Cognitive flexibility in juvenile anorexia nervosa patients before and after weight recovery

Abstract

Deficits in set-shifting abilities have been robustly described in adult patients with anorexia nervosa (AN). These deficits are associated with behavioral traits, such as rigidity and perfectionism, and are independent of starvation. However, little is known about neurocognitive deficits in juvenile patients with AN. The brain circuits that support set shifting are not fully mature in these patients. One possibility is that neuroendocrinological changes, such as elevated cortisol levels, contributing to alterations in cognitive performance in individuals with AN. Set-shifting abilities (Visual Set-Shifting Task), cortisol levels, self-reported perfectionism and obsessive personality traits were assessed in 28 female adolescent patients with AN before (T0) and after (T1) weight rehabilitation and compared with 27 age- and IQ-matched healthy controls (CG). Compared with the CG, AN patients showed increased reaction times (RT) in shift trials (p < 0.001) and reduced error rates in both shift and non-shift trials across time points (p < 0.05). Across all subjects, perfectionism was associated with increased RTs during shift trials at T1 (r = 0.35, p < 0.05). Subjects with lower cortisol levels showed increased RTs and more errors in non-shift trials (p < 0.05). In contrast to the findings in adult patients, adolescent patients with AN did not display a marked deficit in set-shifting abilities. Instead, they demonstrated a perfectionistic cognitive style that was characterized by increased RTs in shift trials but improved accuracy. One could speculate that the shorter duration of illness and the incomplete maturation of the prefrontal cortices contribute to these findings.

A systematic review of cognitive remediation therapy for anorexia nervosa - development, current state and implications for future research and clinical practice

“…the inability to shift or change mental and behavioural strategies) and central coherence (i.e. the preoccupation with details at the cost of global/contextual processing) contribute to the development of the illness, its perseverance and the likelihood of recovery [12–16]. Early neuropsychological studies and clinical observations of adults with AN laid the groundwork for the development of cognitive remediation therapy (CRT), an intervention specifically tailored to remedy weaknesses in these two domains (i.e.…”

Clinical investigation of set-shifting subtypes in anorexia nervosa

“…To date, perfectionistic traits have been found not only to be positively related to cognitive rigidity (Ferrari and Mautz, 1997;Bühren et al, 2012) but also to play a role in action monitoring in depressed samples (Schrijvers et al, 2010). Individuals affected by ObsessiveCompulsive Disorder (OCD) tend to be characterized by both perfectionism and sub-optimal set-shifting abilities (Cavedini et al, 2010;Bradbury et al, 2011;Demeter et al, 2013) raising the hypothesis that perfectionistic personality traits could underpin both AN symptomatology and poor set-shifting abilities (Friederich and Herzog, 2011).…”

A systematic review of cognitive remediation therapy for anorexia nervosa ¿ development, current state and implications for future research and clinical practice

“…However, as all current RCTs are oriented towards adult patients, we still know little about the intervention's potential in terms of efficacy in younger AN populations. Further, as many recent studies fail to detect neuropsychological impairment in adolescent AN patients [12,40,[77][78][79][80][81], it might be timely to consider other components than neuropsychological performance when assessing the effect of CRT in this patient group, and to learn from recent results suggesting that CRT is more beneficent for those struggling with cognitive weaknesses than in those who perform within the norms [57]. For young AN patients, one might suggest revisiting one of the original aims of the intervention; preparation for subsequent treatment [25,61], but also to pay attention to results recently surfaced such as attrition reduction [59] and enhancing the effectiveness of concurrent treatments [57].…”

“…Eleven studies explore CRT in adult samples (ages , six studies explore CRT in adolescents (ages [12][13][14][15][16][17][18][19], and the remaining four studies samples mix adolescent and adult patients (ages . With the exception of seven male participants, all patients included in the studies (receiving CRT) were female (N = 355), and the vast majority of participants were diagnosed with AN.…”

“…the inability to shift or change mental and behavioural strategies) and central coherence (i.e. the preoccupation with details at the cost of global/contextual processing) contribute to the development of the illness, its perseverance and the likelihood of recovery [12][13][14][15][16]. Early neuropsychological studies and clinical observations of adults with AN laid the groundwork for the development of cognitive remediation therapy (CRT), an intervention specifically tailored to remedy weaknesses in these two domains (i.e.…”