Faculty Bibliography

Adiposity is associated with chronic low-grade systemic inflammation and increased inflammation in the hypothalamus, a key structure in feeding behavior. It remains unknown whether inflammation impacts other brain structures that regulate feeding behavior. We studied 44 overweight/obese and 19 lean individuals with MRI and plasma fibrinogen levels (marker of inflammation). We performed MRI-based segmentations of the medial and lateral orbitofrontal cortex (OFC) and hippocampal volumes. Gray matter (GM) volumes were adjusted for head size variability. We conducted logistic and hierarchical regressions to assess the association between fibrinogen levels and brain volumetric data. Using diffusion tensor imaging (DTI), we created apparent diffusion coefficient (ADC) maps and conducted voxelwise correlational analyses. Fibrinogen concentrations were higher among the overweight/obese (t[61]=-2.33, P=0.023). Lateral OFC associated together with fibrinogen correctly classified those with excess of weight (accuracy=76.2%, sensitivity=95.5%, and specificity=31.6%). The lateral OFC volumes of overweight/obese were negatively associated with fibrinogen (r=-0.37, P=0.016) and after accounting for age, hypertension, waist/hip ratio and lipid and sugar levels, fibrinogen significantly explained an additional 9% of the variance in the lateral OFC volume (beta=-0.348, DeltaR(2)=0.093, DeltaF P=0.046). Among overweight/obese the associations between GM ADC and fibrinogen were significantly positive (P<0.001) in the left and right amygdala and the right parietal region. Among lean individuals these associations were negative and located in the left prefrontal, the right parietal and the left occipital lobes. This is the first study to report that adiposity-related inflammation may reduce the integrity of some of the brain structures involved in reward and feeding behaviors

Objectives Obesity is on the rise in the US and is linked to the development of type 2 diabetes and cardiovascular disease. Emerging evidence over the last decade suggests that obesity may also adversely affect executive function and brain structure. Although a great deal of research focuses on how diet affects the brain and cognitive performance, no study focuses on how food choice may be associated with brain integrity. Here we investigated how lean and overweight/obese (o/o) adults differed in their food choices and how brain structure and cognition may be associated with those choices. Design As part of an ongoing study on diabetes and the brain, participants had routine blood work and a research MRI, received a battery of neurocognitive tests, and were instructed to keep a 3-day food diary. Results and conclusions The lean group ate more high quality foods and less low quality foods compared to the o/o group. In the o/o group, high quality food choices were associated with orbitofrontal cortex volume. The lean group performed better than the o/o group on neurocognitive measures of executive function, such as the Stroop Interference Test, the Wisconsin Card Sort Test and the Trail Making Test B-A, and on attention and concentration tasks such as the Digit Symbol Substitution Test. Taken together, these preliminary data suggest that in obesity poor food choices may be associated with frontal cognitive impairments that may be the result of, or contribute to, decreases in orbitofrontal cortex volume. Therefore, longitudinal studies are warranted to investigate a causal link between food choice and executive functioning

AIMS/HYPOTHESIS: Central nervous system abnormalities, including cognitive and brain impairments, have been documented in adults with type 2 diabetes who also have multiple co-morbid disorders that could contribute to these observations. Assessing adolescents with type 2 diabetes will allow the evaluation of whether diabetes per se may adversely affect brain function and structure years before clinically significant vascular disease develops. METHODS: Eighteen obese adolescents with type 2 diabetes and 18 obese controls without evidence of marked insulin resistance, matched on age, sex, school grade, ethnicity, socioeconomic status, body mass index and waist circumference, completed MRI and neuropsychological evaluations. RESULTS: Adolescents with type 2 diabetes performed consistently worse in all cognitive domains assessed, with the difference reaching statistical significance for estimated intellectual functioning, verbal memory and psychomotor efficiency. There were statistical trends for executive function, reading and spelling. MRI-based automated brain structural analyses revealed both reduced white matter volume and enlarged cerebrospinal fluid space in the whole brain and the frontal lobe in particular, but there was no obvious grey matter volume reduction. In addition, assessments using diffusion tensor imaging revealed reduced white and grey matter microstructural integrity. CONCLUSIONS/INTERPRETATION: This is the first report documenting possible brain abnormalities among obese adolescents with type 2 diabetes relative to obese adolescent controls. These abnormalities are not likely to result from education or socioeconomic bias and may result from a combination of subtle vascular changes, glucose and lipid metabolism abnormalities and subtle differences in adiposity in the absence of clinically significant vascular disease. Future efforts are needed to elucidate the underlying pathophysiological mechanisms

To determine whether the cognitive impairments observed in adults with type 2 diabetes mellitus (T2DM) exist in preclinical disease, we compared 38 adult participants with evidence of insulin resistance (IR) to 54 age-, gender-, and education-matched control participants on a battery of neuropsychological tests. We found that participants with IR had performance reductions in declarative memory and executive functioning. When we examined IR simultaneously with other biomedical indicators with which it co-occurs, only IR itself was associated with declarative memory, and hemoglobin A1c (HbA1c) was associated with executive functioning and working memory. We conclude that individuals with insulin resistance already demonstrate similar reductions in cognitive performance as those described in T2DM

Very few attempts have been made to apply a mathematical model to the learning curve in the California Verbal Learning Test list A immediate recall. Our rationale was to find out whether modeling of the learning curve can add additional information to the standard CVLT [corrected] measures. We applied a standard transfer function in the form Y = B3*exp(-B2*(X-1))+B4*(1-exp(-B2*(X-1))), where X is the trial number; Y is the number of recalled correct words, B2 is the learning rate, B3 is readiness to learn and B4 is ability to learn. The coefficients of the model were found to be independent measures not duplicating standard CVLT [corrected] measures. Regression analysis revealed that readiness to learn (B3) and ability to learn (B4) were significantly (p < .05) higher in a group of healthy participants than in a group of participants with type 2 diabetes mellitus (T2DM), but the learning rate (B2) did not differ (p > .2). The proposed model is appropriate for clinical application and as a guide for research and may be used as a good supplemental tool for the CVLT [corrected] and similar memory tests.

CONTEXT: Autism is a condition of unknown origin with well-documented impairments in social perception and cognition. OBJECTIVE: To assess the relevance of the fusiform-amygdala system to the pathophysiology of autism spectrum conditions. DESIGN: Cross-sectional case-control study. SETTING: University hospital. PARTICIPANTS: A total of 27 adults with autism spectrum conditions and 29 age-, sex-, and intelligence quotient-matched typically developed healthy controls. Patients were assessed according to DSM-IV criteria using the Autism Diagnostic Interview-Revised. INTERVENTIONS: We applied an automated measurement to estimate fusiform gyrus cortical thickness and a manual tracing method to obtain amygdala volumes. We analyzed volumetric covariance among these brain regions and assessed the functional relevance of anatomical findings by analyzing correlations with emotional face-processing performance. MAIN OUTCOME MEASURES: Fusiform gyrus cortical thickness, amygdala volume, emotional face processing. RESULTS: We found a specific local increase in cortical thickness of the fusiform gyrus and associated impairments in face processing in individuals with autism. Anatomical covariance between amygdala volume and the increase in fusiform gyrus local thickness was significantly smaller in the group with autism spectrum conditions. CONCLUSIONS: Our data provide the first anatomical evidence of an abnormal amygdala-fusiform system and its behavioral relevance to face-processing deficits in autism spectrum conditions. In light of recent evidence of the involvement of the fusiform gyrus and amygdala in social perception as well as the areas of social cognition and emotional awareness, all of which are relevant to autism, our findings might represent a core pathophysiological mechanism of autism.

Familial dysautonomia (FD) is a hereditary peripheral and central nervous system disorder with poorly defined central neuropathology. This prospective pilot study aimed to determine if MRI would provide objective parameters of central neuropathology. There were 14 study subjects, seven FD individuals (18.6 +/- 4.2 years, 3 female) and seven controls (19.1 +/- 5.8 years, 3 female). All subjects had standardized brain MRI evaluation including quantitative regional volume measurements, diffusion tensor imaging (DTI) for assessment of white matter (WM) microstructural integrity by calculation of fractional anisotropy (FA), and proton MR spectroscopy ((1)H MRS) to assess neuronal health. The FD patients had significantly decreased FA in optic radiation (p = 0.009) and middle cerebellar peduncle (p = 0.004). Voxel-wise analysis identified both GM and WM microstructural damage among FD subjects as there were nine clusters of WM FA reductions and 16 clusters of GM apparent diffusion coefficient (ADC) elevations. Their WM proportion was significantly decreased (p = 0.003) as was the WM proportion in the frontal region (p = 0.007). (1)H MRS showed no significant abnormalities. The findings of WM abnormalities and decreased optic radiation and middle cerebellar peduncle FA in the FD study group, suggest compromised myelination and WM micro-structural integrity in FD brains. These neuroimaging results are consistent with clinical visual abnormalities and gait disturbance. Furthermore the frontal lobe atrophy is consistent with previously reported neuropsychological deficits