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

1
Department of Neuroscience, Functional Pharmacology, Uppsala University, 751 24 Uppsala, Sweden
2
Centre for Integrated Research (CIR), Area of Diagnostic Imaging, University “Campus Bio-Medico di Roma”, 00128 Rome, Italy
3
Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, 119146 Moscow, Russia
*
Author to whom correspondence should be addressed.
Nutrients 2019, 11(8), 1907; https://doi.org/10.3390/nu11081907
Received: 20 July 2019 / Revised: 5 August 2019 / Accepted: 12 August 2019 / Published: 15 August 2019
(This article belongs to the Special Issue Childhood Eating and Feeding Disturbances)
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Abstract

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. View Full-Text
Keywords: adolescents; adolescence; eating disorders; anorexia nervosa; fMRI; functional magnetic resonance imaging adolescents; adolescence; eating disorders; anorexia nervosa; fMRI; functional magnetic resonance imaging
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Olivo, G.; Gaudio, S.; Schiöth, H.B. Brain and Cognitive Development in Adolescents with Anorexia Nervosa: A Systematic Review of fMRI Studies. Nutrients 2019, 11, 1907.

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