Cortical thinning and associated connectivity changes in patients with anorexia nervosa

Feliberto De La Cruz,Karl-Jürgen Bär,Stefanie Suttkus,Regine Zopf,Andy Schumann,Nadin Helbing

doi:10.1038/s41398-021-01237-6

Feliberto De La Cruz, Karl-Jürgen Bär + Show 4 more

Open Access

https://doi.org/10.1038/s41398-021-01237-6

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Abstract

Structural brain abnormalities are a consistent finding in anorexia nervosa (AN) and proposed as a state biomarker of the disorder. Yet little is known about how regional structural changes affect intrinsic resting-state functional brain connectivity (rsFC). Using a cross-sectional, multimodal imaging approach, we investigated the association between regional cortical thickness abnormalities and rsFC in AN. Twenty-two acute AN patients and twenty-six age- and gender-matched healthy controls underwent a resting-state functional magnetic resonance imaging scan and cognitive tests. We performed group comparisons of whole-brain cortical thickness, seed-based rsFC, and network-based statistical (NBS) analyses. AN patients showed cortical thinning in the precuneus and inferior parietal lobules, regions involved in visuospatial memory and imagery. Cortical thickness in the precuneus correlated with nutritional state and cognitive functions in AN, strengthening the evidence for a critical role of this region in the disorder. Cortical thinning was accompanied by functional connectivity reductions in major brain networks, namely default mode, sensorimotor and visual networks. Similar to the seed-based approach, the NBS analysis revealed a single network of reduced functional connectivity in patients, comprising mainly sensorimotor- occipital regions. Our findings provide evidence that structural and functional brain abnormalities in AN are confined to specific regions and networks involved in visuospatial and somatosensory processing. We show that structural changes of the precuneus are linked to nutritional and functional states in AN, and future longitudinal research should assess how precuneus changes might be related to the evolution of the disorder.

Highlights

Anorexia nervosa (AN) is a severe mental disorder characterized by a distorted body image and restriction of food intake
Cortical thickness We observed significantly reduced cortical thickness in anorexia nervosa (AN) patients compared to healthy controls (HC) in the precuneus and inferior parietal regions (Fig. 1, left and Table 2)
No significantly increased cortical thickness was observed in AN patients compared with healthy controls

Summary

Introduction

Anorexia nervosa (AN) is a severe mental disorder characterized by a distorted body image and restriction of food intake. The extreme underweight of AN patients is linked to the elevated mortality rate known to be the highest among mental disorders[1,2]. Post-mortem investigation have related malnutrition in AN patients to changes in cerebral structures[5,6]. Modern neuroimaging studies have provided substantial evidence for changes in brain structure in AN7–10. Decreased cortical thickness (CT) is a consistent finding in adult and adolescent patients with AN13,14. After weight gain, this cortical thinning can be reversed to a normal level[15,16,17]. Decreases of CT can be detected in healthy subjects with subclinical traits for disordered eating behavior[21]. Regional cortical thinning patterns might, be an adequate marker for progression and remission of AN20

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