Estrogen Effects on ADHD and Cognition

雌激素对多动症和认知的影响

• 批准号: 10246302
• 负责人: MICHELLE M MARTEL
• 金额: $ 66.37万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-10 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10246302
• 关键词: Adolescence; Adult; Affect; Age; Animals; Attention; Attention deficit hyperactivity disorder; Back; Basic Science; Biological; Biological Assay; Childhood; Clinic; Clinical; Cognition; Cognitive; Communities; Data; Deltastab; Diagnosis; Disease; Dopamine; Estradiol; Estrogens; Evaluation; Exclusion Criteria; Exhibits; Feasibility Studies; Female; Goals; Gonadal Steroid Hormones; Health; Hormonal; Hormone use; Hormones; Human; Impairment; Impulsivity; Laboratories; Link; Longitudinal Studies; Measurement; Measures; Menstrual cycle; Menstruation; Neurocognitive; Ovarian hormone; Ovulation; Participant; Persons; Pharmaceutical Preparations; Phase; Prevalence; Progesterone; Psychology; Puberty; Publishing; Quasi-experiment; Rattus; Research Design; Risk; Risk Factors; Role; Sampling; Short-Term Memory; Symptoms; Test Result; Testing; Thinking; Translating; Universities; Visit; Withdrawal; Woman; Work; animal data; base; clinical practice; clinical predictors; clinically significant; cognitive function; cognitive performance; cognitive testing; comorbidity; design; falls; hypothalamic pituitary gonadal axis; improved; inattention; innovation; male; multilevel analysis; perimenstrual; personalized approach; proliferative phase Menstrual cycle; recruit; response; saliva sample; sex; social media; treatment response; virtual; young adult; young woman

Females with Attention-Deficit/Hyperactivity Disorder (ADHD) remain dramatically understudied, even though they exhibit increased impairment beginning around puberty. Estrogen rises rapidly at puberty and exerts important effects on dopamine and cognition in both humans and animals. Both animal and human work suggest that cognition and ADHD symptoms may be sensitive to hormonal effects, particularly in highly impulsive females. Yet, the effect of estrogen on ADHD symptoms in young adult women remains virtually unstudied. Our pilot data in 33 naturally-cycling young women suggest that among women with greater ADHD symptoms, within-person declines in estrogen, particularly in the context of rising levels of progesterone, just post-ovulation, are associated with clinically significant increases in ADHD symptoms. Yet, no published empirical work has directly examined the role of circulating estrogen in relation to ADHD symptoms and cognitive mechanisms in women with ADHD. The current study would pioneer a new stage of work by being the first to utilize a rigorous quasi-experimental design that involves intensive longitudinal measurement across the menstrual cycle in order to examine within-person estrogen effects on ADHD and cognitive mechanisms in young women with ADHD. A sample of 120 young women ages 18 to 25 with inattention, overactivity, or impulsivity problems will be recruited from the university health center and local ADHD clinic, psychology department, and through social media. Participants will be comprehensively assessed for ADHD and exclusion criteria (e.g., use of hormone-based medication or hormonal conditions). Female participants will complete well-established assessment measures of ADHD and other psychopathological symptoms and diagnoses and cognition and provide saliva samples of hormones in the laboratory during a baseline laboratory visit within the first few days of the start of their menstrual cycle (i.e., during the mid-follicular phase, characterized by stable low estrogen). Then, they will provide daily saliva samples for hormone assay each morning and complete short daily assessments of ADHD and cognition every evening for up to 2 full menstrual cycles. They will also complete laboratory cognitive testing of inhibition and working memory targeted to key cycle phases characterized by declining estrogen (post-ovulatory, perimenstrual) and a cycle phase characterized by stable high estrogen levels (midluteal), based on menses onset and ovulation test results. Multi-level modeling will evaluate the clinical significance of within-person estrogen associations with ADHD and cognition with consideration of progesterone as an interactive factor. Effects of comorbid disorders and affect will also be explored. Study results have the potential to shift our understanding of ADHD in women by consideration of dynamic hormone influences. In addition, results will change clinical practice by indicating the need to account for cycle phase in ADHD evaluations in women, as well as suggest personalized approaches to treatment targeted to cycle phase or hormone levels.

尽管患有注意力缺陷/多动症（ADHD）的女性仍然没有得到充分的研究 他们从青春期开始表现出更多的损伤。青春期雌激素迅速上升并发挥作用 对人类和动物的多巴胺和认知产生重要影响。动物和人类的工作 表明认知和多动症症状可能对荷尔蒙的影响敏感，特别是在高度 冲动的女性。然而，雌激素对年轻成年女性多动症症状的影响实际上仍然存在 未经研究。我们对 33 名自然骑行的年轻女性进行的试点数据表明，在患有严重 ADHD 的女性中， 症状，体内雌激素下降，特别是在孕激素水平上升的情况下， 排卵后，与 ADHD 症状的临床显着增加相关。然而还没有发表 实证工作直接检验了循环雌激素与多动症症状相关的作用， 患有多动症的女性的认知机制。目前的研究将开创一个新的工作阶段 第一个采用严格的准实验设计，涉及跨区域的密集纵向测量 月经周期，以检查人体内雌激素对多动症和认知机制的影响 患有多动症的年轻女性。 120 名年龄在 18 至 25 岁之间注意力不集中、过度活跃或 冲动问题将从大学健康中心和当地多动症诊所、心理学招募 部门以及通过社交媒体。参与者将接受多动症和排斥的全面评估 标准（例如，使用基于激素的药物或激素状况）。女性参与者将完成 完善的 ADHD 和其他精神病理症状和诊断评估措施 认知并在基线实验室访问期间在实验室提供激素的唾液样本 月经周期开始的最初几天（即卵泡中期，其特征是稳定 雌激素水平低）。然后，他们将每天早上提供每日唾液样本进行激素检测并完成 每天晚上对 ADHD 和认知进行简短的每日评估，持续最多 2 个完整的月经周期。他们还将 针对关键周期阶段的抑制和工作记忆的完整实验室认知测试 以雌激素下降为特征（排卵后、围经期）和以稳定为特征的周期阶段 根据月经开始和排卵测试结果，雌激素水平较高（黄体中期）。多层次建模将 评估人体内雌激素与 ADHD 和认知的临床意义 考虑黄体酮作为交互因素。合并症和影响的影响也将是 探索过。研究结果有可能改变我们对女性多动症的理解 动态激素的影响。此外，结果将通过表明需要考虑来改变临床实践 针对女性多动症评估的周期阶段，并建议个性化的治疗方法 针对周期阶段或激素水平。