Neuroimaging of diet and medication in the treatment of ADHD

饮食和药物治疗多动症的神经影像学

基本信息

批准号：
8442418
负责人：
STEVEN R. PLISZKA
金额：
$ 22.72万
依托单位：
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-01-03 至 2014-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8442418
关键词：
Affect Aftercare Age Amygdaloid structure Anterior Attention Attention deficit hyperactivity disorder Behavior Behavioral Belief Biological Markers Blinded Brain Child Clinical Trials Complex Conflict (Psychology)Control Groups Counseling Data Development Diet Dietary Intervention Double-Blind Method Enrollment Family Food Functional Magnetic Resonance Imaging Functional disorder Goals Grant Household Image Imaging Techniques Insula of Reil Lateral Magnetism Medial Methylphenidate Metric Modeling Moods Nutritional Outcome Parents Participant Perception Pharmaceutical Preparations Phase Placebos Plant Roots Prefrontal Cortex Psychological Impact Randomized Relative (related person)Reporting Rest Rewards Running Societies Structure Symptoms Taste Perception Testing Ventral Striatum Work active method base blind diet compliance dietary restriction double-blind placebo controlled trial food restriction intraparietal sulcus neuroimaging nutrition public health relevance relating to nervous system response statistics trial comparing week trial

项目摘要

DESCRIPTION (provided by applicant): Dietary interventions for Attention Deficit Hyperactivity Disorder (ADHD) have been both controversial and popular. Recently, a "few foods" restriction diet was found to be efficacious relative to nutritional counseling in the treatment of ADHD. If these results were to be replicated, then a paradigmatic change in the management of ADHD would be in order. How does one perform a double blind study of a complex dietary treatment? How do dietary interventions compare to stimulant treatment and how might diet affect change at a neural level? In Phase I (2 years) of this R21/33 development grant, we plan to develop a Ruse Diet (RuD) that can be comparable to the Restriction diet (ReD) in impact on the child and family psychologically and which is similar in taste such that a blinded comparison is possible. We will then run a pilot double blind placebo controlled trial with 20 medication free children age 8 to 12 with ADHD. Our hypotheses are that the diet will be acceptable to families and the ReD will be superior to RuD in reducing parent ratings of ADHD behavior. Participants will have fMRI studies at baseline and at the end of the trial. For task fMRI, we will develop and determine the impact of the ReD vs. RuD diet on the regional activation levels and effective connectivity of the "attention" networks while participants perform an anticipation-response conflict task. Effective connectivity analysis will be performed using dynamic causal modeling (DCM). We hypothesize that ReD vs. RuD will be increase activation levels within the ADHD network and in particular change strength of connectivity between the Intraparietal sulcus (IPS), the dorsolateral prefrontal cortex (DLPFC) and the ACC during the anticipation- response conflict task (connectivity changes will be reflected in both task and resting state data). Next, we will pilot a task in which the participants will also passively view pictures of foods that are either on or off the ReD, with pictures of household objects as controls. Such a task is well known to activate a "reward" network of regions (ventral striatum, amygdala, anterior insula, and medial and lateral orbitofrontal cortex (OFC) that has been hypothesize to be involved in ADHD. In Phase II, (3 years), we will seek to determine the relative and combined efficacy of a restriction diet and methylphenidate in the treatment of ADHD, the acceptability/compliance of the diet to families and the child's perception of diet. We plan to randomize 40 children with ADHD (age 8-12) to a 2 (Placebo, methylphenidate) X 2 (ReD vs. RuD) for a five week period, obtaining task-fMRI based on our Phase I work. We will examine the efficacy of the ReD vs medication and determine if there any additive effects of ReD and medication vs. each treatment alone. We obtain fMRI using both the conflict and food imaging tasks both pre and post treatment. We seek to determine if the diet impacts functional connectivity (via DCM as above) in both the attention and reward networks and if such changes predict behavioral outcome.

描述（由申请人提供）：针对注意力缺陷多动障碍（ADHD）的饮食干预既存在争议又很受欢迎。最近，发现“少量食物”限制饮食相对于营养咨询在治疗多动症方面是有效的。如果这些结果能够被复制，那么 ADHD 治疗的范式改变将是理所当然的。如何对复杂的饮食治疗进行双盲研究？饮食干预与兴奋剂治疗相比如何？饮食如何影响神经水平的变化？在 R21/33 开发补助金的第一阶段（2 年）中，我们计划开发一种鲁斯饮食 (RuD)，它对儿童和家庭的心理影响可与限制饮食 (ReD) 相媲美，而且味道也相似这样就可以进行盲法比较。然后我们将进行一项双盲安慰剂对照试验 20 名 8 至 12 岁患有多动症的未接受药物治疗的儿童。我们的假设是，家庭可以接受这种饮食，并且 ReD 在降低家长对 ADHD 行为的评分方面将优于 RuD。参与者将在基线和试验结束时进行功能磁共振成像研究。对于功能磁共振成像任务，我们将开发并确定 ReD 与 RuD 饮食对参与者执行操作时的区域激活水平和“注意”网络有效连接的影响预期-反应冲突任务。将使用动态因果模型（DCM）进行有效的连通性分析。我们假设 ReD 与 RuD 将增加 ADHD 网络内的激活水平，特别是在预期反应冲突任务期间改变顶内沟 (IPS)、背外侧前额叶皮层 (DLPFC) 和 ACC 之间的连接强度（连接性）变化将反映在任务和静息状态数据中）。接下来，我们将试点一项任务，其中参与者还将被动地查看 ReD 上或非 ReD 上的食物图片，并以家用物品的图片作为对照。众所周知，这样的任务会激活区域的“奖励”网络（腹侧纹状体、杏仁核、前岛叶以及内侧和外侧眶额皮质 (OFC)，这些区域被假设与 ADHD 有关。在第二阶段，（3 年）），我们将寻求确定限制饮食和哌醋甲酯治疗 ADHD 的相对和综合疗效、家庭对饮食的可接受性/依从性以及孩子对饮食的看法我们计划将 40 名 ADHD 儿童（8-12 岁）随机分配到 2（安慰剂、哌甲酯）X 2（ReD 与 RuD）组，为期五周，根据我们的第一阶段工作获得任务功能磁共振成像。将检查 ReD 与药物的疗效，并确定 ReD 和药物与单独治疗相比是否有任何附加效应。我们使用治疗前和治疗后的冲突和食物成像任务来获得功能磁共振成像。饮食会影响注意力和奖励网络中的功能连接（如上所述通过 DCM），以及这些变化是否可以预测行为结果。