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Chen Q, Wang M, Wu GW, Li WH, Ren XD, Wang YL, Wei X, Wang JN, Yang Z, Li XH, Li ZJ, Tang LR, Zhang P, Wang Z. Characteristics of white matter alterations along fibres in patients with bulimia nervosa: A combined voxelwise and tractography study. Eur J Neurosci 2023; 58:2874-2887. [PMID: 37423618 DOI: 10.1111/ejn.16077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023]
Abstract
Accumulating evidence supports the hypothesis that white matter (WM) abnormalities are involved in the pathophysiology of bulimia nervosa (BN); however, findings from in vivo neuroimaging studies have been inconsistent. We aimed to investigate the possible brain WM alterations, including WM volume and microstructure, in patients with BN. We recruited 43 BN patients and 31 healthy controls (HCs). All participants underwent structural and diffusion tensor imaging. Differences in WM volume and microstructure were evaluated using voxel-based morphometry, tract-based spatial statistics, and automated fibre quantification analysis. Compared with HCs, BN patients showed significantly decreased fractional anisotropy in the middle part of the corpus callosum (nodes 31-32) and increased mean diffusivity in the right cranial nerve V (CN V) (nodes 27-33 and nodes 55-88) and vertical occipital fasciculus (VOF) (nodes 58-85). Moreover, we found decreased axial diffusivity in the right inferior fronto-occipital fasciculus (node 67) and increased radial diffusivity in the CN V (nodes 22-34 and nodes 52-89) and left VOF (nodes 60-66 and nodes 81-85). Meanwhile, WM microstructural changes were correlated with patients' clinical manifestations. We did not find any significant differences in WM volume and the main WM fibre bundle properties between BN patients and HCs. Taken together, these findings provide that BN shows significant brain WM reorganization, but primarily in microstructure (part of WM fibre bundle), which is not sufficient to cause changes in WM volume. The automated fibre quantification analysis could be more sensitive to detect the subtle pathological changes in a point or segment of the WM fibre bundle.
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Affiliation(s)
- Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Miao Wang
- Chinese Institute for Brain Research, Beijing, China
| | - Guo-Wei Wu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Wei-Hua Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiao-Dan Ren
- Beijing Anding Hospital Capital Medical University, Beijing, China
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing, China
| | - Yi-Ling Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuan Wei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jia-Ni Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiao-Hong Li
- Beijing Anding Hospital Capital Medical University, Beijing, China
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing, China
| | - Zhan-Jiang Li
- Beijing Anding Hospital Capital Medical University, Beijing, China
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing, China
| | - Li-Rong Tang
- Beijing Anding Hospital Capital Medical University, Beijing, China
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing, China
| | - Peng Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Gander M, Lenhart L, Steiger R, Buchheim A, Mangesius S, Birkl C, Haid-Stecher N, Fuchs M, Libal A, Dabkowska-Mika A, Gizewski ER, Sevecke K. Attachment Trauma Is Associated with White Matter Fiber Microstructural Alterations in Adolescents with Anorexia Nervosa before and after Exposure to Psychotherapeutic and Nutritional Treatment. Brain Sci 2023; 13:brainsci13050798. [PMID: 37239270 DOI: 10.3390/brainsci13050798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
In the present study, we explore the role of attachment for microstructural white matter (WM) changes in adolescents with anorexia nervosa (AN) before and after exposure to short-term and nutritional treatment. The case sample consisted of 22 female adolescent inpatients with AN (mean age: 15.2 ± 1.2 years) and the control sample were 18 gender-matched healthy adolescents (mean age: 16.8 ± 0.9 years). We performed a 3T MRI in the patient group during the acute state of AN and after weight restoration (duration: 2.6 ± 1 months) and compared the data to a healthy control group. To classify attachment patterns, we used the Adult Attachment Projective Picture System. In the patient sample, over 50% were classified with an attachment trauma/unresolved attachment status. Prior to treatment exposure, fractional anisotropy (FA) reductions and concordant mean diffusivity (MD) increases were evident in the fornix, the corpus callosum and WM regions of the thalamus, which normalized in the corpus callosum and the fornix post-therapy in the total patient sample (p < 0.002). In the acute state, patients with an attachment trauma demonstrated significant FA decreases compared to healthy controls, but no MD increases, in the corpus callosum and cingulum bilaterally, which remained decreased after therapy. Attachment patterns seem to be associated with region-specific changes of WM alterations in AN.
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Affiliation(s)
- Manuela Gander
- Institute of Psychology, Leopold-Franzens-University of Innsbruck, 6020 Innsbruck, Austria
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
| | - Lukas Lenhart
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ruth Steiger
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, Leopold-Franzens-University of Innsbruck, 6020 Innsbruck, Austria
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Christoph Birkl
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Nina Haid-Stecher
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
| | - Martin Fuchs
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
| | - Anna Libal
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
| | - Agnieszka Dabkowska-Mika
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Elke Ruth Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, 6020 Innsbruck, Austria
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3
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Cruz-Carrillo G, Trujillo-Villarreal LA, Ángeles-Valdez D, Concha L, Garza-Villarreal EA, Camacho-Morales A. Prenatal Cafeteria Diet Primes Anxiety-like Behavior Associated to Defects in Volume and Diffusion in the Fimbria-fornix of Mice Offspring. Neuroscience 2023; 511:70-85. [PMID: 36592924 DOI: 10.1016/j.neuroscience.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/25/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
Prenatal exposure to high-energy diets primes brain alterations that increase the risk of developing behavioral and cognitive failures. Alterations in the structure and connectivity of brain involved in learning and memory performance are found in adult obese murine models and in humans. However, the role of prenatal exposure to high-energy diets in the modulation of the brain's structure and function during cognitive decline remains unknown. We used female C57BL6 mice (n = 10) exposed to a high-energy diets (Cafeteria diet (CAF)) or Chow diet for 9 weeks (before, during and after pregnancy) to characterize their effect on brain structural organization and learning and memory performance in the offspring at two-month-old (n = 17). Memory and learning performance were evaluated using the Y-maze test including forced and spontaneous alternation, novel object recognition (NORT), open field and Barnes maze tests. We found no alterations in the short- or long-time spatial memory performance in male offspring prenatally exposed to CAF diet when compared to the control, but they increased time spent in the edges resembling anxiety-like behavior. By using deformation-based morphometry and diffusion tensor imaging analysis we found that male offspring exposed to CAF diet showed increased volume in primary somatosensory cortex and a reduced volume of fimbria-fornix, which correlate with alterations in its white matter integrity. Biological modeling revealed that prenatal exposure to CAF diet predicts low volume in the fimbria-fornix, which was associated with anxiety in the offspring. The findings suggest that prenatal exposure to high-energy diets prime brain structural alterations related to anxiety in the offspring.
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Affiliation(s)
- Gabriela Cruz-Carrillo
- Universidad Autónoma de Nuevo Leon, College of Medicine, Department of Biochemistry, Monterrey, NL, Mexico; Universidad Autónoma de Nuevo Leon, Center for Research and Development in Health Sciences, Neurometabolism Unit, San Nicolás de los Garza, NL, Mexico
| | - Luis Angel Trujillo-Villarreal
- Universidad Autónoma de Nuevo Leon, College of Medicine, Department of Biochemistry, Monterrey, NL, Mexico; Universidad Autónoma de Nuevo Leon, Center for Research and Development in Health Sciences, Neurometabolism Unit, San Nicolás de los Garza, NL, Mexico
| | - Diego Ángeles-Valdez
- Universidad Nacional Autónoma de México, Instituto de Neurobiología, Departamento de Neurobiología Conductual y Cognitiva, Campus UNAM-Juriquilla, 76230 Queretaro, Mexico
| | - Luis Concha
- Universidad Nacional Autónoma de México, Instituto de Neurobiología, Departamento de Neurobiología Conductual y Cognitiva, Campus UNAM-Juriquilla, 76230 Queretaro, Mexico
| | - Eduardo A Garza-Villarreal
- Universidad Nacional Autónoma de México, Instituto de Neurobiología, Departamento de Neurobiología Conductual y Cognitiva, Campus UNAM-Juriquilla, 76230 Queretaro, Mexico
| | - Alberto Camacho-Morales
- Universidad Autónoma de Nuevo Leon, College of Medicine, Department of Biochemistry, Monterrey, NL, Mexico; Universidad Autónoma de Nuevo Leon, Center for Research and Development in Health Sciences, Neurometabolism Unit, San Nicolás de los Garza, NL, Mexico.
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4
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Wang C, La Barrie DL, Powers A, Stenson AF, van Rooij SJH, Stevens JS, Jovanovic T, Bradley B, McGee RE, Fani N. Associations of maternal emotion regulation with child white matter connectivity in Black American mother-child dyads. Dev Psychobiol 2022; 64:e22303. [PMID: 36282745 PMCID: PMC9608357 DOI: 10.1002/dev.22303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/13/2022] [Accepted: 05/21/2022] [Indexed: 01/27/2023]
Abstract
Parental emotion regulation plays a major role in parent-child interactions, and in turn, neural plasticity in children, particularly during sensitive developmental periods. However, little is known about how parental emotion dysregulation is associated with variation in children's brain structure, which was the goal of this study. Forty-five Black American mother-child dyads were recruited from an intergenerational trauma study; emotion regulation in mothers and their children (age 8-13 years) was assessed. Diffusion-weighted images were collected in children; deterministic tractography was used to reconstruct pathways of relevance to emotion regulation. Metrics of white matter connectivity [fractional anisotropy (FA), mean diffusivity (MD)] were extracted for pathways. Socio-economic variables were also included in statistical models. Maternal emotion dysregulation was the strongest predictor of child fornix MD (r = .35, p = .001), indicating that more severe emotion dysregulation in mothers corresponded with lower fornix connectivity in children. Maternal impulsivity was a strong predictor of child fornix MD (r = .51, p < .001). Maternal emotion dysregulation may adversely influence connectivity of the child.s fornix, a hippocampal-striatal pathway implicated in reward processes; these associations remained even after accounting for other socio-environmental factors. Dysregulated maternal emotions may uniquely impact children's adaptation to trauma/stress by affecting networks that support appetitive processing.
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Affiliation(s)
- Chenyang Wang
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anais F Stenson
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit, Michigan, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit, Michigan, USA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Robin E McGee
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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5
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Iorio-Morin C, Sarica C, Elias GJB, Harmsen I, Hodaie M. Neuroimaging of psychiatric disorders. PROGRESS IN BRAIN RESEARCH 2022; 270:149-169. [PMID: 35396025 DOI: 10.1016/bs.pbr.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Psychiatry remains the only medical specialty where diagnoses are still based on clinical syndromes rather than measurable biological abnormalities. As imaging technology and analytical methods evolve, it is becoming clear that subtle but measurable radiological characteristics exist and can be used to experimentally classify psychiatric disorders, predict response to treatment and, hopefully, develop new, more effective therapies. This review highlights advances in neuroimaging modalities that are now allowing assessment of brain structure, connectivity and neural network function, describes technical aspects of the most promising methods, and summarizes observations made in some frequent psychiatric disorders.
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Affiliation(s)
- Christian Iorio-Morin
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Can Sarica
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Irene Harmsen
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Laczkovics C, Nenning KH, Wittek T, Schmidbauer V, Schwarzenberg J, Maurer ES, Wagner G, Seidel S, Philipp J, Prayer D, Kasprian G, Karwautz A. White matter integrity is disrupted in adolescents with acute anorexia nervosa: A diffusion tensor imaging study. Psychiatry Res Neuroimaging 2022; 320:111427. [PMID: 34952446 DOI: 10.1016/j.pscychresns.2021.111427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
Anorexia nervosa (AN) is a highly debilitating mental illness with multifactorial etiology. It oftentimes begins in adolescence, therefore understanding the pathophysiology in this period is important. Few studies investigated the possible impact of the acute state of illness on white matter (WM) tissue properties in the developing adolescent brain. The present study expands our understanding of the implications of AN and starvation on WM integrity. 67 acutely ill adolescent patients suffering from AN restricting type were compared with 32 healthy controls using diffusion tensor imaging assessing fractional anisotropy (FA) and mean diffusivity (MD). We found widespread alterations in the vast majority of the WM regions with significantly decreased FA and increased MD in the AN group. In this highly selective sample in the acute stage of AN, the alterations are likely to be the consequence of starvation. Still, we cannot rule out that some of the affected regions might play a key role in AN-specific psychopathology.
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Affiliation(s)
- Clarissa Laczkovics
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria.
| | - Karl-Heinz Nenning
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Tanja Wittek
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria
| | - Victor Schmidbauer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Julia Schwarzenberg
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria
| | - Elisabeth Sophie Maurer
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria
| | - Gudrun Wagner
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria
| | - Stefan Seidel
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Julia Philipp
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria
| | - Daniela Prayer
- Department of Neurology, Medical University of Vienna, Austria
| | - Gregor Kasprian
- Department of Neurology, Medical University of Vienna, Austria
| | - Andreas Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria
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Geisler D, King JA, Bahnsen K, Bernardoni F, Doose A, Müller DK, Marxen M, Roessner V, van den Heuvel M, Ehrlich S. Altered White Matter Connectivity in Young Acutely Underweight Patients With Anorexia Nervosa. J Am Acad Child Adolesc Psychiatry 2022; 61:331-340. [PMID: 33989747 DOI: 10.1016/j.jaac.2021.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 04/07/2021] [Accepted: 04/30/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Reductions of gray matter volume and cortical thickness in anorexia nervosa (AN) are well documented. However, findings regarding the integrity of white matter (WM) as studied via diffusion weighted imaging (DWI) are remarkably heterogeneous, and WM connectivity has been examined only in small samples using a limited number of regions of interest. The present study investigated whole-brain WM connectivity for the first time in a large sample of acutely underweight patients with AN. METHOD DWI data from predominantly adolescent patients with acute AN (n = 96, mean age = 16.3 years) and age-matched healthy control participants (n = 96, mean age = 17.2 years) were analyzed. WM connectivity networks were generated from fiber-tractography-derived streamlines connecting 233 cortical/subcortical regions. To identify group differences, network-based statistic was used while taking head motion, WM, and ventricular volume into account. RESULTS Patients with AN were characterized by 6 WM subnetworks with abnormal architecture, as indicated by increased fractional anisotropy located primarily in parietal-occipital regions and accompanied by reduced radial diffusivity. Group differences based on number of streamlines reached only nominal significance. CONCLUSION Our study reveals pronounced alterations in the WM connectome in young patients with AN. In contrast to known reductions in gray matter in the acutely underweight state of AN, this pattern does not necessarily indicate a deterioration of the WM network. Future studies using advanced MRI sequences will have to clarify interrelations with axonal packing or myelination, and whether the changes should be considered a consequence of undernutrition or a vulnerability for developing or maintaining AN.
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Affiliation(s)
- Daniel Geisler
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Joseph A King
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Klaas Bahnsen
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Fabio Bernardoni
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Arne Doose
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Dirk K Müller
- Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Michael Marxen
- Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Child and Adolescent Psychiatry, University Hospital C. G. Carus, Technische Universität Dresden, Dresden, Germany
| | - Martijn van den Heuvel
- Connectome Lab, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Eating Disorder Treatment and Research Center, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
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8
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Regnaud A, Boto J, Klauser A, Lövblad KO, Vargas MI, Lazeyras F. Metabolic changes in the cingulate gyrus, precuneus, and white matter in anorexia nervosa using multivoxel MR spectroscopy. J Neuroimaging 2021; 31:1099-1110. [PMID: 34463008 PMCID: PMC9292420 DOI: 10.1111/jon.12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 07/11/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose This study aimed to highlight anorexia nervosa‐related metabolic changes in different brain regions with different gray and white matter contents. Methods In a prospective study, 25 anorexic patients with mean body mass index (BMI) of 14.79 kg/m2 (range 10.04–20.58) were compared with 15 healthy controls with mean BMI of 21.08 kg/m2 (range 18.36–27.34). Two‐dimensional magnetic resonance spectroscopic imaging was acquired in the axial plane above the corpus callosum, including frontal, precentral, postcentral, cingular, and parietal regions, as well as the precuneus, each voxel containing gray and white matter. Results In the anorexic group, a significant increase of choline/creatine was observed in all brain regions except the precuneus: frontal (p = 0.009), cingulate (p = 0.001), precentral (p = 0.001), postcentral (p = 0.001), and parietal (p = 0.002); and in white and gray matter (p< 0.001). Macromolecules09/creatine was decreased in the following regions: frontal (p = 0.003), cingulate (p< 0.001), precentral (p = 0.004), and precuneus (p = 0.007), and in white and gray matter (p< 0.05). We observed significantly lower values of N‐acetyl aspartate/creatine in the frontal (p < 0.001) and precentral (p< 0.001) regions and in voxels containing more than 50% white matter (p = 0.001); and significantly lower values of myo‐inositol/creatine in the precentral (p = 0.006), postcentral (p< 0.001), and precuneus (p = 0.006) regions. Conclusions We observed an increase in choline/creatine in anorexics, possibly reflecting increased cell turnover; a decrease in macromolecules, which was particularly low in the cingulate and precuneus the former being known to be altered in eating disorders; and a decrease in N‐acetyl aspartate/creatine considered as a marker of neuronal density and function.
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Affiliation(s)
- Alice Regnaud
- Division of Neuroradiology, Faculty of Medicine of Geneva, Geneva University Hospital, Geneva, Switzerland
| | - José Boto
- Division of Neuroradiology, Faculty of Medicine of Geneva, Geneva University Hospital, Geneva, Switzerland
| | - Antoine Klauser
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.,Center for Biomedical Imaging (CIBM), University of Geneva, Geneva, Switzerland
| | - Karl-Olof Lövblad
- Division of Neuroradiology, Faculty of Medicine of Geneva, Geneva University Hospital, Geneva, Switzerland
| | - Maria Isabel Vargas
- Division of Neuroradiology, Faculty of Medicine of Geneva, Geneva University Hospital, Geneva, Switzerland
| | - François Lazeyras
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.,Center for Biomedical Imaging (CIBM), University of Geneva, Geneva, Switzerland
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Kappou K, Ntougia M, Kourtesi A, Panagouli E, Vlachopapadopoulou E, Michalacos S, Gonidakis F, Mastorakos G, Psaltopoulou T, Tsolia M, Bacopoulou F, Sergentanis TN, Tsitsika A. Neuroimaging Findings in Adolescents and Young Adults with Anorexia Nervosa: A Systematic Review. CHILDREN-BASEL 2021; 8:children8020137. [PMID: 33673193 PMCID: PMC7918703 DOI: 10.3390/children8020137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 02/06/2023]
Abstract
Background: Anorexia nervosa (AN) is a serious, multifactorial mental disorder affecting predominantly young females. This systematic review examines neuroimaging findings in adolescents and young adults up to 24 years old, in order to explore alterations associated with disease pathophysiology. Methods: Eligible studies on structural and functional brain neuroimaging were sought systematically in PubMed, CENTRAL and EMBASE databases up to 5 October 2020. Results: Thirty-three studies were included, investigating a total of 587 patients with a current diagnosis of AN and 663 healthy controls (HC). Global and regional grey matter (GM) volume reduction as well as white matter (WM) microstructure alterations were detected. The mainly affected regions were the prefrontal, parietal and temporal cortex, hippocampus, amygdala, insula, thalamus and cerebellum as well as various WM tracts such as corona radiata and superior longitudinal fasciculus (SLF). Regarding functional imaging, alterations were pointed out in large-scale brain networks, such as default mode network (DMN), executive control network (ECN) and salience network (SN). Most findings appear to reverse after weight restoration. Specific limitations of neuroimaging studies in still developing individuals are also discussed. Conclusions: Structural and functional alterations are present in the early course of the disease, most of them being partially or totally reversible. Nonetheless, neuroimaging findings have been open to many biological interpretations. Thus, more studies are needed to clarify their clinical significance.
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Affiliation(s)
- Kalliopi Kappou
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Myrto Ntougia
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Aikaterini Kourtesi
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Eleni Panagouli
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Elpis Vlachopapadopoulou
- Department of Endocrinology-Growth and Development, “P. & A. Kyriakou” Children’s Hospital, 115 27 Athens, Greece; (E.V.); (S.M.)
| | - Stefanos Michalacos
- Department of Endocrinology-Growth and Development, “P. & A. Kyriakou” Children’s Hospital, 115 27 Athens, Greece; (E.V.); (S.M.)
| | - Fragiskos Gonidakis
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 115 28 Athens, Greece;
| | - Georgios Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece;
| | - Theodora Psaltopoulou
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
- Department of Clinical Therapeutics, “Alexandra” Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Maria Tsolia
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair Adolescent Health Care, First Department of Pediatrics, “Agia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Theodoros N. Sergentanis
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
- Department of Clinical Therapeutics, “Alexandra” Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Artemis Tsitsika
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
- Correspondence: ; Tel./Fax: +30-210-771-0824
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10
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Keeler J, Patsalos O, Thuret S, Ehrlich S, Tchanturia K, Himmerich H, Treasure J. Hippocampal volume, function, and related molecular activity in anorexia nervosa: A scoping review. Expert Rev Clin Pharmacol 2020; 13:1367-1387. [PMID: 33176113 DOI: 10.1080/17512433.2020.1850256] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Anorexia nervosa (AN) is a serious and persistent eating disorder, characterized by severe dietary restriction and weight loss, with a third of patients developing a severe-enduring form. The factors contributing to this progression are poorly understood, although there is evidence for impairments in neural structures such as the hippocampus, an area particularly affected by malnutrition and chronic stress. AREAS COVERED This study aimed to map the evidence for alterations in hippocampal volume, function, and related molecular activity in anorexia nervosa. PubMed, PsycINFO, and Web of Science were searched for studies related to hippocampal function and integrity using a range of methodologies, such as neuropsychological paradigms, structural and functional magnetic resonance imaging, and analysis of blood components. EXPERT OPINION Thirty-nine studies were included in this review. The majority were neuroimaging studies, which found hippocampus-specific volumetric and functional impairments. Neuropsychological studies showed evidence for a specific memory and learning impairments. There was some evidence for molecular abnormalities (e.g. cortisol), although these were few studies. Taken together, our review suggests that the hippocampus might be a particular region of interest when considering neurobiological approaches to understanding AN. These findings warrant further investigation and may lead to novel treatment approaches.
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Affiliation(s)
- Johanna Keeler
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
| | - Olivia Patsalos
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
| | - Sandrine Thuret
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience , UK
| | - Stefan Ehrlich
- Faculty of Medicine, Technische Universitat Dresden, Division of Psychological and Social Medicine and Developmental Neurosciences , Germany
| | - Kate Tchanturia
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
| | - Hubertus Himmerich
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
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11
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Collantoni E, Tenconi E, Solmi M, Meneguzzo P, Marzola E, D'Agata F, Gotti S, Daga GA, Manara R, Favaro A. Hippocampal volumes in anorexia nervosa at different stages of the disorder. EUROPEAN EATING DISORDERS REVIEW 2020; 29:112-122. [PMID: 33186479 DOI: 10.1002/erv.2806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/14/2020] [Accepted: 11/01/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Hippocampus is involved in a range of cognitive and behavioural processes, and its volume has been found to be reduced in different psychiatric disorders. The present study aims at exploring hippocampal volumes in anorexia nervosa (AN) at different stages of the disorder (a few months after onset, more than 1 year after onset and after recovery). METHODS Two samples were included in the present study. The first was composed of 58 patients (38 with present AN, 20 full recovered from AN) and 38 age-matched healthy women (HW); the second, recruited at a different site, included 20 patients with AN and 16 HW. Hippocampal volume has been estimated using an automated segmentation algorithm. Age, site of scanning and total intracranial volumes were used as covariates in the statistical analyses. RESULTS AN patients showed a reduced hippocampal volume in comparison to HW, with no substantial differences between patients with recent onset and those with a longer duration of illness. Among patients, hippocampal volumes correlated with body mass index, anxiety and drive for thinness. DISCUSSION Our findings suggest an early role of malnutrition in the morphologic alterations of the hippocampus in AN and a possible role of this brain structure in mediating specific psychopathological traits.
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Affiliation(s)
| | - Elena Tenconi
- Department of Neurosciences, University of Padua, Padova, Italy.,Padua Neuroscience Center, University of Padua, Padova, Italy
| | - Marco Solmi
- Department of Neurosciences, University of Padua, Padova, Italy.,Padua Neuroscience Center, University of Padua, Padova, Italy
| | - Paolo Meneguzzo
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Enrica Marzola
- Department of Neuroscience, University of Turin, Torino, Italy
| | | | - Stefano Gotti
- Department of Neuroscience, University of Turin, Torino, Italy
| | | | - Renzo Manara
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Angela Favaro
- Department of Neurosciences, University of Padua, Padova, Italy.,Padua Neuroscience Center, University of Padua, Padova, Italy
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12
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Breithaupt L, Chunga-Iturry N, Lyall AE, Cetin-Karayumak S, Becker KR, Thomas JJ, Slattery M, Makris N, Plessow F, Pasternak O, Holsen LM, Kubicki M, Misra M, Lawson EA, Eddy KT. Developmental stage-dependent relationships between ghrelin levels and hippocampal white matter connections in low-weight anorexia nervosa and atypical anorexia nervosa. Psychoneuroendocrinology 2020; 119:104722. [PMID: 32512249 PMCID: PMC8629489 DOI: 10.1016/j.psyneuen.2020.104722] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/29/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Disruptions in homeostatic and hedonic food motivation are proposed to underlie anorexia nervosa (AN) and atypical AN, restrictive eating disorders which commonly onset in puberty. Ghrelin, a neuroprotective hormone that drives hedonic eating is increased in AN and is expressed in the hippocampus. White matter (WM) undergoes significant change during puberty in regions involved in food motivation, particularly WM tracts connected with the hippocampus. The association between ghrelin and WM region of interest (ROI) with hippocampal connections in restrictive eating disorders, particularly in adolescence during key neurodevelopmental growth, is unknown. METHODS We evaluated fasting plasma ghrelin and WM microstructure (measured by free-water corrected fractional anisotropy (FA-t)) in WM ROIs with hippocampal connections - the fornix and the hippocampal portion of the cingulum - in 56 adolescent females (age range: 11.9 - 22.1 y; mean: 19.0 y) with low-weight eating disorders including AN and atypical AN (N = 36) and healthy controls (N = 20). RESULTS FA-t in the fornix or hippocampal portion of the fornix did not differ between groups. Ghrelin was higher in AN/atypical AN vs. HC and was positively correlated with puberty stage in the AN/atypical AN group, but not the HC group. The correlation between ghrelin and FA-t in the fornix was significantly different in females with AN/atypical AN compared to controls. In AN/atypical AN, pubertal stage moderated the relation between fasting plasma ghrelin and FA-t in the fornix: higher fasting ghrelin was associated with lower FA-t in the fornix in late-post-puberty, but was not associated with FA-t in the early to mid stages of puberty. CONCLUSIONS In post-pubertal females with low-weight AN/atypical AN, higher levels of ghrelin are associated with lower FA-t in the fornix. This relationship is not evident in the early to mid stages of puberty in AN/atypical AN or in HC, and may reflect a lack of possible neuroprotective effects of ghrelin in late-post puberty only. Understanding the effects of ghrelin on WM microstructure longitudinally and following recovery from AN/Atypical AN and how this differs across pubertal stages will be an important next step. These findings could ultimately inform treatment staging and aid in diagnosis and detection of AN/atypical AN.
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Affiliation(s)
- Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Natalia Chunga-Iturry
- Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, USA
| | - Amanda E Lyall
- Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, USA
| | - Suheyla Cetin-Karayumak
- Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, USA
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Nikos Makris
- Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, USA; Department of Neurology, Massachusetts General Hospital, Charlestown, MA, United States of America; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Franziska Plessow
- Harvard Medical School, Boston, MA, USA; Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Ofer Pasternak
- Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, USA; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Laura M Holsen
- Harvard Medical School, Boston, MA, USA; Division of Women's Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Marek Kubicki
- Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, USA; Department of Neurology, Massachusetts General Hospital, Charlestown, MA, United States of America; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Madhusmita Misra
- Harvard Medical School, Boston, MA, USA; Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA; Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth A Lawson
- Harvard Medical School, Boston, MA, USA; Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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13
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Alfano V, Mele G, Cotugno A, Longarzo M. Multimodal neuroimaging in anorexia nervosa. J Neurosci Res 2020; 98:2178-2207. [PMID: 32770570 DOI: 10.1002/jnr.24674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/26/2020] [Accepted: 05/25/2020] [Indexed: 12/13/2022]
Abstract
Anorexia nervosa (AN) is a severe and complex psychiatric disorder characterized by intense fear about weight gain and finalized to food-related control behaviors. Growing interest has been demonstrated about neurobiological processes subtend to AN physiopathology. The present review aimed to collect neurostructural and neurofunctional available data from 2010 to 2019. Results have been organized according to the neuroimaging technique employed, also including a specific section on electroencephalographic results, mostly neglected in previous reviews. Diffuse cerebral vulnerability has been demonstrated and the contribution of several structures has been identified. Insula, cingulate cortex, parietal and frontal areas are primarily involved both by structural and functional perspectives. Moreover, consistent alterations in white matter integrity and brain electrical activity have been reported. Neuroimaging findings give a substantial contribution to AN pathophysiological description, also in order to understand altered but reversible processes in the passage from acute illness phase to disorder's remission, useful also for defining therapy.
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14
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Benear SL, Ngo CT, Olson IR. Dissecting the Fornix in Basic Memory Processes and Neuropsychiatric Disease: A Review. Brain Connect 2020; 10:331-354. [PMID: 32567331 DOI: 10.1089/brain.2020.0749] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The fornix is the primary axonal tract of the hippocampus, connecting it to modulatory subcortical structures. This review reveals that fornix damage causes cognitive deficits that closely mirror those resulting from hippocampal lesions. Methods: We reviewed the literature on the fornix, spanning non-human animal lesion research, clinical case studies of human patients with fornix damage, as well as diffusion-weighted imaging (DWI) work that evaluates fornix microstructure in vivo. Results: The fornix is essential for memory formation because it serves as the conduit for theta rhythms and acetylcholine, as well as providing mnemonic representations to deep brain structures that guide motivated behavior, such as when and where to eat. In rodents and non-human primates, fornix lesions lead to deficits in conditioning, reversal learning, and navigation. In humans, damage to the fornix manifests as anterograde amnesia. DWI research reveals that the fornix plays a key role in mild cognitive impairment and Alzheimer's Disease, and can potentially predict conversion from the former to the latter. Emerging DWI findings link perturbations in this structure to schizophrenia, mood disorders, and eating disorders. Cutting-edge research has investigated how deep brain stimulation of the fornix can potentially attenuate memory loss, control epileptic seizures, and even improve mood. Conclusions: The fornix is essential to a fully functioning memory system and is implicated in nearly all neurological functions that rely on the hippocampus. Future research needs to use optimized DWI methods to study the fornix in vivo, which we discuss, given the difficult nature of fornix reconstruction. Impact Statement The fornix is a white matter tract that connects the hippocampus to several subcortical brain regions and is pivotal for episodic memory functioning. Functionally, the fornix transmits essential neurotransmitters, as well as theta rhythms, to the hippocampus. In addition, it is the conduit by which memories guide decisions. The fornix is biomedically important because lesions to this tract result in irreversible anterograde amnesia. Research using in vivo imaging methods has linked fornix pathology to cognitive aging, mild cognitive impairment, psychosis, epilepsy, and, importantly, Alzheimer's Disease.
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Affiliation(s)
- Susan L Benear
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Chi T Ngo
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Ingrid R Olson
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
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15
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Zhang S, Wang W, Su X, Li L, Yang X, Su J, Tan Q, Zhao Y, Sun H, Kemp GJ, Gong Q, Yue Q. White Matter Abnormalities in Anorexia Nervosa: Psychoradiologic Evidence From Meta-Analysis of Diffusion Tensor Imaging Studies Using Tract Based Spatial Statistics. Front Neurosci 2020; 14:159. [PMID: 32194371 PMCID: PMC7063983 DOI: 10.3389/fnins.2020.00159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 02/11/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Anorexia nervosa (AN) is a debilitating illness whose neural basis remains unclear. Studies using tract-based spatial statistics (TBSS) with diffusion tensor imaging (DTI) have demonstrated differences in white matter (WM) microarchitecture in AN, but the findings are inconclusive and controversial. Objectives: To identify the most consistent WM abnormalities among previous TBSS studies of differences in WM microarchitecture in AN. Methods: By systematically searching online databases, a total of 11 datasets were identified, including 245 patients with AN and 246 healthy controls (HC). We used Seed-based d Mapping to analyze fractional anisotropy (FA) differences between AN patients and HC, and performed meta-regression analysis to explore the effects of clinical characteristics on WM abnormalities in AN. Results: The pooled results of all AN patients showed robustly lower FA in the corpus callosum (CC) and the cingulum compared to HC. These two regions preserved significance in the sensitivity analysis as well as in all subgroup analyses. Fiber tracking showed that the WM tracts primarily involved were the body of the CC and the cingulum bundle. Meta-regression analysis revealed that the body mass index and mean age were not linearly correlated with the lower FA. Conclusions: The most consistent WM microstructural differences in AN were in the interhemispheric connections and limbic association fibers. These common “targets” advance our understanding of the complex neural mechanisms underlying the puzzling symptoms of AN, and may help in developing early treatment approaches.
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Affiliation(s)
- Simin Zhang
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Weina Wang
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Xiaorui Su
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Lei Li
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Xibiao Yang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Jingkai Su
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiaoyue Tan
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Youjin Zhao
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Huaiqiang Sun
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Yue
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
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16
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Meneguzzo P, Collantoni E, Solmi M, Tenconi E, Favaro A. Anorexia nervosa and diffusion weighted imaging: An open methodological question raised by a systematic review and a fractional anisotropy anatomical likelihood estimation meta-analysis. Int J Eat Disord 2019; 52:1237-1250. [PMID: 31518016 DOI: 10.1002/eat.23160] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) is characterized by white matter abnormalities in neuroimaging studies. Fractional anisotropy (FA) is a diffusion tensor imaging (DTI) index that is considered an instrument for the evaluation of white matter alterations. However, the literature has recently pointed out the role of the partial volume effect (PVE) as a confounding factor for the identification of juxtaposed tissues. Our goal was to review the DTI literature in AN and evaluate possible confounding factors linked to the reported results. METHOD A systematic review of the literature was conducted to identify Diffusion Tensor Imaging studies of individuals with AN and, subsequently, an anatomical likelihood estimation (ALE) meta-analysis was performed on studies published before March 18, 2019. RESULTS Twenty-four studies (AN = 517, controls = 542) were included in the qualitative systematic review of the literature. Ten published studies underwent the ALE-analysis (AN = 210, controls = 229), plus data from an unpublished cohort (AN = 38, controls = 38). Two clusters of decreased FA were identified, namely in the left corona radiata, and in the left thalamus. Only one article took the PVE correction analysis into account. CONCLUSIONS The alterations identified must be considered within the limits of a possible methodological bias regarding PVE and free water and re-analysis of the data may be recommended. The preliminary data showed that the alteration of white matter pathways between the limbic structures and brain cortex may be linked to the processing of somatosensory information that could play a key role in the psychopathology of the disorder.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Elena Tenconi
- Department of Neurosciences, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Angela Favaro
- Department of Neurosciences, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
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17
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Abstract
BACKGROUND Excessive worry is a defining feature of generalized anxiety disorder and is present in a wide range of other psychiatric conditions. Therefore, individualized predictions of worry propensity could be highly relevant in clinical practice, with respect to the assessment of worry symptom severity at the individual level. METHODS We applied a multivariate machine learning approach to predict dispositional worry based on microstructural integrity of white matter (WM) tracts. RESULTS We demonstrated that the machine learning model was able to decode individual dispositional worry scores from microstructural properties in widely distributed WM tracts (mean absolute error = 10.46, p < 0.001; root mean squared error = 12.82, p < 0.001; prediction R2 = 0.17, p < 0.001). WM tracts that contributed to worry prediction included the posterior limb of internal capsule, anterior corona radiate, and cerebral peduncle, as well as the corticolimbic pathways (e.g. uncinate fasciculus, cingulum, and fornix) already known to be critical for emotion processing and regulation. CONCLUSIONS The current work thus elucidates potential neuromarkers for clinical assessment of worry symptoms across a wide range of psychiatric disorders. In addition, the identification of widely distributed pathways underlying worry propensity serves to better improve the understanding of the neurobiological mechanisms associated with worry.
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Affiliation(s)
- Chunliang Feng
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
- College of Information Science and Technology, Beijing Normal University, Beijing 100875, China
| | - Zaixu Cui
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104, USA
| | - Dazhi Cheng
- Department of Pediatric Neurology, Capital Institute of Pediatrics, Beijing 100020, China
| | - Rui Xu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Ruolei Gu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
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18
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Gaudio S, Carducci F, Piervincenzi C, Olivo G, Schiöth HB. Altered thalamo–cortical and occipital–parietal– temporal–frontal white matter connections in patients with anorexia and bulimia nervosa: a systematic review of diffusion tensor imaging studies. J Psychiatry Neurosci 2019; 44:324-339. [PMID: 30994310 PMCID: PMC6710091 DOI: 10.1503/jpn.180121] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Anorexia nervosa and bulimia nervosa are complex mental disorders, and their etiology is still not fully understood. This paper reviews the literature on diffusion tensor imaging studies in patients with anorexia nervosa and bulimia nervosa to explore the usefulness of white matter microstructural analysis in understanding the pathophysiology of eating disorders. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify diffusion tensor imaging studies that compared patients with an eating disorder to control groups. We searched relevant databases for studies published from database inception to August 2018, using combinations of select keywords. We categorized white matter tracts according to their 3 main classes: projection (i.e., thalamo–cortical), association (i.e., occipital–parietal–temporal–frontal) and commissural (e.g., corpus callosum). RESULTS We included 19 papers that investigated a total of 427 participants with current or previous eating disorders and 444 controls. Overall, the studies used different diffusion tensor imaging approaches and showed widespread white matter abnormalities in patients with eating disorders. Despite differences among the studies, patients with anorexia nervosa showed mainly white matter microstructural abnormalities of thalamo–cortical tracts (i.e., corona radiata, thalamic radiations) and occipital–parietal–temporal–frontal tracts (i.e., left superior longitudinal and inferior fronto-occipital fasciculi). It was less clear whether white matter alterations persist after recovery from anorexia nervosa. Available data on bulimia nervosa were partially similar to those for anorexia nervosa. LIMITATIONS Study sample composition and diffusion tensor imaging analysis techniques were heterogeneous. The number of studies on bulimia nervosa was too limited to be conclusive. CONCLUSION White matter microstructure appears to be affected in anorexia nervosa, and these alterations may play a role in the pathophysiology of this eating disorder. Although we found white matter alterations in bulimia nervosa that were similar to those in anorexia nervosa, white matter changes in bulimia nervosa remain poorly investigated, and these findings were less conclusive. Further studies with longitudinal designs and multi-approach analyses are needed to better understand the role of white matter changes in eating disorders.
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Affiliation(s)
- Santino Gaudio
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
| | - Filippo Carducci
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
| | - Claudia Piervincenzi
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
| | - Gaia Olivo
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
| | - Helgi B. Schiöth
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
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19
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von Schwanenflug N, Müller DK, King JA, Ritschel F, Bernardoni F, Mohammadi S, Geisler D, Roessner V, Biemann R, Marxen M, Ehrlich S. Dynamic changes in white matter microstructure in anorexia nervosa: findings from a longitudinal study. Psychol Med 2019; 49:1555-1564. [PMID: 30149815 DOI: 10.1017/s003329171800212x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gray matter (GM) 'pseudoatrophy' is well-documented in patients with anorexia nervosa (AN), but changes in white matter (WM) are less well understood. Here we investigated the dynamics of microstructural WM brain changes in AN patients during short-term weight restoration in a combined longitudinal and cross-sectional study design. METHODS Diffusion-weighted images were acquired in young AN patients before (acAN-Tp1, n = 56) and after (acAN-Tp2, n = 44) short-term weight restoration as well as in age-matched healthy controls (HC, n = 60). Images were processed using Tract-Based-Spatial-Statistics to compare fractional anisotropy (FA) across groups and timepoints. RESULTS In the cross-sectional comparison, FA was significantly reduced in the callosal body in acAN-Tp1 compared with HC, while no differences were found between acAN-Tp2 and HC. In the longitudinal arm, FA increased with weight gain in acAN-Tp2 relative to acAN-Tp1 in large parts of the callosal body and the fornix, while it decreased in the right corticospinal tract. CONCLUSIONS Our findings reveal that dynamic, bidirectional changes in WM microstructure in young underweight patients with AN can be reversed with brief weight restoration therapy. These results parallel those previously observed in GM and suggest that alterations in WM in non-chronic AN are also state-dependent and rapidly reversible with successful intervention.
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Affiliation(s)
- Nina von Schwanenflug
- Division of Psychological and Social Medicine and Developmental Neuroscience,Faculty of Medicine,Technische Universität Dresden,Dresden,Germany
| | - Dirk K Müller
- Department of Psychiatry and Neuroimaging Center,Technische Universität Dresden,Dresden,Germany
| | - Joseph A King
- Division of Psychological and Social Medicine and Developmental Neuroscience,Faculty of Medicine,Technische Universität Dresden,Dresden,Germany
| | - Franziska Ritschel
- Division of Psychological and Social Medicine and Developmental Neuroscience,Faculty of Medicine,Technische Universität Dresden,Dresden,Germany
| | - Fabio Bernardoni
- Division of Psychological and Social Medicine and Developmental Neuroscience,Faculty of Medicine,Technische Universität Dresden,Dresden,Germany
| | - Siawoosh Mohammadi
- Department of Systems Neuroscience,Medical Center Hamburg-Eppendorf,Hamburg,Germany
| | - Daniel Geisler
- Division of Psychological and Social Medicine and Developmental Neuroscience,Faculty of Medicine,Technische Universität Dresden,Dresden,Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry,Faculty of Medicine,Eating Disorder Research and Treatment Center, Technische Universität Dresden,Dresden,Germany
| | - Ronald Biemann
- Institute of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke University,Magdeburg,Germany
| | - Michael Marxen
- Department of Psychiatry and Neuroimaging Center,Technische Universität Dresden,Dresden,Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neuroscience,Faculty of Medicine,Technische Universität Dresden,Dresden,Germany
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20
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Barona M, Brown M, Clark C, Frangou S, White T, Micali N. White matter alterations in anorexia nervosa: Evidence from a voxel-based meta-analysis. Neurosci Biobehav Rev 2019; 100:285-295. [PMID: 30851283 DOI: 10.1016/j.neubiorev.2019.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/08/2019] [Accepted: 03/05/2019] [Indexed: 02/06/2023]
Abstract
Anorexia nervosa (AN) is a severe psychiatric disorder with a complex and poorly understood etiology. Recent studies have sought to investigate differences in white matter microstructure in AN, with significant results in several brain regions. A systematic literature search of Embase, PubMed and Psychinfo databases was conducted in order to identify Diffusion Tensor Imaging (DTI) studies of patients with AN and controls. We performed a meta-analysis of studies that met our inclusion criteria (N = 13) using effect size-signed differential mapping (AES-SDM) to detect differences in Fractional Anisotropy (FA) in patients with AN (N = 227) compared to healthy controls (N = 243). The quantitative meta-analysis of DTI studies identified decreased FA in the posterior areas of the corpus callosum, the left superior longitudinal fasciculus II, and the left precentral gyrus, as well as increased FA in the right cortico-spinal projections, and lingual gyrus in AN vs. controls. Studies of WM architecture are still limited in AN; further studies with longitudinal design are needed to better understand the complexity of abnormalities, and their persistence.
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Affiliation(s)
- Manuela Barona
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Melanie Brown
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tonya White
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nadia Micali
- UCL Great Ormond Street Institute of Child Health, London, UK; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Psychiatry, University of Geneva, Geneva, Switzerland.
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21
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Olivo G, Swenne I, Zhukovsky C, Tuunainen A, Saaid A, Salonen‐Ros H, Larsson E, Brooks SJ, Schiöth HB. Preserved white matter microstructure in adolescent patients with atypical anorexia nervosa. Int J Eat Disord 2019; 52:166-174. [PMID: 30676658 PMCID: PMC6590352 DOI: 10.1002/eat.23012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Patients with atypical anorexia nervosa (AN) are often in the normal-weight range at presentation; however, signs of starvation and medical instability are not rare. White matter (WM) microstructural correlates of atypical AN have not yet been investigated, leaving an important gap in our knowledge regarding the neural pathogenesis of this disorder. METHOD We investigated WM microstructural integrity in 25 drug-naïve adolescent patients with atypical AN and 25 healthy controls, using diffusion tensor imaging (DTI) with a tract-based spatial statistics (TBSS) approach. Psychological variables related to the eating disorder and depressive symptoms were also evaluated by administering the eating disorder examination questionnaire (EDE-Q) and the Montgomery-Åsberg depression rating scale (MADRS-S) respectively, to all participants. RESULTS Patients and controls were in the normal-weight range and did not differ from the body mass index standard deviations for their age. No between groups difference in WM microstructure could be detected. DISCUSSION Our findings support the hypothesis that brain structural alterations may not be associated to early-stage atypical AN. These findings also suggest that previous observations of alterations in WM microstructure in full syndrome AN may constitute state-related consequences of severe weight loss. Whether the preservation of WM structure is a pathogenetically discriminant feature of atypical AN or only an effect of a less severe nutritional disturbance, will have to be verified by future studies on larger samples, possibly directly comparing AN and atypical AN.
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Affiliation(s)
- Gaia Olivo
- Department of Neuroscience, Functional PharmacologyUppsala UniversityUppsalaSweden
| | - Ingemar Swenne
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Christina Zhukovsky
- Department of Neuroscience, Functional PharmacologyUppsala UniversityUppsalaSweden
| | - Anna‐Kaisa Tuunainen
- Department of Neuroscience, Functional PharmacologyUppsala UniversityUppsalaSweden
| | - Avista Saaid
- Department of Neuroscience, Functional PharmacologyUppsala UniversityUppsalaSweden
| | - Helena Salonen‐Ros
- Department of Neuroscience, Child and Adolescent PsychiatryUppsala UniversityUppsalaSweden
| | - Elna‐Marie Larsson
- Department of Surgical Sciences, RadiologyUppsala UniversityUppsalaSweden
| | - Samantha J. Brooks
- Department of Human BiologyUniversity of Cape TownCape TownSouth Africa,School of Natural Sciences and PsychologyResearch Centre for Brain & BehaviourLiverpoolUnited Kingdom
| | - Helgi B. Schiöth
- Department of Neuroscience, Functional PharmacologyUppsala UniversityUppsalaSweden
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22
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Nickel K, Tebartz van Elst L, Holovics L, Feige B, Glauche V, Fortenbacher T, Endres D, Zeeck A, Tüscher O, Joos A, Maier S. White Matter Abnormalities in the Corpus Callosum in Acute and Recovered Anorexia Nervosa Patients-A Diffusion Tensor Imaging Study. Front Psychiatry 2019; 10:490. [PMID: 31338044 PMCID: PMC6628864 DOI: 10.3389/fpsyt.2019.00490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 06/21/2019] [Indexed: 12/26/2022] Open
Abstract
Objective: Severe malnutrition in patients with anorexia nervosa (AN) as well as possible trait-related aberrations lead to pronounced structural brain changes whose reversibility after recovery is currently unclear. Previous diffusion tensor imaging (DTI) studies investigating white matter (WM) microstructure alterations in AN are inconsistent. Methods: In this so far largest DTI study in adults, we investigated 33 AN patients, 20 recovered (REC), and 33 healthy women. DTI data were processed using the "DTI and Fiber tools," and the Computational Anatomy Toolbox. WM integrity, both in terms of fractional anisotropy (FA) and mean diffusivity (MD), was assessed. Results: We found a significant FA decrease in the corpus callosum (body) and an MD decrease in the posterior thalamic radiation in the AN group. The REC group displayed FA decrease in the corpus callosum in comparison to HC, whereas there were no MD differences between the REC and HC groups. Conclusion: Despite prolonged restoration of weight in the REC group, no significant regeneration of WM integrity in terms of FA could be observed. Transient changes in MD likely represent a reversible consequence of the acute state of starvation or result from dehydration. Reduction of FA either may be due to WM damage resulting from malnutrition or may be considered a pre-morbid marker.
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Affiliation(s)
- Kathrin Nickel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Holovics
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volkmar Glauche
- Department of Neurology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tina Fortenbacher
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University of Mainz, Mainz, Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychotherapeutic Neurology, Kliniken Schmieder, Gailingen, Germany
| | - Simon Maier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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23
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Lu M, Yang C, Chu T, Wu S. Cerebral White Matter Changes in Young Healthy Individuals With High Trait Anxiety: A Tract-Based Spatial Statistics Study. Front Neurol 2018; 9:704. [PMID: 30197621 PMCID: PMC6117387 DOI: 10.3389/fneur.2018.00704] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/03/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Abnormalities in prespecified and empirical white matter tracts in young patients with anxiety-related disorders have been reported in some diffusion tensor imaging (DTI) studies. However, with few literatures examining the association between the integrity of whole brain white matter and trait anxiety levels in the non-clinical populations, whether white matter changes arise in young healthy individuals with high trait anxiety remains unknown. Methods: We examined whole brain white matter alterations in young healthy individuals with high anxiety but without history of neurological or psychiatric disorders via DTI technology. Group comparison of tract-based spatial statistics (TBSS) was performed to investigate the microstructural diffusion alterations in 38 high anxious subjects in comparison with 34 low anxious subjects matched with age, gender, and degree of education. These analyses controlled for depression to establish specificity to trait anxiety. Results: Young healthy subjects with high trait anxiety had significantly decreased fractional anisotropy (FA) values in multiple clusters, including corona radiate (CR), anterior thalamic radiation (ATR), inferior fronto-occipital fasciculus (IFOF), bilaterally, body, genu, and splenium of corpus callosum (CC) and forceps minor, compared with low trait anxious subjects. For the abnormal FA regions, the other diffusion metrics were also altered slightly. Conclusions: Non-clinical individuals with high anxiety already have white matter alterations in the thalamus-cortical circuit and some emotion-related areas that were widely reported in anxiety-related disorders. The altered white matter may be a vulnerability marker in individuals at high risk of clinical anxiety. These findings can deepen our understanding of the pathological mechanism of anxiety and further support the need for preventive interventions in high anxiety individuals.
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Affiliation(s)
- Min Lu
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Chunlan Yang
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Tongpeng Chu
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Shuicai Wu
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
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24
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Phillipou A, Carruthers SP, Di Biase MA, Zalesky A, Abel LA, Castle DJ, Gurvich C, Rossell SL. White matter microstructure in anorexia nervosa. Hum Brain Mapp 2018; 39:4385-4392. [PMID: 29964345 DOI: 10.1002/hbm.24279] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/03/2018] [Accepted: 06/05/2018] [Indexed: 01/04/2023] Open
Abstract
The neurobiological underpinnings of anorexia nervosa (AN) are unclear. White matter deficits have been described in the illness, but findings are inconsistent between studies. The aim of this study was to investigate differences in white matter microstructure in AN using diffusion-weighted imaging (DWI). It was hypothesised that people with AN, relative to a healthy control (HC) group, would show decreased functional anisotropy (FA) and increased mean diffusivity (MD) in the fornix and superior longitudinal fasciculus, consistent with previous literature. Analyses were conducted on 23 females with AN and 26 age- and gender-matched HCs using tract-based spatial statistics (TBSS). The results revealed widespread FA decreases and MD increases in the AN group. Our hypothesis was largely supported, although FA differences were not specifically found in the fornix. The findings suggest extensive differences in white matter structure in AN, which may contribute to AN pathophysiology.
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Affiliation(s)
- Andrea Phillipou
- Department of Optometry & Vision Sciences, The University of Melbourne, Melbourne, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,Department of Mental Health, Austin Health, Melbourne, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Australia.,Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Sean P Carruthers
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Monash Alfred Psychiatry Research Centre, Monash University & The Alfred Hospital, Melbourne, Australia
| | - Maria A Di Biase
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard, Medical School, Massachusetts.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Australia
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Australia
| | - Larry A Abel
- Department of Optometry & Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - David J Castle
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Monash University & The Alfred Hospital, Melbourne, Australia
| | - Susan L Rossell
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia.,Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Monash Alfred Psychiatry Research Centre, Monash University & The Alfred Hospital, Melbourne, Australia
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25
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Frintrop L, Liesbrock J, Paulukat L, Johann S, Kas MJ, Tolba R, Heussen N, Neulen J, Konrad K, Herpertz-Dahlmann B, Beyer C, Seitz J. Reduced astrocyte density underlying brain volume reduction in activity-based anorexia rats. World J Biol Psychiatry 2018; 19:225-235. [PMID: 28132573 DOI: 10.1080/15622975.2016.1273552] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Severe grey and white matter volume reductions were found in patients with anorexia nervosa (AN) that were linked to neuropsychological deficits while their underlying pathophysiology remains unclear. For the first time, we analysed the cellular basis of brain volume changes in an animal model (activity-based anorexia, ABA). METHODS Female rats had 24 h/day running wheel access and received reduced food intake until a 25% weight reduction was reached and maintained for 2 weeks. RESULTS In ABA rats, the volumes of the cerebral cortex and corpus callosum were significantly reduced compared to controls by 6% and 9%, respectively. The number of GFAP-positive astrocytes in these regions decreased by 39% and 23%, total astrocyte-covered area by 83% and 63%. In neurons no changes were observed. The findings were complemented by a 60% and 49% reduction in astrocyte (GFAP) mRNA expression. CONCLUSIONS Volumetric brain changes in ABA animals mirror those in human AN patients. These alterations are associated with a reduction of GFAP-positive astrocytes as well as GFAP expression. Reduced astrocyte functioning could help explain neuronal dysfunctions leading to symptoms of rigidity and impaired learning. Astrocyte loss could constitute a new research target for understanding and treating semi-starvation and AN.
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Affiliation(s)
- Linda Frintrop
- a Institute of Neuroanatomy, University Hospital, RWTH Aachen University , Aachen , Germany
| | - Johanna Liesbrock
- a Institute of Neuroanatomy, University Hospital, RWTH Aachen University , Aachen , Germany.,b Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital, RWTH Aachen University , Aachen , Germany
| | - Lisa Paulukat
- a Institute of Neuroanatomy, University Hospital, RWTH Aachen University , Aachen , Germany.,b Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital, RWTH Aachen University , Aachen , Germany
| | - Sonja Johann
- a Institute of Neuroanatomy, University Hospital, RWTH Aachen University , Aachen , Germany
| | - Martien J Kas
- c Department of Translational Neuroscience , Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , The Netherlands.,d Groningen Institute for Evolutionary Life Sciences, University of Groningen , the Netherlands
| | - Rene Tolba
- e Institute for Laboratory Animal Science and Experimental Surgery , University Hospital, RWTH Aachen University , Aachen , Germany
| | - Nicole Heussen
- f Department of Medical Statistics , University Hospital Aachen, RWTH Aachen University , Aachen , Germany
| | - Joseph Neulen
- g Department of Gynecological Endocrinology and Reproductive Medicine , University Hospital, RWTH Aachen University , Aachen , Germany
| | - Kerstin Konrad
- b Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital, RWTH Aachen University , Aachen , Germany
| | - Beate Herpertz-Dahlmann
- b Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital, RWTH Aachen University , Aachen , Germany
| | - Cordian Beyer
- a Institute of Neuroanatomy, University Hospital, RWTH Aachen University , Aachen , Germany
| | - Jochen Seitz
- b Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital, RWTH Aachen University , Aachen , Germany
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26
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Pfuhl G, King JA, Geisler D, Roschinski B, Ritschel F, Seidel M, Bernardoni F, Müller DK, White T, Roessner V, Ehrlich S. Preserved white matter microstructure in young patients with anorexia nervosa? Hum Brain Mapp 2018; 37:4069-4083. [PMID: 27400772 DOI: 10.1002/hbm.23296] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 06/13/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
A massive but reversible reduction of cortical thickness and subcortical gray matter (GM) volumes in Anorexia Nervosa (AN) has been recently reported. However, the literature on alterations in white matter (WM) volume and microstructure changes in both acutely underweight AN (acAN) and after recovery (recAN) is sparse and results are inconclusive. Here, T1-weighted and diffusion-weighted MRI data in a sizable sample of young and medication-free acAN (n = 35), recAN (n = 32), and age-matched female healthy controls (HC, n = 62) were obtained. For analysis, a well-validated global probabilistic tractography reconstruction algorithm including rigorous motion correction implemented in FreeSurfer: TRACULA (TRActs Constrained by UnderLying Anatomy) were used. Additionally, a clustering algorithm and a multivariate pattern classification technique to WM metrics to predict group membership were applied. No group differences in either WM volume or WM microstructure were detected with standard analysis procedures either in acAN or recAN relative to HC after controlling for the number of performed statistical tests. These findings were not affected by age, IQ, or psychiatric symptoms. While cluster analysis was unsuccessful at discriminating between groups, multivariate pattern classification showed some ability to separate acAN from HC (but not recAN from HC). However, these results were not compatible with a straightforward hypothesis of impaired WM microstructure. The current findings suggest that WM integrity is largely preserved in non-chronic AN. This finding stands in contrast to findings in GM, but may help to explain the relatively intact cognitive performance of young patients with AN and provide the basis for the fast recovery of GM structures. Hum Brain Mapp 37:4069-4083, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Gerit Pfuhl
- Eating Disorders Research and Treatment Center at the Dept. of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Department of Psychology, UiT the Arctic University of Norway & Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Joseph A King
- Eating Disorders Research and Treatment Center at the Dept. of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Daniel Geisler
- Eating Disorders Research and Treatment Center at the Dept. of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Benjamin Roschinski
- Eating Disorders Research and Treatment Center at the Dept. of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Franziska Ritschel
- Eating Disorders Research and Treatment Center at the Dept. of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Maria Seidel
- Eating Disorders Research and Treatment Center at the Dept. of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Fabio Bernardoni
- Eating Disorders Research and Treatment Center at the Dept. of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Dirk K Müller
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Tonya White
- Department of Child and Adolescent Psychiatry & Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Veit Roessner
- Eating Disorders Research and Treatment Center at the Dept. of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Eating Disorders Research and Treatment Center at the Dept. of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany. .,Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany. .,MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts. .,Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
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Cha J, Ide JS, Bowman FD, Simpson HB, Posner J, Steinglass JE. Abnormal reward circuitry in anorexia nervosa: A longitudinal, multimodal MRI study. Hum Brain Mapp 2018; 37:3835-3846. [PMID: 27273474 DOI: 10.1002/hbm.23279] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/18/2016] [Accepted: 05/20/2016] [Indexed: 12/15/2022] Open
Abstract
Anorexia nervosa (AN) is a debilitating illness and existing interventions are only modestly effective. This study aimed to determine whether AN pathophysiology is associated with altered connections within fronto-accumbal circuitry subserving reward processing. Diffusion and resting-state functional MRI scans were collected in female inpatients with AN (n = 22) and healthy controls (HC; n = 18) between the ages of 16 and 25 years. Individuals with AN were scanned during the acute, underweight phase of the illness and again following inpatient weight restoration. HC were scanned twice over the same timeframe. Based on univariate and multivariate analyses of fronto-accumbal circuitry, underweight individuals with AN were found to have increased structural connectivity (diffusion probabilistic tractography), increased white matter anisotropy (tract-based spatial statistics), increased functional connectivity (seed-based correlation in resting-state fMRI), and altered effective connectivity (spectral dynamic causal modeling). Following weight restoration, fronto-accumbal structural connectivity continued to be abnormally increased bilaterally with large (partial η2 = 0.387; right NAcc-OFC) and moderate (partial η2 = 0.197; left NAcc-OFC) effect sizes. Increased structural connectivity within fronto-accumbal circuitry in the underweight state correlated with severity of eating disorder symptoms. Taken together, the findings from this longitudinal, multimodal neuroimaging study offer converging evidence of atypical fronto-accumbal circuitry in AN. Hum Brain Mapp 37:3835-3846, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jiook Cha
- Department of Psychiatry, Columbia University Medical Center, New York, New York. .,Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York.
| | - Jaime S Ide
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - F Dubois Bowman
- Department of Biostatistics, Mailman School of Public Health, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Helen B Simpson
- Department of Psychiatry, Columbia University Medical Center, New York, New York.,Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, New York
| | - Jonathan Posner
- Department of Psychiatry, Columbia University Medical Center, New York, New York.,Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Joanna E Steinglass
- Department of Psychiatry, Columbia University Medical Center, New York, New York. .,Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, New York.
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Seitz J, Konrad K, Herpertz-Dahlmann B. Extend, Pathomechanism and Clinical Consequences of Brain Volume Changes in Anorexia Nervosa. Curr Neuropharmacol 2018; 16:1164-1173. [PMID: 29119931 PMCID: PMC6187749 DOI: 10.2174/1570159x15666171109145651] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 01/01/1970] [Accepted: 11/07/2017] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Brain volume deficits of grey matter (GM) and white matter (WM) are often found in patients with anorexia nervosa (AN). However, until recently, little was known about the influencing factors of these brain volume alterations, nor their exact quantification and rehabilitation. METHODS This review addresses these open questions and further explores what is now known about the underlying pathobiology and the clinical consequences including human studies as well as animal studies mimicking anorexia nervosa in rodents. RESULTS GM was reduced by 3.7% in adults and 7.6% in adolescents with AN. WM was reduced on average 2.2% in adult patients and 3.2% in adolescents. Most volume deficits in adults are reversible after long-term recovery; for adolescents, data are less clear. The main influencing factors for GM were absolute lowest weight at admission and illness duration. Cerebellar and WM reductions at admission predicted clinical outcome at one year follow-up. New studies found GABA receptor changes in GM and astrocyte loss in both GM and WM, as well as a possible role for oestrogen deficit. All three could partly explain clinical symptoms of anxiety, rigidity and learning impairments in patients with AN. CONCLUSION Brain volume deficits in AN seem to play a causal role in the course and the prognosis of AN. A better understanding of these brain changes could lead to more targeted therapies for patients with AN, including astrocyte-directed approaches.
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Affiliation(s)
- Jochen Seitz
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany
| | - Kerstin Konrad
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany
| | - Beate Herpertz-Dahlmann
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany
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Morean ME, L'Insalata A. Electronic cigarette use among individuals with a self-reported eating disorder diagnosis. Int J Eat Disord 2018; 51:77-81. [PMID: 29076176 DOI: 10.1002/eat.22793] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The primary study aim was to examine whether rates of using e-cigarettes ("vaping") to lose weight are elevated among American adults who self-report having an eating disorder (ED). METHOD Adult vapers who reported either currently having an ED (n = 178; 72.5% women, 83.7% White, mean age 33.26 [SD = 8.35] years) or no ED history (n = 433; 54.7% women, 83.4% White, 35.98 [SD = 11.71] years) completed an anonymous survey. RESULTS Relative to participants reporting no ED history, participants who reported currently having an ED were more likely to report vaping to lose/control weight, because it can be concealed from others, and due to the availability of sweet flavors. Participants reporting a current ED also were more likely to vape daily, to use higher nicotine concentrations, and to vape to relieve negative affect than were individuals without EDs. DISCUSSION Individuals who self-reported currently having an ED endorsed vaping motives that are consistent with eating pathology (e.g., substance-induced weight loss, hiding compensatory behaviors from others). They also were more likely to vape daily and to use higher nicotine concentrations, raising health concerns. The findings suggest that treatment providers should screen for e-cigarette use in clients seeking ED treatment.
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Affiliation(s)
- Meghan E Morean
- Department of Psychology, Oberlin College, 120 W Lorain St. Oberlin, Ohio.,Department of Psychiatry, Yale School of Medicine, 34 Park St., New Haven, Connecticut
| | - Alexa L'Insalata
- Department of Psychology, Oberlin College, 120 W Lorain St. Oberlin, Ohio
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Bang L, Rø Ø, Endestad T. Normal white matter microstructure in women long-term recovered from anorexia nervosa: A diffusion tensor imaging study. Int J Eat Disord 2018; 51:46-52. [PMID: 29120488 DOI: 10.1002/eat.22802] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Studies point to white matter (WM) microstructure alterations in both adolescent and adult patients with anorexia nervosa (AN). These include reduced fractional anisotropy in several WM fiber tracts, suggesting reduced WM integrity. The extent to which these alterations are reversible with recovery from AN is unclear. There is a paucity of research investigating the presence of WM microstructure alterations in recovered AN patients, and results are inconsistent. This study aimed to investigate the presence of WM microstructure alterations in women long-term recovered from AN. METHOD Twenty-one adult women who were recovered from AN for at least 1 year were compared to 21 adult comparison women. Participants were recruited via user-organizations for eating disorders, local advertisements, and online forums. Diffusion tensor imaging was used to compare WM microstructure between groups. Correlations between WM microstructure and clinical characteristics were also explored. RESULTS There were no statistically significant between-group differences in WM microstructure. These null findings remained when employing liberal alpha level thresholds. Furthermore, there were no statistically significant correlations between WM microstructure and clinical characteristics. DISCUSSION Our findings showed normal WM microstructure in long-term recovered patients, indicating the alterations observed during the acute phase are reversible. Given the paucity of research and inconsistent findings, future studies are warranted to determine the presence of WM microstructure alterations following recovery from AN.
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Affiliation(s)
- Lasse Bang
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, Oslo, 0424, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, Oslo, 0424, Norway.,Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, Oslo, 0318, Norway
| | - Tor Endestad
- Institute of Psychology, University of Oslo, P.O. Box 1094 Blindern, Oslo, 0317, Norway
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Lipsman N, Lozano AM, Hamani C. Neuromodulation in Anorexia Nervosa. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00088-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gaudio S, Quattrocchi CC, Piervincenzi C, Zobel BB, Montecchi FR, Dakanalis A, Riva G, Carducci F. White matter abnormalities in treatment-naive adolescents at the earliest stages of Anorexia Nervosa: A diffusion tensor imaging study. Psychiatry Res Neuroimaging 2017; 266:138-145. [PMID: 28666248 DOI: 10.1016/j.pscychresns.2017.06.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/21/2017] [Accepted: 06/18/2017] [Indexed: 11/21/2022]
Abstract
Few studies have examined white matter (WM) integrity in long-lasting Anorexia Nervosa (AN) patients using Diffusion Tensor Imaging (DTI). In this paper, we investigated WM integrity at the earliest stages of AN (i.e. less than 6 months duration). Fourteen treatment-naive female adolescents with AN restrictive type (AN-r) in its earliest stages and 15 age-matched healthy females received brain MRI. Fractional Anisotropy (FA), Axial Diffusivity (AD), Radial diffusivity (RD), and Mean Diffusivity (MD) maps were computed from DTI data using Tract-Based Spatial Statistics analysis. AN-r patients showed FA decreases compared to controls (pFWE < 0.05) mainly in left anterior and superior corona radiata and left superior longitudinal fasciculus. AN-r patients also showed decreased AD in superior longitudinal fasciculus bilaterally and left superior and anterior corona radiata, (pFWE < 0.05). No significant differences were found in RD and MD values between the two groups. FA and AD integrity appears to be specifically affected at the earliest stages of AN. Alterations in the microstructural properties of the above mentioned tracts, also involved in cognitive control and visual perception and processing, may be early mechanisms of vulnerability/resilience of WM in AN and sustain the key symptoms of AN, such as impaired cognitive flexibility and body image distortion.
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Affiliation(s)
- Santino Gaudio
- Departmental Faculty of Medicine and Surgery, Università "Campus Bio-Medico di Roma", Rome, Italy; Eating Disorders Centre "La Cura del Girasole" ONLUS, Rome, Italy; Department of Neuroscience, Functional Pharmacology, Uppsala University, BMC, Box 593, 751 24 Uppsala, Sweden.
| | - Carlo Cosimo Quattrocchi
- Departmental Faculty of Medicine and Surgery, Università "Campus Bio-Medico di Roma", Rome, Italy
| | - Claudia Piervincenzi
- Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy
| | - Bruno Beomonte Zobel
- Departmental Faculty of Medicine and Surgery, Università "Campus Bio-Medico di Roma", Rome, Italy
| | | | - Antonios Dakanalis
- Department of Brain and Behavioural Sciences, University of Pavia, P.za Botta 11, 27100 Pavia, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy; Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Filippo Carducci
- Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy
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Fornix Under Water? Ventricular Enlargement Biases Forniceal Diffusion Magnetic Resonance Imaging Indices in Anorexia Nervosa. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 2:430-437. [PMID: 29560927 DOI: 10.1016/j.bpsc.2017.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acute anorexia nervosa (AN) is characterized by reduced brain mass and corresponding increased sulcal and ventricular cerebrospinal fluid. Recent studies of white matter using diffusion tensor imaging consistently identified alterations in the fornix, such as reduced fractional anisotropy (FA). However, because the fornix penetrates the ventricles, it is prone to cerebrospinal fluid-induced partial volume effects that interfere with a valid assessment of FA. We investigated the hypothesis that in the acute stage of AN, FA of the fornix is markedly affected by ventricular volumes. METHODS First, using diffusion tensor imaging data we established the inverse associations between forniceal FA and volumes of the third and lateral ventricles in a prestudy with 32 healthy subjects to demonstrate the strength of ventricular influence on forniceal FA independent of AN. Second, we investigated a sample of 25 acute AN patients and 25 healthy control subjects. RESULTS Using ventricular volumes as covariates markedly reduced the group effect of forniceal FA, even with tract-based spatial statistics focusing only on the center of the fornix. In addition, after correcting for free water on voxel level, the group differences in forniceal FA between AN patients and controls disappeared completely. CONCLUSIONS It is unlikely that microstructural changes affecting FA occurred in the fornix of AN patients. Previously identified alterations in acute AN may have been biased by partial volume effects and the proposed central role of this structure in the pathophysiology may need to be reconsidered. Future studies on white matter alterations in AN should carefully deal with partial volume effects.
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Olivo G, Wiemerslage L, Swenne I, Zhukowsky C, Salonen-Ros H, Larsson EM, Gaudio S, Brooks SJ, Schiöth HB. Limbic-thalamo-cortical projections and reward-related circuitry integrity affects eating behavior: A longitudinal DTI study in adolescents with restrictive eating disorders. PLoS One 2017; 12:e0172129. [PMID: 28248991 PMCID: PMC5332028 DOI: 10.1371/journal.pone.0172129] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/31/2017] [Indexed: 12/20/2022] Open
Abstract
Few studies have used diffusion tensor imaging (DTI) to investigate the micro-structural alterations of WM in patients with restrictive eating disorders (rED), and longitudinal data are lacking. Twelve patients with rED were scanned at diagnosis and after one year of family-based treatment, and compared to twenty-four healthy controls (HCs) through DTI analysis. A tract-based spatial statistics procedure was used to investigate diffusivity parameters: fractional anisotropy (FA) and mean, radial and axial diffusivities (MD, RD and AD, respectively). Reduced FA and increased RD were found in patients at baseline in the corpus callosum, corona radiata and posterior thalamic radiation compared with controls. However, no differences were found between follow-up patients and controls, suggesting a partial normalization of the diffusivity parameters. In patients, trends for a negative correlation were found between the baseline FA of the right anterior corona radiata and the Eating Disorder Examination Questionnaire total score, while a positive trend was found between the baseline FA in the splenium of corpus callosum and the weight loss occurred between maximal documented weight and time of admission. A positive trend for correlation was also found between baseline FA in the right anterior corona radiata and the decrease in the Obsessive-Compulsive Inventory Revised total score over time. Our results suggest that the integrity of the limbic–thalamo–cortical projections and the reward-related circuitry are important for cognitive control processes and reward responsiveness in regulating eating behavior.
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Affiliation(s)
- Gaia Olivo
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Lyle Wiemerslage
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Ingemar Swenne
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christina Zhukowsky
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Helena Salonen-Ros
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Santino Gaudio
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
- Centre for Integrated Research (CIR), Area of Diagnostic Imaging, Università “Campus Bio-Medico di Roma”, Rome, Italy
| | - Samantha J. Brooks
- Deptartment of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Helgi B. Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
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35
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Hu SH, Feng H, Xu TT, Zhang HR, Zhao ZY, Lai JB, Xu DR, Xu Y. Altered microstructure of brain white matter in females with anorexia nervosa: a diffusion tensor imaging study. Neuropsychiatr Dis Treat 2017; 13:2829-2836. [PMID: 29200856 PMCID: PMC5701551 DOI: 10.2147/ndt.s144972] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Structural studies have reported anorexia nervosa (AN) patients with abnormal gray matter in several brain regions and dysfunction in some connected neural circuits. However, the role of white matter (WM) in AN patients has rarely been investigated. The present study aimed to assess alterations in WM microstructure of the entire brain in females with AN using a voxel-based method on diffusion tensor imaging (DTI) data. MATERIALS AND METHODS The study enrolled 8 female patients with AN and 14 age-matched females as controls (CW). The DTI data was collected from each subject to calculate the fractional anisotropy (FA) maps of the whole brain by the DTI-Studio software. Subsequently, a 2-sample t-test (P<0.05, corrected) was performed to detect the difference in FA maps of AN and CW group, and a Pearson's correlation analyzed the relationship between mean FA value of brain regions and body mass index (BMI). RESULTS Compared with CW, AN patients revealed a significant decrease in FA maps in the left superior frontal gyrus, medial frontal gyrus, anterior cingulate cortex, middle frontal gyrus, inferior frontal gyrus, thalamus, and bilateral insula. Moreover, significantly positive correlations were established between the mean FA value of the left inferior frontal gyrus, insula as well as thalamus and BMI in AN patients. CONCLUSIONS Our findings supported the presence of WM abnormality in patients with AN. The significant differences of FA maps, in patients with AN, were associated with their aberrant BMI. The results further improved our understanding of the pathophysiological mechanisms underlying AN.
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Affiliation(s)
- Shao-Hua Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou
| | - Hong Feng
- Faculty of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou.,Department of Psychiatry, Shaoxing No Seven People's Hospital, Shaoxing
| | - Ting-Ting Xu
- Faculty of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou.,Department of Psychiatry, The Center of Mental Health, Xiaoshan Hospital, Hangzhou
| | - Hao-Rong Zhang
- Shanghai Key Laboratory of Magnetic Resonance, Key Laboratory of Brain Function Genomics, East China Normal University, Shanghai, China
| | - Zhi-Yong Zhao
- Shanghai Key Laboratory of Magnetic Resonance, Key Laboratory of Brain Function Genomics, East China Normal University, Shanghai, China
| | - Jian-Bo Lai
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou
| | - Dong-Rong Xu
- Epidemiology Division and MRI Unit, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Yi Xu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou
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Kim MJ, Brown AC, Mattek AM, Chavez SJ, Taylor JM, Palmer AL, Wu YC, Whalen PJ. The Inverse Relationship between the Microstructural Variability of Amygdala-Prefrontal Pathways and Trait Anxiety Is Moderated by Sex. Front Syst Neurosci 2016; 10:93. [PMID: 27899884 PMCID: PMC5110520 DOI: 10.3389/fnsys.2016.00093] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/03/2016] [Indexed: 01/01/2023] Open
Abstract
Anxiety impacts the quality of everyday life and may facilitate the development of affective disorders, possibly through concurrent alterations in neural circuitry. Findings from multimodal neuroimaging studies suggest that trait-anxious individuals may have a reduced capacity for efficient communication between the amygdala and the ventral prefrontal cortex (vPFC). A diffusion-weighted imaging protocol with 61 directions was used to identify lateral and medial amygdala-vPFC white matter pathways. The structural integrity of both pathways was inversely correlated with self-reported levels of trait anxiety. When this mask from our first dataset was then applied to an independent validation dataset, both pathways again showed a consistent inverse relationship with trait anxiety. Importantly, a moderating effect of sex was found, demonstrating that the observed brain-anxiety relationship was stronger in females. These data reveal a potential neuroanatomical mediator of previously documented functional alterations in amygdala-prefrontal connectivity that is associated with trait anxiety, which might prove informative for future studies of psychopathology.
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Affiliation(s)
- M Justin Kim
- Department of Psychological and Brain Sciences, Dartmouth College Hanover, NH, USA
| | - Annemarie C Brown
- Department of Psychological and Brain Sciences, Dartmouth College Hanover, NH, USA
| | - Alison M Mattek
- Department of Psychological and Brain Sciences, Dartmouth College Hanover, NH, USA
| | - Samantha J Chavez
- Department of Psychological and Brain Sciences, Dartmouth CollegeHanover, NH, USA; Division of Epidemiology, The Ohio State University College of Public HealthColumbus, OH, USA
| | - James M Taylor
- Department of Psychological and Brain Sciences, Dartmouth College Hanover, NH, USA
| | - Amy L Palmer
- Department of Psychological and Brain Sciences, Dartmouth College Hanover, NH, USA
| | - Yu-Chien Wu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine Indianapolis, IN, USA
| | - Paul J Whalen
- Department of Psychological and Brain Sciences, Dartmouth College Hanover, NH, USA
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Frank GKW, Shott ME, Riederer J, Pryor TL. Altered structural and effective connectivity in anorexia and bulimia nervosa in circuits that regulate energy and reward homeostasis. Transl Psychiatry 2016; 6:e932. [PMID: 27801897 PMCID: PMC5314116 DOI: 10.1038/tp.2016.199] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 08/18/2016] [Accepted: 08/24/2016] [Indexed: 12/19/2022] Open
Abstract
Anorexia and bulimia nervosa are severe eating disorders that share many behaviors. Structural and functional brain circuits could provide biological links that those disorders have in common. We recruited 77 young adult women, 26 healthy controls, 26 women with anorexia and 25 women with bulimia nervosa. Probabilistic tractography was used to map white matter connectivity strength across taste and food intake regulating brain circuits. An independent multisample greedy equivalence search algorithm tested effective connectivity between those regions during sucrose tasting. Anorexia and bulimia nervosa had greater structural connectivity in pathways between insula, orbitofrontal cortex and ventral striatum, but lower connectivity from orbitofrontal cortex and amygdala to the hypothalamus (P<0.05, corrected for comorbidity, medication and multiple comparisons). Functionally, in controls the hypothalamus drove ventral striatal activity, but in anorexia and bulimia nervosa effective connectivity was directed from anterior cingulate via ventral striatum to the hypothalamus. Across all groups, sweetness perception was predicted by connectivity strength in pathways connecting to the middle orbitofrontal cortex. This study provides evidence that white matter structural as well as effective connectivity within the energy-homeostasis and food reward-regulating circuitry is fundamentally different in anorexia and bulimia nervosa compared with that in controls. In eating disorders, anterior cingulate cognitive-emotional top down control could affect food reward and eating drive, override hypothalamic inputs to the ventral striatum and enable prolonged food restriction.
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Affiliation(s)
- G K W Frank
- Department of Psychiatry, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,Neuroscience Program, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA,Departments of Psychiatry and Neuroscience, Developmental Brain Research Program, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Gary Pavilion A036/B-130, 13123 East 16th Avenue, Aurora, CO 80045, USA. E-mail:
| | - M E Shott
- Department of Psychiatry, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J Riederer
- Department of Psychiatry, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T L Pryor
- Eating Disorders Center Denver, Denver, CO, USA
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38
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Khalsa SS, Kumar R, Patel V, Strober M, Feusner JD. Mammillary body volume abnormalities in anorexia nervosa. Int J Eat Disord 2016; 49:920-929. [PMID: 27414055 PMCID: PMC5064812 DOI: 10.1002/eat.22573] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Several case reports of Wernicke's Encephalopathy in anorexia nervosa (AN) caused by thiamine deficiency have described mammillary body (MB) injury, but systematic studies are lacking. Here we evaluated whether underweight and weight-restored individuals with AN demonstrate evidence of abnormal MB morphology, via retrospective examination of a previously collected data set. METHOD Using standard-resolution T1-weighted magnetic resonance imaging at 3 Tesla, we measured MB volume and fornix area in a cross-sectional study of 12 underweight AN, 20 weight-restored AN, and 30 age- and sex-matched healthy comparisons. Because of the small size of these structures, a manual tracing approach was necessary to obtain accurate measurements. A blinded expert rater manually traced MB and fornix structures in each participant. RESULTS We observed significantly smaller MB volumes in the underweight AN group. However, the weight-restored AN group exhibited significantly larger MB volumes. The right fornix was smaller in the weight-restored AN group only. DISCUSSION These findings suggest the possibility that MB volume and fornix area could represent potential biomarkers of acute weight loss and restoration, respectively. Verification of this finding through prospective studies evaluating MB morphology, cognition, and thiamine levels longitudinally across individual illness trajectories might be warranted. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:920-929).
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Affiliation(s)
- Sahib S. Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, 74136,Faculty of Community Medicine, University of Tulsa, Tulsa, OK, 74104,Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA,Corresponding author:
| | - Rajesh Kumar
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA 90095, USA,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA,Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Vandan Patel
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Jamie D. Feusner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
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He X, Stefan M, Terranova K, Steinglass J, Marsh R. Altered White Matter Microstructure in Adolescents and Adults with Bulimia Nervosa. Neuropsychopharmacology 2016; 41:1841-8. [PMID: 26647975 PMCID: PMC4869053 DOI: 10.1038/npp.2015.354] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 11/12/2015] [Accepted: 12/04/2015] [Indexed: 12/29/2022]
Abstract
Previous data suggest structural and functional deficits in frontal control circuits in adolescents and adults with bulimia nervosa (BN), but less is known about the microstructure of white matter in these circuits early in the course of the disorder. Diffusion tensor imaging (DTI) data were acquired from 28 female adolescents and adults with BN and 28 age- and BMI-matched healthy female participants. Tract-based spatial statistics (TBSS) was used to detect group differences in white matter microstructure and explore the differential effects of age on white matter microstructure across groups. Significant reductions in fractional anisotropy (FA) were detected in the BN compared with healthy control group in multiple tracts including forceps minor and major, superior longitudinal, inferior fronto-occipital, and uncinate fasciculi, anterior thalamic radiation, cingulum, and corticospinal tract. FA reductions in forceps and frontotemporal tracts correlated inversely with symptom severity and Stroop interference in the BN group. These findings suggest that white matter microstructure is abnormal in BN in tracts extending through frontal and temporoparietal cortices, especially in those with the most severe symptoms. Age-related differences in both FA and RD in these tracts in BN compared with healthy individuals may represent an abnormal trajectory of white matter development that contributes to the persistence of functional impairments in self-regulation in BN.
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Affiliation(s)
- Xiaofu He
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Mihaela Stefan
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Kate Terranova
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Joanna Steinglass
- Eating Disorders Research Unit, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Rachel Marsh
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians & Surgeons, Columbia University, New York, NY, USA,Eating Disorders Research Unit, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians & Surgeons, Columbia University, New York, NY, USA,Division of Child and Adolescent Psychiatry in the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 74, New York, NY 10032, USA, Tel: +1 646 774 5774, Fax: +1 212 543 0522, E-mail:
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Vogel K, Timmers I, Kumar V, Nickl-Jockschat T, Bastiani M, Roebroek A, Herpertz-Dahlmann B, Konrad K, Goebel R, Seitz J. White matter microstructural changes in adolescent anorexia nervosa including an exploratory longitudinal study. Neuroimage Clin 2016; 11:614-621. [PMID: 27182488 PMCID: PMC4857215 DOI: 10.1016/j.nicl.2016.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/12/2016] [Accepted: 04/05/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) often begins in adolescence, however, the understanding of the underlying pathophysiology at this developmentally important age is scarce, impeding early interventions. We used diffusion tensor imaging (DTI) to investigate microstructural white matter (WM) brain changes including an experimental longitudinal follow-up. METHODS We acquired whole brain diffusion-weighted brain scans of 22 adolescent female hospitalized patients with AN at admission and nine patients longitudinally at discharge after weight rehabilitation. Patients (10-18 years) were compared to 21 typically developing controls (TD). Tract-based spatial statistics (TBSS) were applied to compare fractional anisotropy (FA) across groups and time points. Associations between average FA values of the global WM skeleton and weight as well as illness duration parameters were analyzed by multiple linear regression. RESULTS We observed increased FA in bilateral frontal, parietal and temporal areas in AN patients at admission compared to TD. Higher FA of the global WM skeleton at admission was associated with faster weight loss prior to admission. Exploratory longitudinal analysis showed this FA increase to be partially normalized after weight rehabilitation. CONCLUSIONS Our findings reveal a markedly different pattern of WM microstructural changes in adolescent AN compared to most previous results in adult AN. This could signify a different susceptibility and reaction to semi-starvation in the still developing brain of adolescents or a time-dependent pathomechanism differing with extend of chronicity. Higher FA at admission in adolescents with AN could point to WM fibers being packed together more closely.
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Affiliation(s)
- Katja Vogel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany
| | - Inge Timmers
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Vinod Kumar
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany; JARA-Translational Brain Medicine (The Jülich Aachen Research Alliance), Forschungszentrum Jülich GmbH, 52425 Jülich, Germany
| | - Thomas Nickl-Jockschat
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany; JARA-Translational Brain Medicine (The Jülich Aachen Research Alliance), Forschungszentrum Jülich GmbH, 52425 Jülich, Germany
| | - Matteo Bastiani
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands; Oxford Centre for Functional MRI of the Brain, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Alard Roebroek
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany
| | - Kerstin Konrad
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany; Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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41
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Fani N, King TZ, Shin J, Srivastava A, Brewster RC, Jovanovic T, Bradley B, Ressler KJ. STRUCTURAL AND FUNCTIONAL CONNECTIVITY IN POSTTRAUMATIC STRESS DISORDER: ASSOCIATIONS WITH FKBP5. Depress Anxiety 2016; 33:300-7. [PMID: 27038411 PMCID: PMC4983452 DOI: 10.1002/da.22483] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 01/27/2016] [Accepted: 01/29/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The integrity of connections between the hippocampus and the anterior cingulate cortex (ACC) is critical for adaptive cognitive and emotional processing; these connections may be compromised in posttraumatic stress disorder (PTSD). However, there is a lack of PTSD research that combines structural and functional connectivity data, and no studies have examined whether abnormal ACC-hippocampal connectivity is associated with genetic variability, particularly for polymorphisms of a gene that has been previously associated with PTSD, FKBP5. This was the goal of the present study. METHODS Fifty-four women with and without PTSD underwent diffusion tensor imaging and resting-state MRI. Probabilistic tractography was used to examine ACC-hippocampal structural connectivity; mean fractional anisotropy (FA) values were extracted from connectivity streamlines, which represent the cingulum bundle. Genotype data were collected for a single nucleotide polymorphism (SNP) of FKBP5, rs1360780. RESULTS Participants with PTSD demonstrated poorer structural connectivity (lower cingulum FA) compared to traumatized controls (F1, 50 = 6.77, P < .05). An interaction of FKBP5 genotype and diagnostic group was also observed (F1, 37 = 4.52, P = .04), indicating lower cingulum FA in carriers of two risk alleles for this SNP, compared to other diagnostic and genotype groups. Carriers of two FKBP5 risk alleles also demonstrated poorer hippocampus-ACC connectivity at rest (P < .05). When cingulum FA was used a regressor in a brain-wide, seed-based regression analysis, significant associations were found between the hippocampus and dorsal regions of the ACC (P < .05). CONCLUSIONS Individuals with PTSD demonstrated compromised structural connectivity of the hippocampus-ACC pathway. Altered hippocampus-ACC connectivity may represent a highly salient intermediate neural phenotype for PTSD.
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Affiliation(s)
- Negar Fani
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences
| | | | | | | | | | - Tanja Jovanovic
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences
| | - Bekh Bradley
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences,Atlanta VA Medical Center
| | - Kerry J Ressler
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences
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Martin Monzon B, Hay P, Foroughi N, Touyz S. White matter alterations in anorexia nervosa: A systematic review of diffusion tensor imaging studies. World J Psychiatry 2016; 6:177-86. [PMID: 27014606 PMCID: PMC4804264 DOI: 10.5498/wjp.v6.i1.177] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/19/2015] [Accepted: 12/29/2015] [Indexed: 02/05/2023] Open
Abstract
AIM To identify findings concerning white matter (WM) fibre microstructural alterations in anorexia nervosa (AN). METHODS A systematic electronic search was undertaken in several databases up to April 2015. The search strategy aimed to locate all studies published in English or Spanish that included participants with AN and which investigated WM using diffusion tensor imaging (DTI). Trials were assessed for quality assessment according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist and a published quality index guideline. RESULTS A total of 6 studies met the inclusion criteria, four of people in the acute state of the illness, one included both recovered and unwell participants, and one included people who had recovered. Participants were female with ages ranging from 14 to 29 years. All studies but one measured a range of psychopathological features. Fractional anisotropy and mean diffusivity were the main DTI correlates reported. Alterations were reported in a range of WM structures of the limbic system, most often of the fornix and cingulum as well as the fronto-occipital fibre tracts, i.e., regions associated with anxiety, body image and cognitive function. Subtle abnormalities also appeared to persist after recovery. CONCLUSION This diversity likely reflects the symptom complexity of AN. However, there were few studies, they applied different methodologies, and all were cross-sectional.
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Greater Insula White Matter Fiber Connectivity in Women Recovered from Anorexia Nervosa. Neuropsychopharmacology 2016; 41:498-507. [PMID: 26076832 PMCID: PMC5130125 DOI: 10.1038/npp.2015.172] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 02/07/2023]
Abstract
Anorexia nervosa is a severe psychiatric disorder associated with reduced drive to eat. Altered taste-reward circuit white matter fiber organization in anorexia nervosa after recovery could indicate a biological marker that alters the normal motivation to eat. Women recovered from restricting-type anorexia (Recovered AN, n = 24, age = 30.3 ± 8.1 years) and healthy controls (n = 24, age = 27.4 ± 6.3 years) underwent diffusion weighted imaging of the brain. Probabilistic tractography analyses calculated brain white matter connectivity (streamlines) as an estimate of fiber connections in taste-reward-related white matter tracts, and microstructural integrity (fractional anisotropy, FA) was assessed using tract-based spatial statistics. Recovered AN showed significantly (range P<0.05-0.001, Bonferroni corrected) greater white matter connectivity between bilateral insula regions and ventral striatum, left insula and middle orbitofrontal cortex (OFC), and right insula projecting to gyrus rectus and medial OFC. Duration of illness predicted connectivity of tracts projecting from the insula to ventral striatum and OFC. Microstructural integrity was lower in Recovered AN in most insula white matter tracts, as was whole-brain FA in parts of the anterior corona radiata, external capsule, and cerebellum (P<0.05, family-wise error-corrected). This study indicates higher structural white matter connectivity, an estimate of fibers connections, in anorexia after recovery in tracts that connect taste-reward processing regions. Greater connectivity together with less-fiber integrity could indicate altered neural activity between those regions, which could interfere with normal food-reward circuit function. Correlations between connectivity and illness duration suggest that connectivity could be a marker for illness severity. Whether greater connectivity can predict prognosis of the disorder requires further study.
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Treasure J, Zipfel S, Micali N, Wade T, Stice E, Claudino A, Schmidt U, Frank GK, Bulik CM, Wentz E. Anorexia nervosa. Nat Rev Dis Primers 2015; 1:15074. [PMID: 27189821 DOI: 10.1038/nrdp.2015.74] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in adolescence in the peripubertal period. Without early effective treatment, the course is protracted with physical, psychological and social morbidity and high mortality. Despite these effects, patients are noted to value the beliefs and behaviours that contribute to their illness rather than regarding them as problematic, which interferes with screening, prevention and early intervention. Involving the family to support interventions early in the course of the illness can produce sustained changes; however, those with a severe and/or protracted illness might require inpatient nursing support and/or outpatient psychotherapy. Prevention programmes aim to moderate the overvaluation of 'thinness' and body dissatisfaction as one of the proximal risk factors. The low prevalence of AN limits the ability to identify risk factors and to study the timing and sex distribution of the condition. However, genetic profiles, premorbid features, and brain structures and functions of patients with AN show similarities with other psychiatric disorders and contrast with obesity and metabolic disorders. Such studies are informing approaches to address the neuroadaptation to starvation and the other various physical and psychosocial deficits associated with AN. This Primer describes the epidemiology, diagnosis, screening and prevention, aetiology, treatment and quality of life of patients with AN.
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Affiliation(s)
- Janet Treasure
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London SE5 8AF, UK
| | - Stephan Zipfel
- Department of Psychosomatic Medicine, University of Tuebingen, Tuebingen, Germany
| | - Nadia Micali
- University College London, Institute of Child Health, Behavioural and Brain Sciences Unit, London, UK.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tracey Wade
- School of Psychology, Flinders University, Adelaide, Australia
| | - Eric Stice
- Oregon Research Institute, Eugene, Oregon, USA
| | - Angélica Claudino
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Ulrike Schmidt
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London SE5 8AF, UK
| | - Guido K Frank
- Eating Disorder Centre of Denver, University of Colorado, Denver, Colorado, USA
| | - Cynthia M Bulik
- University of North Carolina at Chapel Hill, North Carolina, USA.,Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Wentz
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg Sweden
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Abnormal white matter properties in adolescent girls with anorexia nervosa. NEUROIMAGE-CLINICAL 2015; 9:648-59. [PMID: 26740918 PMCID: PMC4644248 DOI: 10.1016/j.nicl.2015.10.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/13/2015] [Accepted: 10/15/2015] [Indexed: 11/20/2022]
Abstract
Anorexia nervosa (AN) is a serious eating disorder that typically emerges during adolescence and occurs most frequently in females. To date, very few studies have investigated the possible impact of AN on white matter tissue properties during adolescence, when white matter is still developing. The present study evaluated white matter tissue properties in adolescent girls with AN using diffusion MRI with tractography and T1 relaxometry to measure R1 (1/T1), an index of myelin content. Fifteen adolescent girls with AN (mean age = 16.6 years ± 1.4) were compared to fifteen age-matched girls with normal weight and eating behaviors (mean age = 17.1 years ± 1.3). We identified and segmented 9 bilateral cerebral tracts (18) and 8 callosal fiber tracts in each participant's brain (26 total). Tract profiles were generated by computing measures for fractional anisotropy (FA) and R1 along the trajectory of each tract. Compared to controls, FA in the AN group was significantly decreased in 4 of 26 white matter tracts and significantly increased in 2 of 26 white matter tracts. R1 was significantly decreased in the AN group compared to controls in 11 of 26 white matter tracts. Reduced FA in combination with reduced R1 suggests that the observed white matter differences in AN are likely due to reductions in myelin content. For the majority of tracts, group differences in FA and R1 did not occur within the same tract. The present findings have important implications for understanding the neurobiological factors underlying white matter changes associated with AN and invite further investigations examining associations between white matter properties and specific physiological, cognitive, social, or emotional functions affected in AN. AN girls had both increased and decreased FA in 4 white matter tracts. AN girls had increased R1 in 11 white matter tracts. White matter differences in AN are likely related to changes in myelin content.
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Lavagnino L, Amianto F, Mwangi B, D'Agata F, Spalatro A, Zunta-Soares GB, Abbate Daga G, Mortara P, Fassino S, Soares JC. Identifying neuroanatomical signatures of anorexia nervosa: a multivariate machine learning approach. Psychol Med 2015; 45:2805-2812. [PMID: 25990697 DOI: 10.1017/s0033291715000768] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are currently no neuroanatomical biomarkers of anorexia nervosa (AN) available to make clinical inferences at an individual subject level. We present results of a multivariate machine learning (ML) approach utilizing structural neuroanatomical scan data to differentiate AN patients from matched healthy controls at an individual subject level. METHOD Structural neuroimaging scans were acquired from 15 female patients with AN (age = 20, s.d. = 4 years) and 15 demographically matched female controls (age = 22, s.d. = 3 years). Neuroanatomical volumes were extracted using the FreeSurfer software and input into the Least Absolute Shrinkage and Selection Operator (LASSO) multivariate ML algorithm. LASSO was 'trained' to identify 'novel' individual subjects as either AN patients or healthy controls. Furthermore, the model estimated the probability that an individual subject belonged to the AN group based on an individual scan. RESULTS The model correctly predicted 25 out of 30 subjects, translating into 83.3% accuracy (sensitivity 86.7%, specificity 80.0%) (p < 0.001; χ 2 test). Six neuroanatomical regions (cerebellum white matter, choroid plexus, putamen, accumbens, the diencephalon and the third ventricle) were found to be relevant in distinguishing individual AN patients from healthy controls. The predicted probabilities showed a linear relationship with drive for thinness clinical scores (r = 0.52, p < 0.005) and with body mass index (BMI) (r = -0.45, p = 0.01). CONCLUSIONS The model achieved a good predictive accuracy and drive for thinness showed a strong neuroanatomical signature. These results indicate that neuroimaging scans coupled with ML techniques have the potential to provide information at an individual subject level that might be relevant to clinical outcomes.
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Affiliation(s)
- L Lavagnino
- UT Center of Excellence on Mood Disorders,Department of Psychiatry and Behavioral Sciences,UT Houston Medical School,Houston,TX,USA
| | - F Amianto
- Department of Neuroscience,AOU San Giovanni Battista,Turin,Italy
| | - B Mwangi
- UT Center of Excellence on Mood Disorders,Department of Psychiatry and Behavioral Sciences,UT Houston Medical School,Houston,TX,USA
| | - F D'Agata
- Department of Neuroscience,AOU San Giovanni Battista,Turin,Italy
| | - A Spalatro
- Department of Neuroscience,AOU San Giovanni Battista,Turin,Italy
| | - G B Zunta-Soares
- UT Center of Excellence on Mood Disorders,Department of Psychiatry and Behavioral Sciences,UT Houston Medical School,Houston,TX,USA
| | - G Abbate Daga
- Department of Neuroscience,AOU San Giovanni Battista,Turin,Italy
| | - P Mortara
- Department of Neuroscience,AOU San Giovanni Battista,Turin,Italy
| | - S Fassino
- Department of Neuroscience,AOU San Giovanni Battista,Turin,Italy
| | - J C Soares
- UT Center of Excellence on Mood Disorders,Department of Psychiatry and Behavioral Sciences,UT Houston Medical School,Houston,TX,USA
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Seitz J, Walter M, Mainz V, Herpertz-Dahlmann B, Konrad K, von Polier G. Brain volume reduction predicts weight development in adolescent patients with anorexia nervosa. J Psychiatr Res 2015; 68:228-37. [PMID: 26228424 DOI: 10.1016/j.jpsychires.2015.06.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Acute anorexia nervosa (AN) is associated with marked brain volume loss potentially leading to neuropsychological deficits. However, the mechanisms leading to this brain volume loss and its influencing factors are poorly understood and the clinical relevance of these brain alterations for the outcome of these AN-patients is yet unknown. METHODS Brain volumes of 56 female adolescent AN inpatients and 50 healthy controls (HCs) were measured using MRI scans. Multiple linear regression analyses were used to determine the impact of body weight at admission, prior weight loss, age of onset and illness duration on volume loss at admission and to analyse the association of brain volume reduction with body weight at a 1-year follow-up (N = 25). RESULTS Cortical and subcortical grey matter (GM) and cortical white matter (WM) but not cerebellar GM or WM were associated with low weight at admission. Amount of weight loss, age of onset and illness duration did not independently correlate with any volume changes. Prediction of age-adjusted standardized body mass index (BMI-SDS) at 1-year follow-up could be significantly improved from 34% of variance explained by age and BMI-SDS at admission to 47.5-53% after adding cortical WM, cerebellar GM or WM at time of admission. CONCLUSION Whereas cortical GM changes appear to be an unspecific reflection of current body weight ("state marker"), cortical WM and cerebellar volume losses seem to indicate a longer-term risk (trait or "scar" of the illness), which appear to be important for the prediction of weight rehabilitation and long-term outcome.
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Affiliation(s)
- Jochen Seitz
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Universitätsklinikum RWTH Aachen, Neuenhofer Weg 21, 52074 Aachen, Germany; Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Oxfoordlaan 55, Postbox 616, 6200 MD, Maastricht, The Netherlands.
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory (CANLAB), Otto-von-Guericke-University, ZENIT, Leipziger Str. 44, 39120 Magdeburg, Germany.
| | - Verena Mainz
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University Aachen, Germany.
| | - Beate Herpertz-Dahlmann
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Universitätsklinikum RWTH Aachen, Neuenhofer Weg 21, 52074 Aachen, Germany.
| | - Kerstin Konrad
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Universitätsklinikum RWTH Aachen, Neuenhofer Weg 21, 52074 Aachen, Germany.
| | - Georg von Polier
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Universitätsklinikum RWTH Aachen, Neuenhofer Weg 21, 52074 Aachen, Germany.
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Abstract
Over the past decade, brain imaging has helped to better define eating disorder-related brain circuitry. Brain research on gray matter (GM) and white matter (WM) volumes had been inconsistent, possibly due to the effects of acute starvation, exercise, medication, and comorbidity, but newer studies have controlled for such effects. Those studies suggest larger left medial orbitofrontal gyrus rectus volume in ill adult and adolescent anorexia nervosa after recovery from anorexia nervosa, and in adult bulimia nervosa. The orbitofrontal cortex is important in terminating food intake, and altered function could contribute to self-starvation. The right insula, which processes taste but also interoception, was enlarged in ill adult and adolescent anorexia nervosa, as well as adults recovered from the illness. The fixed perception of being fat in anorexia nervosa could be related to altered insula function. A few studies investigated WM integrity, with the most consistent finding of reduced fornix integrity in anorexia and bulimia nervosa-a limbic pathway that is important in emotion but also food intake regulation. Functional brain imaging using basic sweet taste stimuli in eating disorders during the ill state or after recovery implicated repeatedly reward pathways, including insula and striatum. Brain imaging that targeted dopamine-related brain activity using taste-reward conditioning tasks suggested that this circuitry is hypersensitive in anorexia nervosa, but hyporesponsive in bulimia nervosa and obesity. Those results are in line with basic research and suggest adaptive reward system changes in the human brain in response to extremes of food intake-changes that could interfere with normalization of eating behavior.
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Affiliation(s)
- Guido K W Frank
- Departments of Psychiatry and Neuroscience,University of Colorado Anschutz Medical Campus,Children's Hospital Colorado,Aurora,Colorado,USA
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Downey LE, Mahoney CJ, Buckley AH, Golden HL, Henley SM, Schmitz N, Schott JM, Simpson IJ, Ourselin S, Fox NC, Crutch SJ, Warren JD. White matter tract signatures of impaired social cognition in frontotemporal lobar degeneration. NEUROIMAGE-CLINICAL 2015; 8:640-51. [PMID: 26236629 PMCID: PMC4513187 DOI: 10.1016/j.nicl.2015.06.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/03/2015] [Accepted: 06/14/2015] [Indexed: 11/29/2022]
Abstract
Impairments of social cognition are often leading features in frontotemporal lobar degeneration (FTLD) and likely to reflect large-scale brain network disintegration. However, the neuroanatomical basis of impaired social cognition in FTLD and the role of white matter connections have not been defined. Here we assessed social cognition in a cohort of patients representing two core syndromes of FTLD, behavioural variant frontotemporal dementia (bvFTD; n = 29) and semantic variant primary progressive aphasia (svPPA; n = 15), relative to healthy older individuals (n = 37) using two components of the Awareness of Social Inference Test, canonical emotion identification and sarcasm identification. Diffusion tensor imaging (DTI) was used to derive white matter tract correlates of social cognition performance and compared with the distribution of grey matter atrophy on voxel-based morphometry. The bvFTD and svPPA groups showed comparably severe deficits for identification of canonical emotions and sarcasm, and these deficits were correlated with distributed and overlapping white matter tract alterations particularly affecting frontotemporal connections in the right cerebral hemisphere. The most robust DTI associations were identified in white matter tracts linking cognitive and evaluative processing with emotional responses: anterior thalamic radiation, fornix (emotion identification) and uncinate fasciculus (sarcasm identification). DTI associations of impaired social cognition were more consistent than corresponding grey matter associations. These findings delineate a brain network substrate for the social impairment that characterises FTLD syndromes. The findings further suggest that DTI can generate sensitive and functionally relevant indexes of white matter damage in FTLD, with potential to transcend conventional syndrome boundaries. Social cognition deficits define frontotemporal dementias but are poorly understood. We studied brain network correlates of sarcasm processing in these dementias with DTI. Sarcasm deficits were particularly linked to right frontotemporal tract changes. DTI generates functionally relevant metrics of white matter damage in these dementias.
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Affiliation(s)
- Laura E Downey
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Colin J Mahoney
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Aisling H Buckley
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Hannah L Golden
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Susie M Henley
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Nicole Schmitz
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jonathan M Schott
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Ivor J Simpson
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK ; Centre for Medical Image Computing, University College London, London, UK
| | - Sebastien Ourselin
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK ; Centre for Medical Image Computing, University College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
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50
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Hayes DJ, Lipsman N, Chen DQ, Woodside DB, Davis KD, Lozano AM, Hodaie M. Subcallosal Cingulate Connectivity in Anorexia Nervosa Patients Differs From Healthy Controls: A Multi-tensor Tractography Study. Brain Stimul 2015; 8:758-68. [PMID: 26073966 DOI: 10.1016/j.brs.2015.03.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Anorexia nervosa is characterized by extreme low body weight and alterations in affective processing. The subcallosal cingulate regulates affect through wide-spread white matter connections and is implicated in the pathophysiology of anorexia nervosa. OBJECTIVES We examined whether those with treatment refractory anorexia nervosa undergoing deep brain stimulation (DBS) of the subcallosal white matter (SCC) show: (1) altered anatomical SCC connectivity compared to healthy controls, (2) white matter microstructural changes, and (3) microstructural changes associated with clinically-measured affect. METHODS Diffusion magnetic resonance imaging (dMRI) and deterministic multi-tensor tractography were used to compare anatomical connectivity and microstructure in SCC-associated white matter tracts. Eight women with treatment-refractory anorexia nervosa were compared to 8 age- and sex-matched healthy controls. Anorexia nervosa patients also completed affect-related clinical assessments presurgically and 12 months post-surgery. RESULTS (1) Higher (e.g., left parieto-occipital cortices) and lower (e.g., thalamus) connectivity in those with anorexia nervosa compared to controls. (2) Decreases in fractional anisotropy, and alterations in axial and radial diffusivities, in the left fornix crus, anterior limb of the internal capsule (ALIC), right anterior cingulum and left inferior fronto-occipital fasciculus. (3) Correlations between dMRI metrics and clinical assessments, such as low pre-surgical left fornix and right ALIC fractional anisotropy being related to post-DBS improvements in quality-of-life and depressive symptoms, respectively. CONCLUSIONS We identified widely-distributed differences in SCC connectivity in anorexia nervosa patients consistent with heterogenous clinical disruptions, although these results should be considered with caution given the low number of subjects. Future studies should further explore the use of affect-related connectivity and behavioral assessments to assist with DBS target selection and treatment outcome.
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Affiliation(s)
- Dave J Hayes
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Western Research Institute, Division of Brain, Imaging and Behaviour - Systems Neuroscience, University Health Network, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Nir Lipsman
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Western Research Institute, Division of Brain, Imaging and Behaviour - Systems Neuroscience, University Health Network, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - David Q Chen
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Western Research Institute, Division of Brain, Imaging and Behaviour - Systems Neuroscience, University Health Network, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - D Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Karen D Davis
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Western Research Institute, Division of Brain, Imaging and Behaviour - Systems Neuroscience, University Health Network, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Andres M Lozano
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Western Research Institute, Division of Brain, Imaging and Behaviour - Systems Neuroscience, University Health Network, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Mojgan Hodaie
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Western Research Institute, Division of Brain, Imaging and Behaviour - Systems Neuroscience, University Health Network, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
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