Brain and Cognitive Development in Adolescents with Anorexia Nervosa: A Systematic Review of fMRI Studies

Anorexia nervosa (AN) is an eating disorder often occurring in adolescence. AN has one of the highest mortality rates amongst psychiatric illnesses and is associated with medical complications and high risk for psychiatric comorbidities, persisting after treatment. Remission rates range from 23% to...

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Bibliographic Details
Published in:Nutrients 2019-08, Vol.11 (8), p.1907
Main Authors: Olivo, Gaia, Gaudio, Santino, Schiöth, Helgi B
Format: Article
Language:English
Subjects:
adolescence
Adolescent
Adolescent Behavior
Adolescent Development
adolescents
Age Factors
Anorexia
anorexia nervosa
Anorexia Nervosa - diagnostic imaging
Anorexia Nervosa - physiopathology
Anorexia Nervosa - psychology
Anorexia Nervosa - therapy
Brain - diagnostic imaging
Brain - growth & development
Cognition
Cognition Disorders - diagnostic imaging
Cognition Disorders - physiopathology
Cognition Disorders - psychology
eating disorders
Feeding Behavior
Female
fMRI
functional magnetic resonance imaging
Humans
Magnetic Resonance Imaging
Mental Health
Puberty, Delayed - physiopathology
Puberty, Delayed - psychology
Recovery of Function
Review
Risk Factors
Sex Factors
Systematic review
Teenagers
Treatment Outcome
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Summary:Anorexia nervosa (AN) is an eating disorder often occurring in adolescence. AN has one of the highest mortality rates amongst psychiatric illnesses and is associated with medical complications and high risk for psychiatric comorbidities, persisting after treatment. Remission rates range from 23% to 33%. Moreover, weight recovery does not necessarily reflect cognitive recovery. This issue is of particular interest in adolescence, characterized by progressive changes in brain structure and functional circuitries, and fast cognitive development. We reviewed existing literature on fMRI studies in adolescents diagnosed with AN, following PRISMA guidelines. Eligible studies had to: (1) be written in English; (2) include only adolescent participants; and (3) use block-design fMRI. We propose a pathogenic model based on normal and AN-related neural and cognitive maturation during adolescence. We propose that underweight and delayed puberty-caused by genetic, environmental, and neurobehavioral factors-can affect brain and cognitive development and lead to impaired cognitive flexibility, which in turn sustains the perpetuation of aberrant behaviors in a vicious cycle. Moreover, greater punishment sensitivity causes a shift toward punishment-based learning, leading to greater anxiety and ultimately to excessive reappraisal over emotions. Treatments combining physiological and neurobehavioral rationales must be adopted to improve outcomes and prevent relapses.
ISSN:2072-6643
2072-6643
DOI:10.3390/nu11081907