Case report: cognitive performance in an extreme case of anorexia nervosa with a body mass index of 7.7

Abstract

Background: Studies show that adult patients with anorexia nervosa display cognitive impairments. These impairments may be caused by illness-related circumstances such as low weight. However, the question is whether there is a cognitive adaptation to enduring undernutrition in anorexia nervosa. To our knowledge, cognitive performance has not been assessed previously in a patient with anorexia nervosa with a body mass index as low as 7.7 kg/m2. Case presentation: We present the cognitive profile of a 35-year-old woman with severe and enduring anorexia nervosa who was diagnosed at the age of 10 years. She was assessed with a broad neuropsychological test battery three times during a year. Her body mass index was 8.4, 9.3, and 7.7 kg/m 2 , respectively. Her general memory performance was above the normal range and she performed well on verbal and design fluency tasks. Her working memory and processing speed were within the normal range. However, her results on cognitive flexibility tasks (set-shifting) were below the normal range. Conclusions: The case study suggests that it is possible to perform normally cognitively despite extreme and chronic malnutrition though set-shifting ability may be affected. This opens for discussion whether patients with anorexia nervosa can maintain neuropsychological performance in spite of extreme underweight and starvation. Trial registration: ClinicalTrials.gov, NCT02502617. Registered

The Neuropsychological Profile of Severe and Enduring Anorexia Nervosa: A Systematic Review

“…The final study explored the neuropsychological functioning of a single patient with a SE-AN presentation. Despite this case report by Hemmingsen et al ( 2020 ) investigating set-shifting through five measures, the current study focused on the findings from the WCST (Berg, 1948 ) given its popularity and comparability to the other two studies in this review. With no healthy control sample, standardised norms were used as a comparison to determine set-shifting ability 2 weeks after the patient had been admitted into hospital for treatment 3 .…”

“…The third study that included an assessment of memory performance was from a case report by Hemmingsen et al ( 2020 ), which measured memory performance using the Wechsler Memory Scale III (WMS-III; Wechsler, 1997b ). Using standardised norms as a comparison, the participant's scores indicate high average to very superior auditory, visual, immediate and general memory ability.…”

“…Attention is a cognitive process that involves focusing the mind in a clear and vivid manner on one task or object at the expense of others (Cohen, 2014 ). Two studies assessed attention with Seidel et al ( 2021 ) using the CogTrack TM internet-based system (Wesnes et al, 2017 ) and Hemmingsen et al ( 2020 ) using the d2R Test of Attention – Revised (Brickenkamp et al, 2010 ). For the study by Seidel et al ( 2021 ), three tasks created two composite scores for attention.…”

“…The test utilised by Hemmingsen et al ( 2020 ) provided an indication of selective attention whilst balancing the components of speed and accuracy. It is commonly scored by the number of processed targets whilst taking into consideration the number of errors (Hahm et al, 2020 ).…”

“…It is commonly scored by the number of processed targets whilst taking into consideration the number of errors (Hahm et al, 2020 ). Using standardised norms as a comparison, Hemmingsen et al ( 2020 ) reported the participant to have made a number of processed targets within the low average range (21st percentile). Concentration performance was determined to be within the average range (42nd percentile) and the number of errors made within the high average range (>90th percentile).…”