Evaluating anorexia-related brain atrophy using MP2RAGE-based morphometry.

AIM: To evaluate brain atrophy in anorexic patients by automated cerebral segmentation with the magnetization-prepared 2 rapid acquisition gradient echo (MP2RAGE) MRI sequence. MATERIAL AND METHODS: Twenty patients (female; mean age, 27.9 years), presenting consecutively for brain MRI between August 2014-December 2016 with clinical suspicion of anorexia nervosa and BMI<18.5 kg/m2 were included. Controls were ten healthy females (mean age, 26.5 years). Automated brain morphometry was performed based on MP2RAGE. Means of morphometric results in the two groups were compared and correlation with BMI was analysed. RESULTS: Significantly lower volumes of total brain, grey matter (GM), white matter (WM), cerebellum and insula were found in anorexic patients. Anorexics had higher volumes of CSF, ventricles, lateral ventricles and third ventricle. When adjusted means for weight and height were compared, the volume of WM and cerebellum were not significantly different. However, volume of WM was significantly affected by weight and positively correlated with BMI. Significant positive correlations were found between BMI and volumes of total brain, GM, cortical GM and WM. BMI was negatively correlated with volumes of CSF and third ventricle. CONCLUSION: Brain atrophy was demonstrated in anorexic patients with MP2RAGE-based automated segmentation, which seems to reliably estimate brain volume. KEY POINTS: • Automated brain segmentation based on 3-D MRI seems to reliably estimate brain volume. • This technique detected brain atrophy in patients suffering from anorexia nervosa. • Brain changes in anorexia nervosa can be quantitatively and qualitatively followed-up by MRI.

Agreement between physicians and liaison psychiatrists on depression in old age patients of a general hospital: influence of symptom severity, age and personality.

OBJECTIVE: Comorbid depressive episodes are common among general hospital inpatients. However, existing evidence shows that depression is often poorly recognized in patients aged over 60 years. The aim of the study was first to determine the degree of agreement between primary care physicians' and liaison psychiatrists' evaluation of depression, and second, to analyze how patients' clinical presentation and personality traits influence this degree of agreement. METHODS: Agreement was defined as the matching of the physicians' initial referral for depressive mood and the actual diagnosis of a major depressive disorder evaluated by the consultation-liaison service in 148 inpatients aged 60+ years. Nature and severity of psychiatric symptoms were rated on the HoNOS65+ scale and patients' personality traits were assessed with the Big Five Inventory. RESULTS: Forty percent of the patients referred for depressive mood were indeed diagnosed with major depression. Agreement between physicians and psychiatrists was most likely in patients with more severe depressive symptoms and younger age. In contrast, risk for non-agreement was increased for patients with more open personalities, yet lower levels of neuroticism, who were referred for depressive mood even though they presented another or even no psychiatric disorder. CONCLUSION: These data reveal that the detection of late-life depression in general hospitals may be critically influenced by age, symptoms severity and personality traits.

Cerebral Gray and White Matter Involvement in Anorexia Nervosa Evaluated by T1, T2, and T2* Mapping.

BACKGROUND AND PURPOSE: Changes in the brain composition of anorexics could potentially be expected, opening the door to new imaging approaches where quantitative and qualitative MRI have a role. Our purpose was to investigate anorexia-related brain dehydration and myelin depletion by analyzing T1, T2, and T2* relaxation times of different brain structures in anorexics and controls. METHODS: Thirty-eight anorexic female patients (mean age, 26.2 years; age range, 16.2-48.7 years; mean BMI, 14.5 kg/m2 ; BMI range, 10.0-18.4 kg/m2 ) underwent brain MRI between August 2014 and August 2018. Controls were 16 healthy females (mean age, 28.0 years; age range, 22.3-34.7 years; mean BMI, 20.9 kg/m2 ; BMI range, 18.4-26.6 kg/m2 ). T1, T2, and T2* relaxation times were obtained for different brain structures in anorexics and controls as part of this retrospective case-control study. RESULTS: The T1 relaxation times of gray and white matter were significantly lower in anorexics (P = .009), whereas the T2 relaxation times of gray matter were higher (P < .001). There were no statistically significant differences in gray matter T2* relaxation times or in white matter T2 and T2* relaxation times between anorexics and controls. Occipital lobe gray matter showed the shortest T1, T2, and T2* relaxation times of all brain regions (P < .05). CONCLUSIONS: T1 shortening in anorexics suggests both dehydration and myelin loss, whereas T2 prolongation points toward myelin loss (myelin water has lower T2), which seems to be less discernible in white matter. Shorter overall relaxation times in the most posterior regions of the brain suggest higher iron content.