Dynamic changes in the central autonomic network of patients with anorexia nervosa

• Published in: The European journal of neuroscience 2023-05, Vol.57 (9), p.1597-1610
• Main Authors: Cruz, Feliberto, Schumann, Andy, Suttkus, Stefanie, Helbing, Nadin, Bär, Karl‐Jürgen
• Format: Article
• Language: English
• Subjects: Amygdala; Anorexia; Anorexia Nervosa; Autonomic nervous system; Brain; Brain Mapping; brain states; central autonomic network; complexity; Cortex (cingulate); Cortex (insular); dynamic functional connectivity; Eating disorders; Entropy; Gyrus Cinguli; Heart rate; Humans; Magnetic Resonance Imaging; Neural networks; Prefrontal Cortex; Seeds
• ISSN: 0953-816X; 1460-9568
• DOI: 10.1111/ejn.15969

Autonomic cardiac dysfunction is a common complication in patients with anorexia nervosa (AN). Despite its high prevalence, physicians often overlook this clinical condition, and little research has been dedicated so far. To probe the functional role of the neurocircuitry underpinning the poorly understood autonomic cardiac dysfunction, we examined dynamic functional differences in the central autonomic network (CAN) between 21 acute AN individuals and 24 age, sex and heart rate‐matched healthy controls (HC). We assessed functional connectivity (FC) changes in CAN using seeds in the ventromedial prefrontal cortex, left and right anterior insular cortex, left and right amygdala and dorsal anterior cingulate cortex. The overall FC between the six investigated seeds is reduced in AN individuals compared to HC, although no changes were observed for single connections. Moreover, AN exhibited higher complexity in the FC time series of such CAN regions. Contrary to HC, we found that the degree of complexity between FC and heart rate (HR) series did not correlate in AN, suggesting a shift from central to peripheral control of the heart in AN individuals. Using dynamic FC analysis, we showed that the CAN transits across five functional states with no preference for any. Strikingly, at the state of weakest connectivity, the entropy significantly diverges between healthy and AN individuals, reaching its minimum and maximum values, respectively. Overall, our findings provide evidence that core regions of the CAN engaged in cardiac regulation are functionally affected in acute AN. Autonomic cardiac dysfunction is a common complication in anorexia nervosa (AN). Dynamic functional connectivity analysis revealed that the central autonomic network in healthy individuals and AN patients transits between five discrete states with no preference for any. Strikingly, the heart entropy significantly differs between groups at the state of weakest connectivity. Patients exhibited higher complexity in brain connectivity dynamics and no coupling between brain‐heart complexity, suggesting a shift from central to peripheral control of the heart in AN individuals.