Neuropsychology of eating disorders: A systematic review of the literature
Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Grupo de Obesidade e Transtornos Alimentares, Instituto Estadual de Diabetes e Endocrinologia (IEDE-RJ), RJ, Brazil. Revista Brasileira de Psiquiatria
(Impact Factor: 1.77).
The pathophysiology of eating disorders is still unknown, with many factors possibly involved. The existence of a central nervous system (CNS) dysfunction is being investigated with particular interest. One of the most employed strategies to reach this goal is the evaluation of cognitive functioning of patients with eating disorders with neuropsychological tests.
To evaluate the current knowledge about the neuropsychology of ED.
We performed a review of several data bases (including MedLINE, PsychoINFO, LILACS and Cochrane Data Bank), using terms related to main theme of interest. The review comprised articles published up to January, 2004.
Anorexia Nervosa (AN) was the most studied ED from the neuropsychological point-of-view, with studies tending to elicit attentive, visuo-spatial, and visuo-constructive deficits among such patients. On the other side, patients with Bulimia Nervosa (BN) exhibited deficits in the selective aspects of attention and in executive functions. As yet, there is no study covering the neuropsychological aspects of binge-eating disorder. After successful treatment, individuals show improvement of some cognitive deficits, while other seem to persist.
The ED are possibly associated with a certain degree of neuropsychological dysfunction, even though there is no consensus with regard to which function is particularly impaired. The fact that some cognitive dysfunction tend to disappear after treatment argues in favor of the hypothesis that these are functional deficits. Other deficits, however, tend to persist, suggesting that they may precede the development of eating disorders or even contribute to their development or to a worse prognosis. The study of the neuropsychological aspects of ED may help tailoring more selective therapeutic approaches to patients suffering from these disorders.
Available from: Stefan Ehrlich
- "Additional data from recAN patients as well as longitudinal data are needed to verify these findings. Numerous neuropsychological studies in patients with acute AN (acAN) have demonstrated severe deficits in cognitive functioning, in particular in the areas of verbal learning, visuo-spatial thinking, psychomotor speed, and attention (Duchesne et al., 2004). These changes may be related to the well documented cortical atrophy and decreased grey and white matter volumes in these patients (Kerem and Katzman, 2003; Mainz et al., 2012; Ohrmann et al., 2004). "
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ABSTRACT: Several studies support the assumption that brain-derived neurotrophic factor (BDNF) plays an important role in the pathophysiology of eating disorders. In the present cross-sectional and longitudinal study, we investigated BDNF levels in patients with anorexia nervosa (AN) at different stages of their illness and the association with cognitive functioning. We measured serum BDNF in 72 acutely underweight female AN patients (acAN), 23 female AN patients who successfully recovered from their illness (recAN), and 52 healthy control woman (HCW). Longitudinally, 30 acAN patients were reassessed after short-term weight gain. The association between BDNF levels and psychomotor speed was investigated using the Trail Making Test. BDNF serum concentrations were significantly higher in recAN participants if compared to acAN patients and increased with short-term weight gain. In acAN patients, but not HCW, BDNF levels were inversely associated with psychomotor speed. AcAN patients with higher BDNF levels also had lower life time body mass indexes. Taken together, our results indicate that serum BDNF levels in patients with AN vary with the stage of illness. Based on the pleiotropic functions of BDNF, changing levels of this neurotrophin may have different context-dependent effects, one of which may be the modulation of cognitive functioning in acutely underweight patients.
- "Research into the neuropsychology of anorexia nervosa has consistently revealed weaknesses in visual attention, learning, nonvisual memory, and executive functions. There is an even greater body of evidence suggesting impairments in visuospatial processing and memory (see reviews byDuchesne et al., 2004;Lena, Fiocco, & Leyenaar, 2004;Roberts, Tchanturia, Stahl, Southgate, & Treasure, 2007;Zakzanis, Campbell, & Polsinelli, 2010). A further area of interest to have emerged in the neuropsychological literature concerns organizational strategy and central coherence. "
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ABSTRACT: The vast majority of studies in anorexia nervosa that have investigated the domains of central coherence, organizational strategy, and visuospatial memory have focused on adult samples. In addition, studies investigating visuospatial memory have focused on free recall. No study to date has reported the association between recognition memory and central coherence or organizational strategy in younger people with this disorder, yet the capacity to recognize previously seen visual stimuli may contribute to overall visuospatial ability. Therefore, we investigate these domains in children and adolescents with anorexia nervosa compared to age- and gender-matched healthy controls. There were no significant group differences in immediate, delayed, or recognition memory, central coherence, or organization strategy. When compared with controls, patients with anorexia nervosa scored significantly higher on accuracy and took significantly longer when copying the Rey Complex Figure Task. Caution must be taken when interpreting these findings due to lower-than-expected scores in memory performance in the control group and because of a potential lack of sensitivity in the measures used when assessing this younger population. For neuropsychological functions where no normative data exist, we need a deeper, more thorough knowledge of the developmental trajectory and its assessment in young people in the general population before drawing conclusions in anorexia nervosa.
Available from: Ignacio Jáuregui-Lobera
- "The specific pathophysiology of ED is unknown, and it is likely that different factors are involved.4 To date, ED have been described on the basis of overt clinical phenotypes, a method that is perhaps not effective for exploring the specific etiology of these disorders.5 "
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ABSTRACT: Eating disorders are considered psychiatric pathologies that are characterized by pathological worry related to body shape and weight. The lack of progress in treatment development, at least in part, reflects the fact that little is known about the pathophysiologic mechanisms that account for the development and persistence of eating disorders. The possibility that patients with eating disorders have a dysfunction of the central nervous system has been previously explored; several studies assessing the relationship between cognitive processing and certain eating behaviors have been conducted. These studies aim to achieve a better understanding of the pathophysiology of such diseases. The aim of this study was to review the current state of neuropsychological studies focused on eating disorders. This was done by means of a search process covering three relevant electronic databases, as well as an additional search on references included in the analyzed papers; we also mention other published reviews obtained by handsearching.
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