BACKGROUND: Eating disorders affect upwards of 30 million people worldwide and often go undertreated and underdiagnosed. The purpose of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of the Sick, Control, One, Fat and Food (SCOFF) questionnaire for DSM-5 eating disorders in the general population. METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed. A PubMed search was conducted among peer-reviewed articles. Information regarding validation of the SCOFF was required for inclusion. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. RESULTS: The final analysis included 25 studies. The validity of the SCOFF was high across samples with a pooled sensitivity of 0.86 (95% CI, 0.78-0.91) and specificity of 0.83 (95% CI, 0.77-0.88). Subgroup analyses were conducted to examine the impact of methodology, study quality, and clinical characteristics on diagnostic accuracy. Studies with the highest sensitivity tended to be case-control studies of young women with anorexia nervosa (AN) and bulimia nervosa (BN). Studies which included more men, included those diagnosed with binge eating disorder, and recruited from large community samples tended to have lower sensitivity. Few studies reported on BMI and race/ethnicity; thus, subgroups for these factors could not be examined. No studies used reference standards which assessed all DSM-5 eating disorders. CONCLUSION: This meta-analysis of 25 validation studies demonstrates that the SCOFF is a simple and useful screening tool for young women at risk for AN and BN. However, there is not enough evidence to support utilizing the SCOFF for screening for the range of DSM-5 eating disorders in primary care and community-based settings. Further examination of the validity of the SCOFF or development of a new screening tool, or multiple tools, to screen for the range of DSM-5 eating disorders heterogenous populations is warranted. TRIAL REGISTRATION: This study is registered online with PROSPERO (CRD42018089906).

Individuals who report subjective cognitive complaints but perform normally on neuropsychological tests may be at increased risk for pathological cognitive aging. The current study examined the effects of the presence of subjective cognitive complaints on functional brain activity during a working memory task in a sample of middle-aged postmenopausal women. Twenty-three postmenopausal women aged 50–60 completed a cognitive complaint battery of questionnaires. Using 20% of items endorsed as the threshold, twelve women were categorized as cognitive complainers (CC) and 11 were non-complainers (NC). All subjects then took part in a functional MRI scanning session during which they completed a visual-verbal N-back test of working memory. Results showed no difference in working memory performance between CC and NC groups. However, the CC group showed greater activation relative to the NC group in a broad network involved in working memory including the middle frontal gyrus (BA 9 and 10), the precuneus (BA 7), and the cingulate gyrus (BA 24 and 32). The CC group recruited additional regions of the working memory network compared to the NC group as the working memory load and difficulty of the task increased. This study showed brain activation differences during working memory performance in a middle-aged group of postmenopausal women with subjective cognitive complaints but without objective cognitive deficit. These findings suggest that subjective cognitive complaints in postmenopausal women may be associated with increased cortical activity during effort-demanding cognitive tasks.

Prior research shows that menopause is associated with changes in cognition in some older women. However, how estrogen loss and subsequent estrogen treatment affects cognition and particularly the underlying brain processes responsible for any cognitive changes is less well understood. We examined the ability of estradiol to modulate the manipulation of information in working memory and related brain activation in postmenopausal women. Twenty healthy postmenopausal women (mean age (SD) = 59.13 (5.5)) were randomly assigned to three months of 1 mg oral 17-β estradiol or placebo. At baseline and three months later each woman completed a visual verbal N-back sequential letter test of working memory during functional magnetic resonance imaging (fMRI). The fMRI data showed that women who were treated with estradiol for three months had increased frontal activation during the more difficult working memory load conditions compared to women treated with placebo. Performance on the verbal working memory task showed no difference between estradiol and placebo treated subjects. These data are consistent with prior work showing increases in frontal activation on memory tasks after estrogen treatment. However, this is the first study to show that estrogen-induced increases in brain activity were tied to cognitive load during a verbal working memory task. These data suggest that estradiol treatment effects on cognition may be in part produced through modulation of frontal lobe functioning under difficult task conditions.

Estradiol has been shown to affect cholinergic modulation of cognition in human and nonhuman animal models. This study examined the brain-based interaction of estradiol treatment and anticholinergic challenge in postmenopausal women during the performance of a working memory task and functional MRI. Twenty-four postmenopausal women were randomly and blindly placed on 1 mg oral 17-β estradiol or matching placebo pills for three months after which they participated in three anticholinergic challenge sessions. During the challenge sessions, subjects were administered the antimuscarinic drug scopolamine, the antinicotinic drug mecamylamine, or placebo. After drug administration, subjects completed a fMRI session during which time they performed a visual verbal N-back test of working memory. Results showed that scopolamine increased activation in the left medial frontal gyrus (BA 10) and mecamylamine increased activation in the left inferior frontal gyrus (BA 46). Estradiol treatment compared to placebo treatment significantly reduced the activation in this left medial frontal region during scopolamine challenge. Estradiol treatment also increased activation in the precuneus (BA 31) during mecamylamine challenge. These data are the first to show that estradiol modulated antimuscarinic- and anitnicotinic-induced brain activity and suggest that estradiol affected cholinergic system regulation of cognition-related brain activation in humans.

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