Effects of integrated hospital treatment on the default mode, salience, and frontal-parietal networks in anorexia nervosa: A longitudinal resting-state functional magnetic resonance imaging study

Abstract

The psychopathology of patients with anorexia nervosa has been hypothesized to involve inappropriate self-referential processing, disturbed interoceptive awareness, and excessive cognitive control, including distorted self-concern, disregard of their own starvation state, and extreme weight-control behavior. We hypothesized that the resting-state brain networks, including the default mode, salience and frontal-parietal networks, might be altered in such patients, and that treatment might normalize neural functional connectivity, with improvement of inappropriate self-cognition. We measured resting-state functional magnetic resonance images from 18 patients with anorexia nervosa and 18 healthy subjects before and after integrated hospital treatment (nourishment and psychological therapy). The default mode, salience, and frontal-parietal networks were examined using independent component analysis. Body mass index and psychometric measurements significantly improved after treatment. Before treatment, default mode network functional connectivity in the retrosplenial cortex and salience network functional connectivity in the ventral anterior insula and rostral anterior cingulate cortex were decreased in anorexia nervosa patients compared with those in controls. Interpersonal distrust was negatively correlated with salience network functional connectivity in the rostral anterior cingulate cortex. Default mode network functional connectivity in the posterior insula and frontal-parietal network functional connectivity in the angular gyrus were increased in anorexia nervosa patients compared with those in controls. Comparison between pre- and post-treatment images from patients with anorexia nervosa exhibited significant increases in default mode network functional connectivity in the hippocampus and retrosplenial cortex, and salience network functional connectivity in the dorsal anterior insula following treatment. Frontal-parietal network functional connectivity in the angular cortex showed no significant changes. The findings revealed that treatment altered the functional connectivity in several parts of default mode and salience networks in patients with anorexia nervosa. These alterations of neural function might be associated with improvement of self-referential processing and coping with sensations of discomfort following treatment for anorexia nervosa.

Predicting Anorexia Nervosa and Autistic Characteristics in Individuals with Anorexia Nervosa from Resting State Cyclic Connectivity

“…The neurobiology of AN is poorly understood (Frank, Shott & DeGuzman, 2019), however the use neuroimaging, particularly resting state functional magnetic resonance imaging (rsfMRI) offers promise in demonstrating neurophenotypes that characterise AN. Previous work, utilising rsfMRI, has characterised atypical connectivity in individuals with AN involving temporal regions (Olivo et al, 2018), as well as the ventral attention, default mode and the salience networks (Spalatro et al, 2019; Gondo et al, 2023). Atypical connectivity, as demonstrated by rsfMRI, is also not just isolated to the underweight stage of illness course (Boehm et al, 2016; Gondo et al, 2023).…”

“…Previous work, utilising rsfMRI, has characterised atypical connectivity in individuals with AN involving temporal regions (Olivo et al, 2018), as well as the ventral attention, default mode and the salience networks (Spalatro et al, 2019; Gondo et al, 2023). Atypical connectivity, as demonstrated by rsfMRI, is also not just isolated to the underweight stage of illness course (Boehm et al, 2016; Gondo et al, 2023). Cross-sectional studies with weight restored individuals with AN has suggested altered connectivity involving the frontoparietal network (Boehm et al, 2016).…”

“…Cross-sectional studies with weight restored individuals with AN has suggested altered connectivity involving the frontoparietal network (Boehm et al, 2016). Studies examining pre and post treatment in individuals with AN has also shown atypical connectivity involving the default mode and salience networks (Gondo et al, 2023).…”