Young women with a history of adolescent-onset anorexia nervosa exhibit persistent structural brain changes and cognitive deficits, according to Canadian investigators.

Young women with a history of adolescent-onset anorexia nervosa exhibit persistent structural brain changes and cognitive deficits, according to Canadian investigators writing in the August electronic issue of Pediatrics.

Dr. Debra K. Katzman of the University of Toronto, Ontario and colleagues studied 66 young women, mean age 21.3 years, who had received treatment for anorexia nervosa as adolescents. The study group was compared with a control group of 42 healthy age-matched controls.

For the patients, the average interval from initial treatment to follow-up was 6.5 years. All subjects underwent a clinical examination, MRI brain scans and cognitive evaluation. Clinical data were analyzed first as a function of weight recovery (at least 85 per cent of ideal body weight vs less than 85 per cent) and then as a function of menstrual status.

Women with a history of anorexia nervosa who remained at low weight had larger lateral ventricles than controls. The investigators report that 24-hour urinary free-cortisol levels were positively correlated with volume of the temporal horns of the lateral ventricles and negatively correlated with volumes of the hippocampi in study subjects.

Participants who were amenorrheic or had irregular menses showed significant cognitive deficits across a broad range of domains, Dr. Katzman and colleagues report.

"The volumetric analysis of brain structure supports the reversibility of structural brain abnormalities after weight recovery and correction of hypercortisolemia," the investigators write. "Moreover, cognitive function and brain structure were differentially associated with clinical variables, menstrual status and cortisol levels, respectively."

"Taken together, future research in adolescent-onset anorexia nervosa should focus on the interaction between sex hormones and neurotransmitter systems that may not manifest as detectable structural brain changes," the authors note. "Clinical investigation addressing the role of estrogen in mediating cognitive function in anorexia nervosa also requires additional study."

Pediatrics 2008