test maddelerinden işitsel görsel bütünleştirme ve söndürme testinde kontrol grubuna göre anlamlı düzeyde düşük performans saptanmıştır. ‘Diğer’ alt testlerinden bellek, sinkinezi ve bakışı sabit tutma güçlüğü alt test maddelerinde DEHB’li erişkinlerde kontrol grubuna göre düşük performans saptanmıştır. Tartışma: DEHB’nin çocukluk çağında yaygın olduğu ve erişkin dönemde belirtilerin azaldığı belirtilmektedir. DEHB’de erişkinlikte de frontal lobda, serebellumda, pariyetal lobda ve/veya bunların birbirleriyle bağlantısını sağlayan fronto-striyatal yolaklarda bir işlev bozukluğunun sürdüğü, bunun ise bozukluğun gidişini ve tedaviyi etkileyebileceği düşünülmektedir.
Neuropsychologic functions and soft neurologic signs in adult ADHD
Objective: Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric illness and etiopathogenetic studies focus on fronto-striatal circuit. Soft neurologic signs that are used in the investigation of brain function disorders in psychiatric diseases were studied more in childhood ADHD. In the present study, it is aimed to study the neuropsychologic test performances that are sensitive to frontal lobe functions and soft neurologic signs in adult ADHD. Methods: Sixty subjects with ADHD and 60 healthy control subjects aging between 18-60 years were included into the study. Presence of comorbid psychiatric disorder was not investigated in the ADHD group. Neurological examination for soft signs and neuropsychologic tests (Digit span, verbal memory, Stroop task and Wisconsin card sorting test (WCST)) were performed to both groups. Neurological examination for soft signs and neuropsychologic tests of 59 patients and 46 control subjects were regarded as effective and were analyzed statistically. Results: Mean age was 28.93±8.08 years in the ADHD group (59.3% female, 40.7% male) and 32.07±8.11 years in the control group (63.0% female, 37.0% male). Significantly low performance was determined in digit span, verbal memory and Stroop task tests in adult ADHD group according to the control group. No difference was determined in WCST between adult ADHD and control groups. In the neurological examination for soft signs, adult ADHD group had significantly low performance according to the control group in motor coordination and finger-thumb opposition tests. Adult ADHD group had significantly low performance according to the control group in sensory integration and audiovisual integration and extinction tests. Adult ADHD group had low performance according to the control group in memory, synkinesis and gaze impersistence tests in “Others tests”. Discussion: It is implied that ADHD is common in childhood and its symptoms decrease in adulthood. It is also thought that a functional defect continues in frontal lobe, cerebellum, parietal lobe and/or in fronto-striatal pathways that provide associations between each other and this may affect the prognosis and treatment of the disorder.

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