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Scientific Discussion This forum is limited to published/presented scientific research, in a quasi-academic format, with references where appropriate; clear and structured discourse is encouraged

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  #1  
Old 09-28-18, 12:11 AM
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ADHD as a risk for degenerative brain diseases.

This has been suspected for a long while, and we do know now that the key circuits in ADHD are cotrico-basal ganglia- cerebello- thalamocortical, so the areas of the problem make sense.


In Nature, no less:

https://www.nature.com/articles/s41386-018-0207-5



Quote:
Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity and involves dysregulated dopaminergic pathways. Dopaminergic agents (i.e., amphetamine and methylphenidate) are thus prescribed to treat ADHD. As little is known regarding long-term consequences of either ADHD or its treatment, the objective of this study was to determine if either alters the risk of diseases of the basal ganglia and cerebellum, including Parkinson’s disease. Statewide medical records from 1996 to 2016 were retrieved from the Utah Population Database to conduct a retrospective cohort study. Participants included ADHD patients (International Classification of Diseases, 9th revision (ICD-9) diagnosis codes 314.0–314.2, 314.8, 314.9) and 5:1 random sex-matched and age-matched subjects with no ADHD diagnosis history. Both patients and non-ADHD subjects met the following eligibility criteria: (1) no prior diagnosis of Parkinson’s disease, secondary parkinsonism, basal ganglia disease, or essential tremor (ICD-9 codes 332.0, 332.1, 333.0, 333.1), (2) born in 1950 or later and age ≥20 years at last follow-up, and (3) no history of substance abuse (illicit drugs or alcohol). Outcomes were measured as time to diagnosis of diseases of the basal ganglia and cerebellum, death, or study-end. A Cox model incorporating a competing risk of death was used to provide hazard ratio estimates.

Patients with ADHD (N = 31,769) had a 2.4-fold increased risk of basal ganglia and cerebellum diseases (95% confidence interval (CI): 2.0–3.0; P < 0.0001) compared with 158,790 non-ADHD persons, after controlling for sex and age and adjusting for tobacco use and psychotic conditions. In 4960 ADHD patients prescribed psychostimulants, risk of basal ganglia and cerebellum diseases between ages 21 and 49 years was especially pronounced, at 8.6-fold (95% CI: 4.8–15.6; P < 0001).



The association of ADHD patients prescribed psychostimulants with higher risk of diseases of the basal ganglia and cerebellum may reflect a more severe ADHD phenotype rather than a direct association between prescribed stimulant use and basal ganglia or cerebellum disorders. Future studies to assess and stratify patient risk so as to inform treatment are warranted.

The major basal ganglia disease being spoken of is Parkinson's Disease, and cerebellar issues can include cerebellar ataxia (seen most severely in severe alcoholics). Ive had some minor cerebellar signs for years- hence the neurorehabilitation.
I have now found more good evidence linking these neck problems i have with both ADHD and other affective spectrum disorders, and also Parkinson's disease.

So I am hoping that this is a correlation caused by the underlying issue at the junction between the neck and the skull- because in my case that is being addressed effectively at last.

I will post more on that later as I have had an enormous breakthrough there- but am struggling to describe it briefly.
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Old 09-28-18, 01:00 AM
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Re: ADHD as a risk for degenerative brain diseases.

It's an interesting idea, and I've wondered before about the potential connection, since ADHD and Parkinson's are both primarily based in dopamine deficiency (but in different brain areas?). I've also wondered why drugs for Parkinson's don't work for treating ADHD (and vice versa).
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Old 09-28-18, 04:33 AM
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Re: ADHD as a risk for degenerative brain diseases.

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Originally Posted by CharlesH View Post
It's an interesting idea, and I've wondered before about the potential connection, since ADHD and Parkinson's are both primarily based in dopamine deficiency (but in different brain areas?). I've also wondered why drugs for Parkinson's don't work for treating ADHD (and vice versa).



Well it is more than an idea-- it is a researched fact.
Look st the confidence intervals:
Patients with ADHD (N = 31,769) had a 2.4-fold increased risk of basal ganglia and cerebellum diseases (95% confidence interval (CI): 2.0–3.0; P < 0.0001)

There is a less than one in ten thousand possibility that this is a chance finding.This is actually the guts of why I recently stated that replication of a study is not necessary to accepting the result.
Replication is nice- but with an outcome like that most researchers would just say "why bother replicating itæ

The reason why there has been so much trouble with unrepeatable results comes from the drug industry- who have managed to push the idea that a confidence interval of p<0.05 (meaning the odds of a result being a fluke are less than 1/20) is a good idea.


Now the idea of these things being a "dopamine disorder" is an old way of thinking that was imposed on us by pharmaceutical companies and based on really primitive ideas of neurology. (They were doing their best, poor dears).

Now the advent of upright MRI has changed everything- and we now know that these upper neck injuries (which are highly prevalent) interfere with cerebrospinal fluid flow from the cranium to the spine. We now actually have images of the diverted cerebrospinal fluid flow blasting the substantia nigra (the bit that dies in Parkinson's) which is one of the walls of the third ventricle.


So the bottom line is that the same issue (craniocervical instability) causes both problems. Parkinsons is an issue in which many of the dopamine producing neurones die.

I suspect the dopamine issue in ADHD is that the need to constantly adjust and adapt to an unstable body means that multiple fast re-fixations of attention are needed- and those neurones just get a bit fatigued.


You'll have to take my word for that for now- I am still perusing the truckload of published evidence I have recently encountered. ( I only have a few weeks sick leave left so I will have to work very fast to cover this).

".


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Old 09-28-18, 08:43 AM
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Re: ADHD as a risk for degenerative brain diseases.

excerpt:
In 4960 ADHD patients prescribed psychostimulants, risk of basal ganglia and cerebellum diseases between ages 21 and 49 years was especially pronounced, at 8.6-fold (95% CI: 4.8–15.6; P < 0001).



The association of ADHD patients prescribed psychostimulants with higher risk of diseases of the basal ganglia and cerebellum may reflect a more severe ADHD phenotype rather than a direct association between prescribed stimulant use and basal ganglia or cerebellum disorders. Future studies to assess and stratify patient risk so as to inform treatment are warranted.
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Old 09-29-18, 07:04 AM
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Re: ADHD as a risk for degenerative brain diseases.

Quote:
Originally Posted by lisariver View Post
excerpt:
In 4960 ADHD patients prescribed psychostimulants, risk of basal ganglia and cerebellum diseases between ages 21 and 49 years was especially pronounced, at 8.6-fold (95% CI: 4.8–15.6; P < 0001).



The association of ADHD patients prescribed psychostimulants with higher risk of diseases of the basal ganglia and cerebellum may reflect a more severe ADHD phenotype rather than a direct association between prescribed stimulant use and basal ganglia or cerebellum disorders. Future studies to assess and stratify patient risk so as to inform treatment are warranted.

Well spotted. It is not the stimulants in themselves.
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