Neuroimaging Findings in Adolescents and Young Adults with Anorexia Nervosa: A Systematic Review

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 October 05, 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.

Differential alterations of amygdala nuclei volumes in acutely ill patients with anorexia nervosa and their associations with leptin levels

“…Log 10 -leptin remained a significant predictor of the plotted amygdala nuclei volumes after multiple testing FDR-adjustment, additional adjustment for BMI-SDS in follow-up RLMs, and after excluding all AN with leptin concentrations <LOD in a confirmatory analysis (online SM 2.4, Table S6). Kappou et al, 2021;King et al, 2015;Zhang et al, 2018), a bilateral cluster located in the rostral-medial amygdala was particularly affected in AN as indicated by large effect sizes of group differences. This anatomical cluster comprised bilateral accessory basal and cortical nuclei, corticoamygdaloid transition, and left medial nucleus.…”

The Synergistic Effects of a Complementary Physiotherapeutic Scheme in the Psychological and Nutritional Treatment in a Teenage Girl with Type 1 Diabetes Mellitus, Anxiety Disorder and Anorexia Nervosa

“…AN is the most studied and well-known eating disorder (ED) that usually develops during adolescence. AN is a psychiatric disorder characterized by deteriorated body image, persistent eating restriction and low body weight as well as the structural and functional brain alterations that are associated with this psychopathology [ 13 , 35 ]. In 2013, the American Psychiatric Association revised the diagnostic criteria for AN, making the criteria about the body weight less restrictive, while removing the criterion for amenorrhea in order to make the criteria gender-neutral [ 13 , 36 ].…”

A meta‐analytic investigation of grey matter differences in anorexia nervosa and autism spectrum disorder

“…Increased volume of the orbitofrontal cortex (OFC) has been associated with food avoidance in AN (Frank et al., 2013). Other studies report reduced attention to facial stimuli and decreased understanding of other's emotions in AN (Kappou et al., 2021; Tottenham & Galván, 2016).…”