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Background
There is increasing interest in associations between cognitive impairments and clinical symptoms in Anorexia Nervosa (AN), however, the relationship with everyday function is unclear. The current review synthesizes existing data regarding associations between scores on tests of set-shifting and central coherence and functional outcome me...
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... articles met the inclusion criteria. The systematic search process is illustrated in Fig. 1. Included studies used a variety of measures of set-shifting, central coherence and functional outcome, and different methods of analysis, therefore a descriptive review was conducted. The included studies are summarized in Table 1. The table is organized according to the type of functional outcome measure used. The first section ...
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Executive dysfunctions constitute a significant public health problem due to their high impact on everyday life and personal independence. Therefore, the identification of early strategies to assess and rehabilitate these impairments appears to be a priority. The ecological limitations of traditional neuropsychological tests and the numerous diffic...
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... В настоящий момент существует несколько направлений, изучающих функционирование когнитивных процессов и их влияние на развитие НА. Часть исследователей фокусировала свое внимание на изучении нарушений когнитивных процессов, таких как память, внимание, мышление, восприятие в результате заболевания и дефицита веса [11], другая группа исследовала этиологически обусловленные когнитивные процессы, влияющие на развитие и поддержание расстройств пищевого поведения. В том числе были изучены такие функции, как: слабая центральная когерентность, трудности с выполнением задач по смене установок, когнитивная ригидность, компульсивность и др. ...
... В том числе были изучены такие функции, как: слабая центральная когерентность, трудности с выполнением задач по смене установок, когнитивная ригидность, компульсивность и др. [4,[10][11][12][13][14][15][16]. ...
Введение. Многочисленные исследования свидетельствуют о многообразии когнитивных нарушений в клинической картине нервной анорексии (НА). Однако остается не до конца изученной связь общего соматопсихического истощения на фоне дефицита веса с когнитивными процессами. Цель. Изучение специфики когнитивного функционирования при НА у пациентов с разным уровнем дефицита веса, находящихся на стационарном лечении. Материалы и методы. Было проведено кросс-секционное обсервационное исследование когнитивных особенностей пациентов с НА (n=82). Использовались методики, традиционно применяемые в экспериментально-психологическом исследовании для оценки кратковременной памяти, концентрации внимания, когнитивной ригидности, процессов обобщения: «Заучивание 10 слов», «Корректурная проба Бурдона», «Таблицы Шульте», тест Струпа, «Простые аналогии», «Сравнение понятий». Результаты. Средние показатели концентрации внимания, работоспособности, объема запоминания, переключаемости колебались вокруг нормативных значений при наличии значительного разброса данных по результатам выполнения отдельных методик, что свидетельствует о разном уровне когнитивного функционирования в исследуемой группе. Достоверные корреляции с дефицитом веса не были установлены. В ряде случаев пациенты с более низкой массой тела (ИМТ <14,0) обнаруживали более высокие показатели отсроченного запоминания и когнитивной переключаемости. У пациентов с большей длительностью заболевания НА чаще отмечались нарушения внимания и операциональной стороны мышления по типу искажения обобщений. Заключение. Необходимо дальнейшее изучение клинико-психопатологической структуры различных типов НА и связи дефицита веса с метакогнитивными особенностями пациентов, что будет способствовать поиску наиболее значимых мишеней для более эффективного терапевтического воздействия.
ntroduction. Numerous studies have reported a variety of cognitive dysfunction in Anorexia nervosa (AN). However, the relationship between general somatic or mental exhaustion under the weight loss and cognitive dysfunction remains incompletely understood. Purpose. To investigate the specificity of cognitive functioning in hospitalized AN patients with different degrees of weight loss. Materials and methods. A cross-sectional observational study of the cognitive characteristics of patients with AN (n=82) was conducted. Traditional methods of experimental psychological testing for investigating short-term memory, attention concentration, cognitive flexibility and generalisation processes were used: "Memorizing 10 words", Bourdon’s Corrective Test, Schulte Tables, Stroop’s Test, "Simple analogies", "Comparison of concepts". Results. The average indicators of attention concentration, performance, short-term memory and cognitive rigidity corresponded to the normative values. At the same time, there was a significant scatter of data in the results of the cognitive tests, indicating the unevenness of attention and memory processes and a different level of cognitive functioning in the clinical group. No significant correlations with weight loss were found. In some cases, patients with lower body weight (BMI <14.0) revealed higher short-term memory and cognitive flexibility. Patients with longer duration of AN were more likely to have attention and formal thinking deficits, as measured by the distortion of generalization type. Conclusion. It is necessary to further investigate the clinical and psychopathological structure of different types of AN and the relationship between weight loss and metacognitive characteristics of patients, which will contribute to the search for the most important targets for more effective therapeutic intervention.
... AN is associated with poor cognitive flexibility, referring to the ability to change thoughts or actions according to situational demands. These findings are mostly observed in adults, and conclusions, including those of adolescents, are less consistent [20,[52][53][54][55]. Our analysis showed that shifting did not change before and after treatment. ...
Background: The present study aimed to evaluate cognitive function and laboratory parameters in adolescent girls with anorexia nervosa (AN) before and after nutritional rehabilitation (NR) compared to healthy female peers (CG). Methods: We evaluated 36 girls with AN at two-time points, during acute malnutrition (AN1) and after NR, in a partially normalized weight status (AN2). We compared their cognitive functions and laboratory parameters to 48 healthy CG subjects. Cognitive function was assessed using a Cognitive Assessment Battery (CAB) assessment, depressive symptom levels were assessed using a Beck Depression Inventory (BDI) assessment, and eating disorders were assessed using an Eating Attitude Test (EAT-26). Results: The AN1 group scored better in total cognition, attention, estimation, and spatial perception than the CG group (p < 0.05), with scores increasing in the AN2 group. Shifting and visual perception values did not differ between the study groups (p = 0.677, p = 0.506, respectively). Laboratory tests showed no significant abnormalities and did not differ significantly between groups (p > 0.05). There was a negative correlation for EAT-26 and CAB in the AN1 group (rho = −0.43, p = 0.01), but not for BDI. Conclusions: Cognitive function in adolescent girls with AN was better than CG and correlated with EAT-26 score. These results highlight the high compensatory capacity of the adolescent body to maintain cognitive function despite severe malnutrition. Our results suggest that although normalization of body weight is crucial, other factors can significantly influence improvements in cognitive function. Cognitive deficits and laboratory tests may not be biomarkers of early forms of AN.
... The current study aimed to investigate the links between nutritional status in people with AN, as indexed by body composition, in addition to BMI, and cognitive flexibility at different times of the disease. In addition, we considered a range of potentially confounding factors identified in the literature as likely impacting our variable of interest [4][5][6]. ...
Background: According to the Cognitive–Interpersonal model of anorexia nervosa (AN), the combined influence of cognitive and socio-emotional difficulties would constitute vulnerability and maintaining factors. Poor cognitive flexibility is one of the endophenotypic candidates (i.e., a trait marker) of the disorder, but few studies have examined its association with illness symptom variations, notably weight status. The study aimed to evaluate the relationships between cognitive flexibility performances and nutritional status indices (BMI; body composition) at different times of the disorder. Methods: Cross-sectional and longitudinal associations between cognitive flexibility (TAP 2.1) and nutritional status indices, along with anxious and depressive (HAD) and eating disorder (EDE-Q) symptomatology were investigated using univariate and multivariate analyses in a cohort of AN inpatients evaluated at hospital admission (N = 167) and discharge (N = 94). Results: We found no or negligible associations between nutritional status and HAD or EDE-Q scores or cognitive flexibility performances, either cross-sectionally or longitudinally. Cognitive performances did not significantly differ between the AN subtypes. Conclusions: In agreement with the Cognitive–Interpersonal model of AN, cognitive flexibility is independent of nutritional status, as well as the AN subtype. It is also independent of the levels of anxious, depressive, or ED symptomatology. A new therapeutic approach targeting cognitive flexibility and intolerance to change could benefit severely emaciated people with AN, regardless of disease subtype and level of dysphoria.
... Future research should clarify the link between WCC/CR and specific disordered eating behaviours (e.g., MacNeil & Leung, 2022;Tamiya et al., 2018). As recent clinical research highlights a role for CR and WCC in anxiety, low mood, life satisfaction (MacNeil & Leung, 2022), social and executive functioning (Dann et al., 2021), it would be important to assess whether such cognitive styles contributed to these features in community samples also. ...
... Because cognitive profiles in AN are shown to relate to specific symptoms of the disorder, the similarities in disordered eating behaviors between ARFID and AN raise the question of whether the two conditions might also share commonalities in their cognitive profiles. Differences in cognitive functioning in AN compared to healthy controls (HC) are well-documented and considered to contribute to manifestation and maintenance of eating disorder pathology, including dietary restriction (e.g., [1,2]). In contrast, whether/how cognitive functioning might be altered in individuals with ARFID is unknown, but important to study to inform diagnostic differences as well as possible mechanisms underlying reasons for restrictions-which may offer additional treatment targets. ...
... We used a well-supported measure of this cognitive construct (i.e., the testmybrain.org Delay Discounting Task), which is important considering the task impurity problem common in cognitive and neuropsychological testing [1,24]. Prior research suggests that discounting for hypothetical and real rewards produces very similar results, supporting the validity of the testmybrain.org ...
Background
Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are the two primary restrictive eating disorders; however, they are driven by differing motives for inadequate dietary intake. Despite overlap in restrictive eating behaviors and subsequent malnutrition, it remains unknown if ARFID and AN also share commonalities in their cognitive profiles, with cognitive alterations being a key identifier of AN. Discounting the present value of future outcomes with increasing delay to their expected receipt represents a core cognitive process guiding human decision-making. A hallmark cognitive characteristic of individuals with AN (vs. healthy controls [HC]) is reduced discounting of future outcomes, resulting in reduced impulsivity and higher likelihood of favoring delayed gratification. Whether individuals with ARFID display a similar reduction in delay discounting as those with AN (vs. an opposing bias towards increased delay discounting or no bias) is important in informing transdiagnostic versus disorder-specific cognitive characteristics and optimizing future intervention strategies.
Method
To address this research question, 104 participants (ARFID: n = 57, AN: n = 28, HC: n = 19) completed a computerized Delay Discounting Task. Groups were compared by their delay discounting parameter (ln)k.
Results
Individuals with ARFID displayed a larger delay discounting parameter than those with AN, indicating steeper delay discounting (M ± SD = −6.10 ± 2.00 vs. −7.26 ± 1.73, p = 0.026 [age-adjusted], Hedges’ g = 0.59), with no difference from HC (p = 0.514, Hedges’ g = −0.35).
Conclusion
Our findings provide a first indication of distinct cognitive profiles among the two primary restrictive eating disorders. The present results, together with future research spanning additional cognitive domains and including larger and more diverse samples of individuals with ARFID (vs. AN), will contribute to identifying maintenance mechanisms that are unique to each disorder as well as contribute to the optimization and tailoring of treatment strategies across the spectrum of restrictive eating disorders.
... Particularly, neuropsychological research has highlighted two main cognitive deficits in AN, i.e., cognitive inflexibility (or limited set-shifting) [10] and intense attention to detail (or reduced central coherence) that indicate reduced executive and visual-constructive functions [11][12][13]. Reduced set-shifting refers to cognitive difficulties in shifting attentional control upon different tasks and in using different cognitive strategies as environmental circumstances change, while reducing central coherence involves intense focus on details rather than thinking in a holistic processing of information [14][15][16]. Among individuals with AN, both weak set-shifting and reduced central coherence are typically observed through obsessions with food, body image, weight, and compulsive actions like monitoring ...
Background: Cognitive remediation therapy (CRT) for anorexia nervosa (AN) is an intervention specifically focused on addressing cognitive difficulties associated with the eating disorder. This systematic review of systematic reviews and meta-analysis aimed to provide a summary of the existing literature examining the efficacy of CRT in improving the neuropsychological, psychological , and clinical parameters of patients with AN. Methods: Systematic reviews and meta-analyses were sought in electronic databases, encompassing studies that explored the impact of CRT on AN. Three eligible reviews were identified based on the inclusion criteria. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was employed to evaluate the methodological quality of the reviews, and all included reviews demonstrated satisfactory methodological quality with an R-AMSTAR score of ≥22. Relevant information was extracted from each review and qualitatively compiled. Results: Findings suggest that CRT can help people increase their awareness of cognitive styles and information processing and have a positive effect on patients' responses to treatment. Conclusions: Further research is required to better understand its impact on other relevant outcomes, including psychological variables, to optimize the treatment's benefits.
... These neuropsychological assessments require specialized training and are time-consuming and costly to conduct, preventing routine use. It is also thought that the WCST and some subscales of the DKEFS (i.e., Color word interference test) generally capture several domains of cognitive functioning, and performance is not specifically indicative of cognitive flexibility or set-shifting ability (Dann et al., 2021;Friederich & Herzog, 2010;Miles et al., 2022;Stedal & Dahlgren, 2015). Self-report measures of general (Behavior Rating Inventory of Executive Function for Adults (BRIEF-A) (Roth et al., 2005), and eating disorder-specific cognitive flexibility, including the Detail and Flexibility Questionnaire (Roberts et al., 2011), the Cognitive Flexibility Inventory (Dennis & Vander Wal, 2009), and the Eating Disorder Flexibility Index (EDFLIX) (Dahlgren et al., 2019) generally correlate only weakly with established performance-based assessments and evidence for their validity and reliability in diverse samples is lacking (Lounes et al., 2011;. ...
Objective:
Anorexia nervosa (AN) is associated with significant individual mental and physical suffering and public health burden and fewer than half of patients recover fully with current treatments. Comorbid exercise dependence (ExD) is common in AN and associated with significantly worse symptom severity and treatment outcomes. Research points to cognitive inflexibility as a prominent executive function inefficiency and transdiagnostic etiologic and maintaining mechanism linking AN and ExD. This study will evaluate the initial efficacy of adjunctive Cognitive Remediation Therapy (CRT), which has been shown to produce cognitive improvements in adults with AN, in targeting cognitive inflexibility in individuals with comorbid AN and ExD. As an exploratory aim, this study also addresses the current lack of quick and cost-effective assessments of cognitive flexibility by establishing the utility of two proposed biomarkers, heart rate variability and salivary oxytocin.
Method:
We will conduct a single-group, within-subjects trial of an established CRT protocol delivered remotely as an adjunct to inpatient or intensive outpatient treatment as usual (TAU) to adult patients (n = 42) with comorbid AN and ExD. Assessments, including self-report, neuropsychological, and biomarker measurements, will occur at three time points.
Results:
We expect CRT to increase cognitive flexibility transdiagnostically and consequently, along with TAU, positively impact AN and ExD compulsivity and symptom severity, including weight gain.
Discussion:
Findings will inform the development of more effective integrative interventions for AN and ExD targeting shared mechanisms and facilitate the routine assessment of cognitive flexibility as a transdiagnostic risk and maintaining factor across psychopathologies in clinical and research settings.
Public significance:
Patients with anorexia nervosa often engage in excessive exercise, leading to harmful outcomes, including increased suicidal behavior. This study examines the preliminary efficacy of an intervention that fosters flexible and holistic thinking in patients with problematic eating and exercise to, along with routine treatment, decrease harmful exercise symptoms. This study also examines new biological markers of the inflexible thinking style thought to be characteristic of anorexia nervosa and exercise dependence.
... Dysfunctional excitatory and inhibitory activity and connectivity within and between these regions is thought to contribute to errors in food-associated reward prediction [120], errors in processing and awareness of motivational, emotional and feeding cues, and hormonal signals [3,5,113], and a bias towards negative appraisals of self (particularly body image) [121]. These errors in information processing are thought to drive core cognitive deficits in executive control, reward processing and interoceptive awareness that manifest as cognitive inflexibility [122,123], detail-focussed processing [124], harm avoidance [125] and impaired emotional regulation [126]. Many of these aspects of AN are replicated in preclinical ABA models that describe changes in the glutamatergic system. ...
... Theoretically, through modulating glutamatergic and GABAergic neurotransmission, regulators of synaptic plasticity (i.e. BDNF and mTOR), and proinflammatory signalling (depicted in Fig. 2), combined low-dose ketamine and zinc may be able to uncouple dysfunctional neural circuits, and normalise those required for addressing impairments in executive control, reward processing and interoceptive awareness [122][123][124][125][126]. For those living with AN, the possibility of improving their cognitive function may provide a more meaningful reason for exploring novel treatments such as that proposed here, in contrast to the typical focus placed on weight gain and the associated aberrant cognition [35]. ...
Anorexia nervosa is a disorder associated with serious adverse health outcomes, for which there is currently considerable treatment ineffectiveness. Characterised by restrictive eating behaviours, distorted body image perceptions and excessive physical activity, there is growing recognition anorexia nervosa is associated with underlying dysfunction in excitatory and inhibitory neurometabolite metabolism and signalling. This narrative review critically explores the role of N-methyl-d-aspartate receptor-mediated excitatory and inhibitory neurometabolite dysfunction in anorexia nervosa and its associated biomarkers. The existing magnetic resonance spectroscopy literature in anorexia nervosa is reviewed and we outline the brain region-specific neurometabolite changes that have been reported and their connection to anorexia nervosa psychopathology. Considering the proposed role of dysfunctional neurotransmission in anorexia nervosa, the potential utility of zinc supplementation and sub-anaesthetic doses of ketamine in normalising this is discussed with reference to previous research in anorexia nervosa and other neuropsychiatric conditions. The rationale for future research to investigate the combined use of low-dose ketamine and zinc supplementation to potentially extend the therapeutic benefits in anorexia nervosa is subsequently explored and promising biological markers for assessing and potentially predicting treatment response are outlined.
... Motivation to recover is frequently low, due to perceived benefits of restrictive eating behaviors (28). The illness has been associated with high maturity fear, intolerance of uncertainty, perfectionism, anxiety, trauma, cognitive rigidity and alexithymia (13,26,(29)(30)(31)(32)(33)(34)(35)(36)-however, these associations are typically measured quantitatively and thus limited to binary, researcher-derived constructs (impacting interpretive potential). Deriving a more nuanced understanding of these cognitions from the words of those who experience them may be vital to the development of novel therapeutic techniques that enhance interoception, motivation for change and self-efficacy and to understanding why existing treatments aren't successful for many individuals. ...
Anorexia Nervosa (AN) has the highest mortality rate of the mental disorders, with still less than 50% of affected individuals achieving recovery. Recent calls to bring innovative, empirical research strategies to the understanding of illness and its core psychopathological features highlight the need to address significant paucity of efficacious treatment. The current study brings a phenomenological approach to this challenge, synthesizing lived experience phenomena as described by qualitative literature. Fifty-three studies published between the years 1998 and 2021 comprising a total of 1557 participants aged 12–66 suffering from AN or sub-threshold AN are included. Reciprocal and refutational analysis generated six key third-order constructs: “emotion experienced as overwhelming,” “identity,” “AN as a tool,” “internal conflict relating to Anorexia,” “interpersonal communication difficulties” and “corporeality.” Twenty-six sub-themes were identified, the most common being fear, avoidance, AN as guardian/protector, and AN as intertwined with identity. Some themes associated with current treatment models such as low self-esteem, need for social approval and feelings of fatness were less common. We highlight the significant role of intense and confusing emotion in AN, which is both rooted in and engenders amplified fear and anxiety. Restrictive eating functions to numb these feelings and withdraw an individual from a chaotic and threatening world whilst providing a sense of self around which to build an illness identity. Results have implications for therapeutic practice and overly protective weight and shape focused medical treatment models, which may serve to reinforce the disease.
... In AN, despite increasing interest in associations between cognitive flexibility and clinical characteristics, little empirical work has been undertaken to assess the possible impact on everyday function. The available research suggests cognitive flexibility measured using standard neuropsychological performance tests is not strongly associated with functional outcome in AN [9]. However, self-report measures of cognitivebehavioral flexibility appear to be sensitive to the everyday issues experienced by adolescents with AN, and indicate that behavioral response shifting may be more problematic than cognitive shifting [25,42]. ...
PurposeThis study examined the relationship between self-reported cognitive-behavioral flexibility scores on the Eating Disorder Flexibility Index (EDFLIX) and objective social and occupational functional milestones in participants with a lifetime diagnosis of anorexia nervosa (AN). The Work and Social Adjustment Scale (WSAS) was included to compare objective and subjective measures.Methods114 female adult participants with a current (53.5%) or past (46.5%) full or partial AN syndrome diagnosis completed an online survey which included functional milestone questions, the EDFLIX, WSAS, EDE-Q, and DASS-21.ResultsEveryday flexibility scores were significantly associated with WSAS scores, but not functional milestones for the same domain. Lower flexibility was related to higher WSAS work impairment but was not associated with poor occupational outcomes. Lower flexibility was related to higher WSAS social impairment but was not associated with less frequent social contact with friends. Milestones across work, social and relationship areas were not significantly correlated, suggesting individuals have areas of strength and weakness across functional domains. In contrast, WSAS ratings indicated broad functional impairment.Conclusion
Results from the milestones suggest self-reported cognitive-behavioral flexibility is not a strong determinant of everyday function. Results from the subjective WSAS function measure and the more objective functional milestones were not consistent. To obtain a more balanced assessment of everyday functioning in AN, both subjective and objective measures should be considered.Level of evidenceLevel III Case–control analytic study.
