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      Differential Neural Responses to Food Images in Women with Bulimia versus Anorexia Nervosa


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          Previous fMRI studies show that women with eating disorders (ED) have differential neural activation to viewing food images. However, despite clinical differences in their responses to food, differential neural activation to thinking about eating food, between women with anorexia nervosa (AN) and bulimia nervosa (BN) is not known.


          We compare 50 women (8 with BN, 18 with AN and 24 age-matched healthy controls [HC]) while they view food images during functional Magnetic Resonance Imaging (fMRI).


          In response to food (vs non-food) images, women with BN showed greater neural activation in the visual cortex, right dorsolateral prefrontal cortex, right insular cortex and precentral gyrus, women with AN showed greater activation in the right dorsolateral prefrontal cortex, cerebellum and right precuneus. HC women activated the cerebellum, right insular cortex, right medial temporal lobe and left caudate. Direct comparisons revealed that compared to HC, the BN group showed relative deactivation in the bilateral superior temporal gyrus/insula, and visual cortex, and compared to AN had relative deactivation in the parietal lobe and dorsal posterior cingulate cortex, but greater activation in the caudate, superior temporal gyrus, right insula and supplementary motor area.


          Women with AN and BN activate top-down cognitive control in response to food images, yet women with BN have increased activation in reward and somatosensory regions, which might impinge on cognitive control over food consumption and binge eating.

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          Most cited references 34

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          The cognitive control network: Integrated cortical regions with dissociable functions.

          Consensus across hundreds of published studies indicates that the same cortical regions are involved in many forms of cognitive control. Using functional magnetic resonance imaging (fMRI), we found that these coactive regions form a functionally connected cognitive control network (CCN). Network status was identified by convergent methods, including: high inter-regional correlations during rest and task performance, consistently higher correlations within the CCN than the rest of cortex, co-activation in a visual search task, and mutual sensitivity to decision difficulty. Regions within the CCN include anterior cingulate cortex/pre-supplementary motor area (ACC/pSMA), dorsolateral prefrontal cortex (DLPFC), inferior frontal junction (IFJ), anterior insular cortex (AIC), dorsal pre-motor cortex (dPMC), and posterior parietal cortex (PPC). We used a novel visual line search task which included periods when the probe stimuli were occluded but subjects had to maintain and update working memory in preparation for the sudden appearance of a probe stimulus. The six CCN regions operated as a tightly coupled network during the 'non-occluded' portions of this task, with all regions responding to probe events. In contrast, the network was differentiated during occluded search. DLPFC, not ACC/pSMA, was involved in target memory maintenance when probes were absent, while both regions became active in preparation for difficult probes at the end of each occluded period. This approach illustrates one way in which a neuronal network can be identified, its high functional connectivity established, and its components dissociated in order to better understand the interactive and specialized internal mechanisms of that network.
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            'Liking' and 'wanting' food rewards: brain substrates and roles in eating disorders.

            What brain reward systems mediate motivational 'wanting' and hedonic 'liking' for food rewards? And what roles do those systems play in eating disorders? This article surveys recent findings regarding brain mechanisms of hedonic 'liking', such as the existence of cubic-millimeter hedonic hotspots in nucleus accumbens and ventral pallidum for opioid amplification of sensory pleasure. It also considers brain 'wanting' or incentive salience systems important to appetite, such as mesolimbic dopamine systems and opioid motivation circuits that extend beyond the hedonic hotspots. Finally, it considers some potential ways in which 'wanting' and 'liking' might relate to eating disorders.
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              Estimating sample size in functional MRI (fMRI) neuroimaging studies: statistical power analyses.

              Estimation of statistical power in functional MRI (fMRI) requires knowledge of the expected percent signal change between two conditions as well as estimates of the variability in percent signal change. Variability can be divided into intra-subject variability, reflecting noise within the time series, and inter-subject variability, reflecting subject-to-subject differences in activation. The purpose of this study was to obtain estimates of percent signal change and the two sources of variability from fMRI data, and then use these parameter estimates in simulation experiments in order to generate power curves. Of interest from these simulations were conclusions concerning how many subjects are needed and how many time points within a scan are optimal in an fMRI study of cognitive function. Intra-subject variability was estimated from resting conditions, and inter-subject variability and percent signal change were estimated from verbal working memory data. Simulations derived from these parameters illustrate how percent signal change, intra- and inter-subject variability, and number of time points affect power. An empirical test experiment, using fMRI data acquired during somatosensory stimulation, showed good correspondence between the simulation-based power predictions and the power observed within somatosensory regions of interest. Our analyses suggested that for a liberal threshold of 0.05, about 12 subjects were required to achieve 80% power at the single voxel level for typical activations. At more realistic thresholds, that approach those used after correcting for multiple comparisons, the number of subjects doubled to maintain this level of power. Copyright 2002 Elsevier Science B.V.

                Author and article information

                Role: Editor
                PLoS One
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                20 July 2011
                : 6
                : 7
                [1 ]Department of Neuroscience, Uppsala University, Uppsala, Sweden
                [2 ]Department of Neuroimaging, Centre for Neuroimaging Sciences, King's College London Institute of Psychiatry, London, United Kingdom
                [3 ]Section of Eating Disorders, Department of Psychological Medicine, King's College London Institute of Psychiatry, London, United Kingdom
                [4 ]Psychosomatic and General Internal Medicine, Centre for Psychosocial Medicine, Heidelberg, Germany
                Royal Holloway, University of London, United Kingdom
                Author notes

                Conceived and designed the experiments: SJB RU H-CF JT ICC. Performed the experiments: SJB H-CF. Analyzed the data: SJB OGO. Contributed reagents/materials/analysis tools: SJB OGO VG MB SCRW HBS JT ICC. Wrote the paper: SJB. Commented on the manuscript draft: OGO H-CF VG JT ICC. Helped in the recruitment of patients: JT ICC.

                Brooks et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                Page count
                Pages: 8
                Research Article
                Sensory Systems
                Visual System
                Mental Health
                Cognitive Psychology
                Eating Disorders



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