The cerebral neurovascular coupling and glymphatic circulation dysfunction in children with attention deficit/hyperactivity disorder.

BACKGROUND: Based on the executive dysfunction hypothesis, the deficiency of executive function is the basis of the core symptoms of attention deficit/hyperactivity disorder (ADHD). This study aims to apply MRI to evaluate changes in neurovascular coupling (NVC) and glymphatic system functions in patients with ADHD and to explore the relationship between these changes and executive function, in order to reveal the potential neural mechanisms underlying ADHD symptomatology. METHODS: This study enrolled sixty-six individuals diagnosed with ADHD and forty-one healthy control participants (HC). We compared the differences in NVC and the index along the perivascular space (ALPS) between the two groups. Partial correlation analysis was employed to examine the associations among clinical data, executive function, the ALPS index, and NVC alterations in ADHD patients. Furthermore, a combined diagnostic model was developed using NVC, the ALPS index, and sleep duration, and its diagnostic performance was assessed through logistic regression analysis. The robustness of the joint diagnostic model was subsequently evaluated using a five-fold cross-validation approach. RESULTS: In comparison to the HC group, patients with ADHD exhibited a significant reduction in NVC and alterations in the ALPS. Specifically, the ADHD group demonstrated decreased NVC across 19 brain regions, encompassing 8 regions within the frontal lobe, 5 within the parietal lobe, 4 within the occipital lobe, and 2 within the temporal lobe. Partial correlation analysis revealed an association between NVC values and the ALPS index, executive function, and sleep duration. Furthermore, receiver operating characteristic (ROC) analysis demonstrated good diagnostic efficacy of the combined model, validated through five-fold cross-validation, yielding an area under the curve (AUC) of 0.863, 95% CI: (0.790, 0.926), with a sensitivity of 0.864 and a specificity of 0.683. CONCLUSION: Children with ADHD exhibit impairments in the NVC and the glymphatic system function, with NVC dysfunction linked to glymphatic impairment and executive function deficits. This study offers novel insights into ADHD-related brain dysfunction through the perspectives of NVC and the glymphatic system. CLINICAL TRIAL NUMBER: Not applicable.