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Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. e426-e437 (doi:10.1542/peds.2008-0170)
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ARTICLE

Cognitive Function and Brain Structure in Females With a History of Adolescent-Onset Anorexia Nervosa

Harold T. Chui, MSca, Bruce K. Christensen, PhDa,b,c, Robert B. Zipursky, MDa,b,c, Blake A. Richards, MScc, M. Katherine Hanratty, BScc, Noor J. Kabani, PhDc,d,e, David J. Mikulis, MDf,g, Debra K. Katzman, MDa,h,i

a Institute of Medical Science and Departments of
b Psychiatry
d Medical Biophysics
f Medical Imaging
h Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
c Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
e Department of Clinical Integrative Biology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
g Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
i Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada

OBJECTIVE. Abnormalities in cognitive function and brain structure have been reported in acutely ill adolescents with anorexia nervosa, but whether these abnormalities persist or are reversible in the context of weight restoration remains unclear. Brain structure and cognitive function in female subjects with adolescent-onset anorexia nervosa assessed at long-term follow-up were studied in comparison with healthy female subjects, and associations with clinical outcome were investigated.

PATIENTS AND METHODS. Sixty-six female subjects (aged 21.3 ± 2.3 years) who had a diagnosis of adolescent-onset anorexia nervosa and treated 6.5 ± 1.7 years earlier in a tertiary care hospital and 42 healthy female control subjects (aged 20.7 ± 2.5 years) were assessed. All participants underwent a clinical examination, magnetic resonance brain scan, and cognitive evaluation. Clinical data were analyzed first as a function of weight recovery (n = 14, <85% ideal body weight; n = 52, ≥85% ideal body weight) and as a function of menstrual status (n = 18, absent/irregular menses; n = 29, oral contraceptive pill; n = 19, regular menses). Group comparisons were made across structural brain volumes and cognitive scores.

RESULTS. Compared with control subjects, participants with anorexia nervosa who remained at low weight had larger lateral ventricles. Twenty-four–hour urinary free-cortisol levels were positively correlated with volumes of the temporal horns of the lateral ventricles and negatively correlated with volumes of the hippocampi in clinical participants. Participants who were amenorrheic or had irregular menses showed significant cognitive deficits across a broad range of many domains.

CONCLUSIONS. Female subjects with adolescent-onset anorexia nervosa showed abnormal cognitive function and brain structure compared with healthy individuals despite an extended period since diagnosis. To our knowledge, this is the first study to report a specific relationship between menstrual function and cognitive function in this patient population. Possible mechanisms underlying neural and cognitive deficits with anorexia nervosa are discussed. Additional examination of the effects of estrogen on cognitive function in female subjects with anorexia nervosa is necessary.

Key Words: adolescent-onset anorexia nervosa • cognitive function • brain structure • menstrual function

Abbreviations: AN—anorexia nervosa • MR—magnetic resonance • UFC—urinary free cortisol • Ccr—creatinine clearance • IBW—ideal body weight • OCD—obsessive-compulsive disorder • OCP—oral contraceptive pill • HSD—honestly significant difference

Accepted Mar 27, 2008.


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