Aberrant Function of Learning and Cognitive Control Networks Underlie Inefficient Cognitive Flexibility in Anorexia Nervosa: A Cross-Sectional fMRI Study

Abstract

ObjectivesPeople with Anorexia Nervosa exhibit difficulties flexibly adjusting behaviour in response to environmental changes. This has previously been attributed to problematic behavioural shifting, characterised by a decrease in fronto-striatal activity. Additionally, alterations of instrumental learning, which relies on fronto-striatal networks, may contribute to the observation of inflexible behaviour. The authors sought to investigate the neural correlates of cognitive flexibility and learning in Anorexia Nervosa.MethodThirty-two adult females with Anorexia Nervosa and thirty-two age-matched female control participants completed the Wisconsin Card Sorting Task whilst undergoing functional magnetic resonance imaging. Event-related analysis permitted the comparison of cognitive shift trials against those requiring maintenance of rule-sets and allowed assessment of trials representing learning.ResultsAlthough both groups performed similarly, we found significant interactions in the left middle frontal gyrus, precuneus and superior parietal lobule whereby blood-oxygenated-level dependent response was higher in Anorexia Nervosa patients during shifting but lower when maintaining rule-sets, as compared to healthy controls. During learning, posterior cingulate cortex activity in healthy controls decreased whilst increasing in the Anorexia Nervosa group, whereas the right precuneus exhibited the opposite pattern. Furthermore, learning was associated with lower blood-oxygenated-level dependent response in the caudate body, as compared to healthy controls.ConclusionsPeople with Anorexia Nervosa display widespread changes in executive function. Whilst cognitive flexibility appears to be associated with aberrant functioning of the fronto-parietal control network that mediates between internally and externally directed cognition, fronto-striatal alterations, particularly within the caudate body, were associated with instrumental learning. Together, this shows how perseverative tendencies could be a substrate of multiple high-order processes that may contribute to the maintenance of Anorexia Nervosa.

Cognitive persistence: Development and validation of a novel measure from the Wisconsin Card Sorting Test

“…Specifically, persistence was associated with error responses in the left IFG and dACC, as well as dACC adaptive-control. The absence of a significant association between set-shifting and cingulo-opercular effects may seem to contradict prior studies that have reported increased activity in cingulo-opercular regions during rule switches (Hampshire, Gruszka, & Owen, 2008; Konishi et al, 2002; Konishi et al, 1998; Lao-Kaim et al, 2015). However, we intentionally measured cingulo-opercular activity during error detection and subsequent improvements in performance—that is, activity related to overcoming obstacles.…”

“…Relative to rule maintenance trials, switching rules evokes a robust frontal P3a component (Barceló, 2003) that is modulated by uncertainty of decision-response outcomes (Kopp & Lange, 2013). Efficient shifting in healthy young adults engages left precuneus, left inferior frontal gyrus (IFG), right dorsal anterior cingulate cortex (dACC) and right middle frontal gyrus (MFG) compared to correctly repeating a rule (Lao-Kaim et al, 2015). In addition, parametrically increasing rule search demands elicits greater activity in the bilateral IFG and MFG, bilateral inferior parietal lobe, right angular gyrus, superior parietal lobule, precuneus and putamen (Wang et al, 2015).…”

Cortico-Striatal-Thalamic Loop Circuits of the Salience Network: A Central Pathway in Psychiatric Disease and Treatment

“…Similarly, AN patients have also been shown to have altered frontostriatal activation on executive function tasks, including the Wisconsin Card Sorting Task (Lao-Kaim et al, 2015), and delay discounting (Wierenga et al, 2014; Decker et al, 2015). During reward conditioning, AN patients show abnormally high SN activity relative to controls (Frank et al, 2012), and an increased preference for delayed rewards over immediate rewards.…”

Psychological and Neurobiological Correlates of Food Addiction

“…A variety of eating behaviors, including the processing of tastes, appearances, and scents of food, and satiety, reward, motivation, reappraisal, craving, and consumption associated with food have been investigated with fMRI (Giuliani & Pfeifer, 2015; Huerta, Sarkar, Duong, Laird, & Fox, 2014; Jiang, Soussignan, Schaal, & Royet, 2015; Murdaugh, Cox, Cook, & Weller, 2012; Robinson, Fischer, Ahuja, Lesser, & Maniates, 2016; Rolls, 2015; Rolls, Kellerhals, & Nichols, 2015; Simmons et al, 2014; Thomas et al, 2015; van Bloemendaal et al, 2015; Wang, Smith, & Delgado, 2016). Evaluation of FA has demonstrated alterations in brain regions involved in reward processing, homeostatic regulation, emotional reactivity, and executive control (Gearhardt, Boswell, & Potenza, 2014; Lao-Kaim et al, 2015; Simon et al, 2016; Ziauddeen, Farooqi, & Fletcher, 2012). Because neuroimaging of FA is still in preliminary stages, only a few studies are currently available to review.…”