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.

中文翻译：

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有注意力缺陷/多动症史的患者患上神经节和小脑的疾病的风险增加。

注意缺陷/多动障碍（ADHD）的特征是持续的注意力不集中和/或活动亢进，并涉及多巴胺能途径失调。因此开出了多巴胺能药物（即苯丙胺和哌醋甲酯）来治疗多动症。关于多动症或其治疗的长期后果知之甚少，该研究的目的是确定二者是否改变了基底神经节和小脑疾病（包括帕金森氏病）的风险。从犹他州人口数据库中检索了1996年至2016年的全州医疗记录，以进行回顾性队列研究。参加者包括多动症患者（国际疾病分类，第9次修订版（ICD-9），诊断代码314.0-314.2、314.8、314.9）和无ADHD诊断史的5：1性别匹配和年龄匹配的随机受试者。患者和非ADHD受试者均符合以下入选标准：（1）没有事先诊断出帕金森氏病，继发性帕金森氏病，基底神经节疾病或原发性震颤（ICD-9代码332.0、332.1、333.0、333.1），（2）出生于1950年或更晚，在最后一次随访中年龄≥20岁，并且（3）没有滥用药物（非法药物或酒精）的病史。测量结果作为诊断基底节和小脑疾病，死亡或研究结束的时间。使用包含竞争性死亡风险的Cox模型来提供危险比估计。ADHD患者（N = 31,769）与基底节和小脑疾病的患病风险相比增加了2.4倍（95％置信区间（CI）：2.0-3.0； P <0.0001），而非ADHD患者为158,790，在控制性别和年龄并调整烟草使用和精神病状态之后。在4960名多动症患者中开具了精神兴奋剂，其中21岁至49岁之间发生基底节和小脑疾病的风险尤为明显，为8.6倍（95％CI：4.8-15.6； P <0001）。多动症患者处方的精神兴奋药患上基底节和小脑疾病的风险较高，这可能反映了更严重的多动症表型，而不是处方兴奋剂使用与基底神经节或小脑疾病之间的直接关联。有必要进行进一步的研究以评估和分层患者风险，从而为治疗提供依据。多动症患者所处方的精神兴奋药与基底节和小脑疾病风险较高的关联可能反映了更严重的多动症表型，而不是处方兴奋剂使用与基底神经节或小脑疾病之间的直接关联。将来需要进行评估和分层患者风险以告知治疗方法的研究。多动症患者所处方的精神兴奋药与基底节和小脑疾病风险较高的关联可能反映了更严重的多动症表型，而不是处方兴奋剂使用与基底神经节或小脑疾病之间的直接关联。有必要进行进一步的研究以评估和分层患者风险，从而为治疗提供依据。