Abstract
Objective: Severe malnutrition in patients with anorexia nervosa (AN) as well as possible trait-related aberrations lead to pronounced structural brain changes whose reversibility after recovery is currently unclear. Previous diffusion tensor imaging (DTI) studies investigating white matter (WM) microstructure alterations in AN are inconsistent. Methods: In this so far largest DTI study in adults, we investigated 33 AN patients, 20 recovered (REC), and 33 healthy women. DTI data were processed using the “DTI and Fiber tools,” and the Computational Anatomy Toolbox. WM integrity, both in terms of fractional anisotropy (FA) and mean diffusivity (MD), was assessed. Results: We found a significant FA decrease in the corpus callosum (body) and an MD decrease in the posterior thalamic radiation in the AN group. The REC group displayed FA decrease in the corpus callosum in comparison to HC, whereas there were no MD differences between the REC and HC groups. Conclusion: Despite prolonged restoration of weight in the REC group, no significant regeneration of WM integrity in terms of FA could be observed. Transient changes in MD likely represent a reversible consequence of the acute state of starvation or result from dehydration. Reduction of FA either may be due to WM damage resulting from malnutrition or may be considered a pre-morbid marker.
Highlights
Anorexia nervosa (AN) is a severe mental disorder associated with persistent restriction of energy intake leading to a significantly low body weight, a preoccupation with weight gain, and an altered body perception [1].Pathophysiology is currently unclear, but many studies point toward the involvement of various interacting developmental, genetic, environmental, and neurobiological factors [2, 3].In terms of neurobiological alterations, most previous structural imaging studies focused on volumetric gray matter (GM) or white matter (WM) alterations and mainly reported reductions of these two measures in acute AN [4,5,6]
Differences in Fractional anisotropy (FA) were detectable between the REC and HC groups, whereas there were no alterations between REC and HC concerning mean diffusivity (MD)
Reduction of Fractional anisotropy (FA) either may be due to white matter (WM) damage resulting from malnutrition or may be considered a pre-morbid marker
Summary
Anorexia nervosa (AN) is a severe mental disorder associated with persistent restriction of energy intake leading to a significantly low body weight, a preoccupation with weight gain, and an altered body perception [1].Pathophysiology is currently unclear, but many studies point toward the involvement of various interacting developmental, genetic, environmental, and neurobiological factors [2, 3].In terms of neurobiological alterations, most previous structural imaging studies focused on volumetric gray matter (GM) or white matter (WM) alterations and mainly reported reductions of these two measures in acute AN [4,5,6]. DTI is a noninvasive imaging technique that allows quantitative maps of microscopic, natural displacements of water molecules that occur in brain tissues as part of physical diffusion processes [7]. Lower FA reflects isotropic, i.e., either unrestricted or restricted diffusion in all spatial directions [10]. Another important marker is mean diffusivity (MD) defined as the average diffusion irrespective of directionality [8]. MD is a sensitive marker that can be altered by any disease process that affects the barriers (e.g., cell membranes) which restrict water diffusion [11]. Increased tissue water in edema was reported to increase, whereas cell proliferation in neoplasia may decrease MD [8]
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