Mood and orthostatic norepinephrine response in anorexia nervosa

Clinical picture of a patient with a novel PSEN1 mutation (L424V)

Young onset dementia raises concern about familial and non degenerative dementias. We describe a patient with early dementia. At the age of 26, a woman developed symptoms of anorexia nervosa, at 30 a memory and attention deficit, and at 34 abnormal behavior with impulsivity, aggression, and dysexecutive disorder. At 36 she showed aphasia, stereotyped behavior, hyperreflexia, grasping reflex, urinary incontinence, myoclonus, and seizures. Blood and cerebrospinal fluid were normal. Brain computed tomography and single photon emission computed tomography showed diffuse cortico-subcortical atrophy and frontotemporoparietal hypoperfusion. A Leu424Val mutation was present in PSEN1 gene. PSEN1 mutations can produce Alzheimer's disease, frontotemporal dementia, and dementia with Lewy bodies phenotypes, or a combination of them. It has been proposed that the mutation type and location may influence the molecular pathogenesis and thus PSEN1 would represent a molecular connexion between these entities. This case shows a novel PSEN1 mutation with outstanding amnesic and frontal symptoms.

Hormonal and psychological factors linked to the increased thermic effect of food in malnourished fasting anorexia nervosa

OBJECTIVES

In patients with anorexia nervosa (AN), weight gain is lower than that expected from the energy content of the meals. Thus we investigated the thermic effect of food (TEF) in relation to subjective feelings and plasma hormone levels in a group of AN patients.

METHODS

TEF, feelings (14 items), and plasma release of beta-endorphin, ACTH, cortisol, dopamine, and catecholamines were evaluated in 15 AN patients (body mass index, 13.6 +/- 1.2 kg.m(-2)) and in 15 healthy women after three gastric loads (0, 300, 700 kcal) infused by a nasogastric tube in a blind design.

RESULTS

In AN, the blind loads induced an energy-dependent increase in TEF (P < 0.001), which was higher than that observed in healthy women (P < 0.001). Only in AN, a load-dependent decline in the high basal plasma level of beta-endorphin (P < 0.01), an increase in plasma ACTH (P < 0.02) after the two caloric loads, and an increase in cortisol, norepinephrine, and dopamine levels after the 700-kcal load only (P < 0.05) were noted. A calorie-dependent (P < 0.001) increase in nausea, abdominal discomfort, and fear of being fat ratings and a decrease in liking to eat (P < 0.001) and body image were observed in AN patients (P < 0.05). TEF correlated with ratings on satiation, nausea, uncomfortable abdominal swelling, body image, and fear of being fat (for all, P < 0.01).

CONCLUSION

In AN women, blindly infused loads induced a dose-dependent increase in TEF, which correlated with the increase in plasma cortisol, ACTH, and catecholamines as in unpleasant sensations, fear of being fat, and anxiety as well as a decline in elevated basal beta-endorphin. These results could explain the difficulty for AN patients in gaining weight.

Central and peripheral noradrenalin regulation in eating disorders

Norepinephrine and its metabolites were studied in various body fluids (plasma, urine and cerebrospinal fluid) of patients with anorexia nervosa, bulimia nervosa and healthy young women. The reaction of plasma norepinephrine to different stimuli like orthostatic challenge, test meals, standardized exercise, mental challenge tests etc. were studied. All results indicate a reduced noradrenergic activity in the central and peripheral nervous system of patients with eating disorders. The clinical consequences of these changes are hypotension, bradicardia, hypothermia and depression. Evidence is presented that the reduced activity of the sympathetic nervous system is caused by starvation (anorexia nervosa) or intermittent dieting (bulimia nervosa).

Semistarvation-induced hyperactivity compensates for decreased norepinephrine and dopamine turnover in the mediobasal hypothalamus of the rat

Male Wistar rats were housed in running wheel cages and were restricted in their food intake, in order to reduce the initial body weight by 30% within 10 days. Rats increased their daily running up to distances between 7 and 11 km compared to the maximum 2.5 km in controls fed ad libitum. The hypothalamic noradrenaline (NE) turnover, as estimated by the concentration of the major metabolite MHPG, was significantly decreased in semistarved sedentary rats compared to controls. Hyperactivity resulted in marked elevation of NE turnover at all time points examined. Semistarvation-induced decreases of dopamine (DA) turnover as estimated by the concentrations of its major metabolite DOPAC, could also be compensated by hyperactivity. The circadian pattern of NE turnover parallels the pattern of running activity. MHPG levels at times of high activity were even higher than in controls fed ad libitum (p less than 0.01). The availability of the precursor tyrosine, as indicated by the ratio of plasma tyrosine to the large neutral amino acids, was significantly decreased in semistarvation (p less than 0.0001); hyperactivity caused a further decrease (p less than 0.001), indicating that tyrosine availability is not, under these conditions, a limiting factor for noradrenaline turnover. The combined influence of semistarvation and hyperactivity on central catecholamine turnover in the rat is discussed as an animal model for the effects of malnutrition and heavy exercise often observed in anorexia nervosa.