Clinical and Cognitive Functioning Changes After Partial Hospitalization in Patients With Anorexia Nervosa

Abstract

Introduction: Anorexia nervosa is usually associated with emotional and cognitive difficulties. Little knowledge is available about the changes in cognitive functioning in patients undergoing treatments. The aim of the present study was to longitudinally assess the impact of partial hospitalization on clinical and cognitive functioning in anorexia nervosa.Materials and Methods: 56 women with anorexia nervosa according to DSM-5 criteria and 58 healthy women were enrolled in the study. At baseline, all participants underwent clinical, diagnostic and neuropsychological assessment (T0). Patients were also assessed at the end of the treatment program (T1; n = 56).Results: BMI improved significantly throughout treatment. At baseline, patients showed significantly poorer executive abilities and less specific autobiographical memory. After the day-hospital program, decision-making abilities improved significantly. Response to treatment was predicted by BMI at admission and duration of illness, but neuropsychological performance did not contribute to the prediction model.Discussion: Cognitive difficulties, mostly regarding executive functions, resulted differently affected by clinical improvement. In particular, while cognitive monitoring and cognitive inhibition appear to be mostly stable trait-like characteristics, decision-making is both more state-dependent and sensitive to clinical status. None of the cognitive variables added information about the response to day hospital treatment; patients with short duration of illness and a rapidly decreasing BMI would benefit more from intensive interventions than less “acute” patients. These observations, if confirmed by future studies, have important clinical implications in order to understand the impact of malnutrition on cognitive functioning and to provide individualized effective treatment for patients with anorexia nervosa.

Phonological working memory is adversely affected in adults with anorexia nervosa: a systematic literature review

“…When measuring visuospatial WM, the TMT was the most common task, followed by the Corsi Blocks/Spatial span and the RCFT (Online Resource Table S4). AN and HC groups tended to perform at similar levels across the three measures with no significant difference found in 70% of the studies using the TMT, 80% of the Corsi blocks/Spatial span studies and in 80% of the RCFT studies [ 39 – 41 , 56 , 57 , 61 , 62 , 71 , 72 , 74 – 76 ] (Fig. 2 B).…”

“…No WM component differences were found at the group level when age groups of AN cohorts were mixed in studies. The reviewed studies presented WM impairments in approximately 25% of the tasks relying on the phonological loop and in 30% using the visuospatial sketchpad [ 56 , 76 ] (Fig. 3 C).…”

“…Obsessive compulsive disorder (OCD) was also present in the patient cohorts of van Noort et al [ 39 ] and Malagoli et al [ 37 ], but no exact demographic values were given and no links between WM performance and OCD were made despite the high comorbidity risk in AN, and in particular AN-BP [ 78 , 79 ]. Twelve of the studies included in this review outlined certain psychiatric co-morbidities and psychotropic medications as exclusion factors in AN patient recruitment [ 34 , 55 , 57 – 62 , 72 – 74 , 76 ].…”

“…n = 21, ADHD n = 4, addictive behaviours n = 6, suicide risk n = 26, meds. n = 40 Tenconi et al [ 76 ] Italian F 58 19.50 21.30 19.60 15.60 1.99 N.R 56 Overall means and sums 947 22.20 21.40 22.97 15.71 4.00 225 (in) 188 (out) 850 428 163 257 Attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), binge/purging subtype of anorexia nervosa (AN-BP), body mass index (BMI), disorder (dis. ), restricting subtype of anorexia nervosa (AN-R), medications (meds.…”

Cognitive remediation therapy for anorexia nervosa as a rolling group intervention: Data from a longitudinal study in an eating disorders specialized inpatient unit

“…Anorexia nervosa is also distinguished by a psychopathological core that includes depressive symptomatology and high rates of anxiety and interpersonal and emotional impairments (Meneguzzo et al., 2020; Monteleone et al., 2019; Solmi et al., 2019). The AN onset is usually during adolescence and a specific neuropsychological profile, characterised by specific impairments of executive functions that are partially modified by weight recovery (Tenconi et al., 2021) has been proposed. Indeed, this neuropsychological profile has a strong link to treatment outcome and is characterised by poor cognitive flexibility, impaired central coherence, and inefficient visuospatial processing (Brown et al., 2018; Fuglset, 2019; Harper et al., 2017; Reville et al., 2016; Tenconi et al., 2010).…”