Brain iron levels in attention-deficit/hyperactivity disorder: A pilot MRI study

Cortese, Samuele; Azoulay, R.; Castellanos, F. Xavier; Chalard, François; Lecendreux, Michel; Chéchin, D.; Delorme, Richard; Sebag, G.; Sbarbati, Andrea; Mouren, Marie Christine; Bernardina, Bernardo Dalla; Konofal, Éric

doi:10.3109/15622975.2011.570376

Cited by 119 publications

(118 citation statements)

References 56 publications

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“…This observation supports the hypotheses that dopamine deficiency characterizes ADHD before medication and that the dopaminergic system adapts in response to psychostimulants (4,5). Along with an aberrant dopaminergic system, reports of reduced serum and brain iron in ADHD suggest that iron homeostasis may also be disrupted (6)(7)(8). However, psychostimulant medication history was unaccounted for in these studies.…”

Section: Participantssupporting

confidence: 49%

Multimodal MR Imaging of Brain Iron in Attention Deficit Hyperactivity Disorder: A Noninvasive Biomarker That Responds to Psychostimulant Treatment?

Adisetiyo¹,

Jensen²,

Tabesh

et al. 2014

Radiology

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).q RSNA, 2014 Purpose:To comprehensively assess brain iron levels in typically developing control subjects and patients with attention deficit hyperactivity disorder (ADHD) when psychostimulant medication history is accounted for. Materials and Methods:This prospective study was approved by the institutional review board, and informed consent was obtained. Brain iron was indexed noninvasively by using magnetic resonance (MR) imaging relaxation rates (R2, R2*, R29) and magnetic field correlation (MFC) in the globus pallidus, putamen, caudate nucleus, and thalamus for 22 patients with ADHD (12 medication-naïve patients and 10 with a history of psychostimulant treatment) and 27 control subjects (age range, 8-18 years). Serum iron measures were also collected. Subgroup differences were analyzed with data-appropriate omnibus tests followed by post hoc pairwise comparisons; false discovery rate correction was conducted to control for multiple comparisons. Results:Medication-naïve ADHD patients had significantly lower striatal and thalamic MFC indexes of brain iron than did control subjects (putamen, P = .012; caudate nucleus, P = .008; thalamus, P = .012) and psychostimulant-medicated ADHD patients (putamen, P = .006; caudate nucleus, P = .010; thalamus, P = .021). Conversely, the MFC indexes in medicated patients were comparable to those in control subjects. No significant differences were detected with R2, R2*, R29, or serum measures. Conclusion:Lower MFC indexes of striatal and thalamic brain iron in medication-naïve ADHD patients and lack of differences in psychostimulant-medicated patients suggest that MFC indexes of brain iron may represent a noninvasive diagnostic biomarker that responds to psychostimulant treatment.q RSNA, 2014

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Section: Participantssupporting

confidence: 49%

Multimodal MR Imaging of Brain Iron in Attention Deficit Hyperactivity Disorder: A Noninvasive Biomarker That Responds to Psychostimulant Treatment?

Adisetiyo¹,

Jensen²,

Tabesh

et al. 2014

Radiology

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“…Publications with results consistent with our study include Donfrancesco et al [15], Menegassi et al [25] and Kwon et al [27], which all reported no significant difference between ADHD patients and healthy control cases in terms of serum ferritin levels. Publications with results inconsistent with those of our study include Konofal et al [16,17], Juneja et al [18], Mahmoud et al [21], Cortese et al [22] and Bener et al [23], which found significantly lower ferritin levels in ADHD cases relative to healthy control cases. The studies with results inconsistent with those obtained in our study had small numbers of samples, with the exception of the study by Bener et al [23] (number of ADHD patients \60, number of healthy control cases \30).…”

Section: Discussionsupporting

confidence: 37%

“…The results of recent studies regarding iron deficiency and ADHD have not been consistent. While some studies have reported a significant relationship between ADHD and low serum ferritin levels [16][17][18][19][20][21][22][23], others studies have reported no such relationship [15,[24][25][26][27]. Further, not all of these studies have compared the results of ADHD patients with those of healthy controls.…”

Section: Introductionmentioning

confidence: 91%

Iron Deficiency Parameters in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

Percinel¹,

Yazıcı

Üstündağ

2015

Child Psychiatry Hum Dev

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The aim of this study is to compare iron deficiency parameters in patients with stimulant-naive attention-deficit/hyperactivity disorder (ADHD) and healthy controls, to investigate whether there are differences among the ADHD presentations, and to evaluate the relationship between ADHD symptom severity and serum ferritin levels. In addition, ADHD-Predominantly Inattentive (ADHD-PI) patients with restrictive hyperactivity/impulsivity symptoms were evaluated as a separate group with "restrictive inattention presentation" (ADHD-Rest) and were compared with other groups. Patients with ADHD-Rest are typically defined as having six or more symptoms of inattention and fewer than three symptoms of hyperactivity/impulsivity. A total of 200 ADHD cases consisting of 100 ADHD-Combine (ADHD-C) and 100 ADHD-PI and a total of 100 healthy control cases were included in the study. The Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version was performed in a semi-structured interview during the diagnosis. The Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale, the Conners' Rating Scale-Revised: Long Form (Parent-Teacher) (CPRSR:L, CTRS-R:L) were used for clinical evaluation. Hemogram, serum iron, iron binding capacity and serum ferritin levels were assessed. There were no significant differences between the ADHD patients and the healthy control cases in terms of iron deficiency parameters. Further, there were no significant differences among the ADHD presentations in terms of the same parameters, nor were there any significant differences when the groups were examined after the identification of the ADHD-Rest. The CPRS-R:L Hyperactivity and the CTRS-R:L Hyperactivity scores were negatively correlated with serum ferritin level in the ADHD group. To our knowledge, our current study is the first to compare serum ferritin levels in ADHD-Rest with other presentations of ADHD, and included the largest number of patients that were classified by ADHD presentations. Elucidation of these findings is important for both the etiology and treatment of ADHD.

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“…The extent to which serum ferritin correlates with iron levels in the brain remains unclear. 32 Omega-3 fatty acids seem also to have a relationship with ADHD. Two recent meta-analyses reported a small but beneficial effect of omega-3 supplementation on reducing symptoms of ADHD.…”

Section: Discussionmentioning

confidence: 99%

The Mediterranean Diet and ADHD in Children and Adolescents

et al. 2017

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OBJECTIVES: Although attention-deficit/hyperactivity disorder (ADHD) has been related to nutrient deficiencies and "unhealthy" diets, to date there are no studies that examined the relationship between the Mediterranean diet and ADHD. We hypothesized that a low adherence to a Mediterranean diet would be positively associated with an increase in ADHD diagnosis. METHODS:A total of 120 children and adolescents (60 with newly diagnosed ADHD and 60 controls) were studied in a sex-and age-matched case-control study. ADHD diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Energy, dietary intake, adherence to a Mediterranean diet, and familial background were measured. Logistic regression was used to determine associations between the adherence to a Mediterranean diet and ADHD. RESULTS:Lower adherence to a Mediterranean diet was associated with ADHD diagnosis (odds ratio: 7.07; 95% confidence interval: 2.65-18.84; relative risk: 2.80; 95% confidence interval: 1.54-5.25). Both remained significant after adjusting for potential confounders. Lower frequency of consuming fruit, vegetables, pasta, and rice and higher frequency of skipping breakfast and eating at fast-food restaurants were associated with ADHD diagnosis (P < .05). High consumption of sugar, candy, cola beverages, and noncola soft drinks (P < .01) and low consumption of fatty fish (P < .05) were also associated with a higher prevalence of ADHD diagnosis.CONCLUSIONS: Although these cross-sectional associations do not establish causality, they raise the question of whether low adherence to a Mediterranean diet might play a role in ADHD development. Our data support the notion that not only "specific nutrients" but also the "whole diet" should be considered in ADHD.

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Brain iron levels in attention-deficit/hyperactivity disorder: A pilot MRI study

Abstract: Low iron in the thalamus may contribute to ADHD pathophysiology.

Cited by 119 publications

References 56 publications

Multimodal MR Imaging of Brain Iron in Attention Deficit Hyperactivity Disorder: A Noninvasive Biomarker That Responds to Psychostimulant Treatment?

Multimodal MR Imaging of Brain Iron in Attention Deficit Hyperactivity Disorder: A Noninvasive Biomarker That Responds to Psychostimulant Treatment?

Iron Deficiency Parameters in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

The Mediterranean Diet and ADHD in Children and Adolescents

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