[The Prevalence of Attention Deficit/Hyperactivity Disorder (ADHD) Among Adolescents in Stationary Rehabilitation]. / Die Prävalenz der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Erwachsenenalter bei Patienten in der stationären Rehabilitation.

BACKGROUND: ADHD in adulthood is assumed to be a positive predictor for many comorbid diseases and impairments affecting all domains of life, particularly career performance. Participation in social and professional life is limited for populations which qualify for rehabilitation programs, and thus the prevalence of ADHD is presumably also higher in these populations. METHOD: To estimate the prevalence of ADHD in a population undergoing rehabilitation, 1010 people aged 18 to 75 years were screened for the presence of ADHD in adulthood. Additional impairments were measured and compared to a group of non ADHD participants. RESULTS: As expected a higher prevalence of ADHD was found in the population undergoing rehabilitation than in the general population (10.5%) Participants with ADHD who had recently begun rehabilitation seemed to have more impairments than non ADHD-participants. Participants with ADHD who were near the end of rehabilitation were more severely impaired in their capacity to reintegrate into their previous occupation, but not for the general employment market. CONCLUSION: Adult ADHD should be more closely investigated, especially in rehabilitation programs. Affected clients not only had more severe impairments, but more often had a profession that did not fit their capability.

Dopamine transporter imaging in adult patients with attention-deficit/hyperactivity disorder.

The aim of this study was to provide in vivo evidence for the hypothesis that dopaminergic neurotransmission is altered in adult patients with attention-deficit/hyperactivity disorder (ADHD). We used high-resolution brain-dedicated single-photon emission computed tomography and the dopamine transporter (DAT) marker [(123)I]FP-CIT in 17 adult treatment-naïve ADHD patients and 14 age-matched controls. Magnetic resonance imaging-based region of interest analysis was performed to quantify the DAT availability (expressed as a ratio of specific to non-displaceable binding, V(3)'') in the striatum. Additionally, the specific radiotracer binding was assessed in the thalamus and the midbrain/brainstem regions (reflecting also the availability of the serotonin transporter to which [(123)I]FP-CIT binds with moderate affinity). In the striatal areas of the ADHD patients, a significantly reduced specific tracer binding was found (V(3)'': 5.18+/-0.98; controls 6.36+/-1.34). In contrast, the specific [(123)I]FP-CIT binding did not differ from controls in the thalamus and midbrain/brainstem areas. These data indicate a reduced dopaminergic but not serotonergic transmitter reuptake function in adult ADHD. Further studies will have to deal with the question of whether these findings have the potential to influence treatment decisions in this complex disorder.

The clinical spectrum of blunt cerebrovascular injury.

BACKGROUND: Incidence, prevalence, and clinical impact of blunt cerebrovascular injury (BCVI) are unknown. There are no standardized recommendations for screening. REVIEW SUMMARY: A databank of 306 patients with a history of trauma was searched for all subjects with a proven or suspected concomitant BCVI. All patients had undergone MRI for the evaluation of traumatic and vascular cerebral lesions. The diagnosis of BCVI relies on angiographic and/or ultrasound findings. By way of illustration, the case histories of the patients are reported. Eleven subjects (3.6%) were identified. In 8 patients (2.6%), the diagnosis of BCVI can be regarded as proven; in 3 patients (0.98%), a diagnosis of BCVI is probable. The patients could be sorted into the following categories: (i) patients with BCVI and early strokes, (ii) patients with BCVI and late strokes, (iii) patients with early strokes and no detectable BCVI/vessel abnormality, (iv) patients with occult BCVI. Evidence of cerebral ischemia/stroke was present in 9 patients (82%, or 2.9% of all patients). In all patients with stroke, it was the major or sole cause of disability. CONCLUSIONS: BCVI and BCVI-related strokes are not rare. The time window for the development of ischemic complications is highly variable and may be longer than is currently assumed. Even if clinically silent, a diagnosis of BCVI has medicolegal implications and may influence therapy and prognosis in later life. Because of the association of BCVI and motor vehicle accidents, screening is suggested in these patients, and ultrasound could be a practical tool. Although there is substantial suspicion for BCVI in individual trauma patients suffering from stroke, the diagnosis cannot always been proven.

Characterization of cerebral microangiopathy using 3 Tesla MRI: correlation with neurological impairment and vascular risk factors.

PURPOSE: To investigate whether clinical and neuropsychological impairment in cerebral small-vessel disease (CSVD) can be evaluated by means of morphological magnetic resonance imaging (MRI). MATERIALS AND METHODS: MRI at 3 Tesla in T2- and T1-weighted sequences was evaluated in 44 patients with cerebral microangiopathy, and 30 patients with combined cerebral micro- and macroangiopathy. The MR characteristics were correlated to clinical data, attentional impairment, and the patients' individual vascular risk factor profiles. Fifteen healthy age-matched control subjects participated in the study to assess MR signal changes in nonhypertensive elderly subjects. RESULTS: Patients and normal controls differed significantly in the extent of MR signal changes. A close relation between age, obesity, hypertension, and MR signal abnormalities was evident in all patients. Patients with pure CSVD additionally showed an association between their MR-defined severity of disease and their degree of neurological impairment, and their vascular risk score. In contrast, attentional impairment did not relate to the MR-defined severity of CSVD. CONCLUSION: MR signal changes in CSVD show a close relationship to some risk factors of individual patients.