Abstract
Neuroimaging studies on anorexia nervosa (AN) have consistently reported globally reduced gray matter in patients with acute AN. While first studies on adolescent AN patients provide evidence for the reversibility of these impairments after weight gain, longitudinal studies with detailed regional analysis for adult AN patients are lacking and factors associated with brain restitution are poorly understood. We investigated structural changes in anorexia nervosa using T1-weighted magnetic resonance images with surface-based morphometry. The sample consisted of 26 adult women with severe AN and 30 healthy controls. The longitudinal design comprised three time points, capturing the course of weight-restoration therapy in AN patients at distinct stages of weight gain (BMI ≤ 15.5 kg/m2; 15.5 < BMI < 17.5 kg/m2; BMI ≥ 17.5 kg/m2). Compared to controls, AN patients showed globally decreased cortical thickness and subcortical volumes at baseline. Linear mixed effect models revealed the reversibility of these alterations, with brain restoration being most pronounced during the first half of treatment. The restoration of cortical thickness of AN patients negatively correlated with age, but not duration of illness. After weight restoration, residual group differences of cortical thickness remained in the superior frontal cortex. These findings indicate that structural brain alterations of adult patients with severe AN recuperate independently of the duration of illness during weight-restoration therapy. The temporal pattern of brain restoration suggests a decrease in restoration rate over the course of treatment, with patients’ age as a strong predictor of brain restitution, possibly reflecting decreases of brain plasticity as patients grow older.
Highlights
Anorexia nervosa (AN) is a severe and enduring psychiatric disorder, characterized by significantly reduced body weight[1] and associated with reduced brain matter[2,3]
We aimed to identify and monitor disease-specific structural brain alterations in patients with severe AN using three time points: (TP1) at the beginning of inpatient treatment in a stage of severe underweight, (TP2) during inpatient treatment after initial weight gain, and (TP3) at discharge with a body mass index ≥ 17.5 (BMI; kg/m2)
We explored whether restoration of brain structure in AN patients was associated with a shorter duration of illness, with improvements in BMI, eating disorder-related cognitions, or with a younger age at the time of treatment
Summary
Anorexia nervosa (AN) is a severe and enduring psychiatric disorder, characterized by significantly reduced body weight[1] and associated with reduced brain matter[2,3]. For adult AN patients, only global tissue volumes have been investigated[23,24], but longitudinal studies with detailed regional analyses are lacking. In this longitudinal study, we aimed to identify and monitor disease-specific structural brain alterations in patients with severe AN using three time points: (TP1) at the beginning of inpatient treatment in a stage of severe underweight, (TP2) during inpatient treatment after initial weight gain, and (TP3) at discharge with a body mass index ≥ 17.5 (BMI; kg/m2). We explored whether restoration of brain structure in AN patients was associated with a shorter duration of illness, with improvements in BMI, eating disorder-related cognitions, or with a younger age at the time of treatment
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