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

Abstract

Characteristics of Severe and Enduring Anorexia Nervosa (SE-AN) are being investigated to differentiate the patients experiencing SE-AN from those at earlier stages of the AN disease. The current systematic review was the first step in exploring neuropsychological functioning as a potentially identifying characteristic for long-term presentations. With a subgroup of AN patients reflecting a unique neuropsychological profile that is proportionate to the quantity of patients that go on to develop SE-AN, it was the aim of this review to assess neuropsychological functioning in the later stage of the disease. In accordance with PRISMA guidelines, a literature search was conducted using four electronic databases (PsycINFO, MEDLINE, Web of Science, and Scopus) for neuropsychological research on AN participants with a seven or more year illness duration. Datasets that met inclusion criteria were screened for SE-AN participants (N = 166) and neuropsychological data extracted together with potentially confounding variables and information required to conduct a quality assessment. In research investigating decision-making, participants with a SE-AN presentation demonstrated significantly lower functioning compared to healthy controls. There was conflicting evidence for differences in intellectual functioning and set-shifting abilities with no variability indicated in central coherence, memory, attention, reasoning, or processing speed. If findings from this preliminary analysis are confirmed through empirical research, implications include earlier identification of SE-AN patients and more effective treatment development.

Research Review: Neuropsychological functioning in young anorexia nervosa: A meta‐analysis

“…Our moderator analyses also showed a significant effect of age, revealing that older participants exhibited a stronger negative effect, that is, poorer neuropsychological test performance. Previous studies have suggested that prolonged illness may amplify neuropsychological difficulties (Lang, Stahl, et al., 2014) with preliminary evidence from a recently conducted systematic review suggesting this may be particularly relevant in the domains of decision‐making, intellectual functioning and set shifting abilities (Broomfield, Stedal, & Touyz, 2021). Harper, Brodrick, Van Enkevort, and McAdams (2017) proposed that neuropsychological functioning is an important predictor of patients’ ability to recover.…”

Does hypoleptinemia trigger entrapment in anorexia nervosa? Etiological and clinical considerations

“…Patients with AN present with varying degrees of underweight and starvation and different disease durations. In general, both somatic and mental problems increase with the degree and duration of underweight/starvation (Broomfield et al., 2021; Gibson et al., 2020). If leptin plays an important role in the development of the clinical symptoms of AN, the variability among patients with respect to FYI (leptin level, sObR), BMI, fat mass, disease duration and the degree of the adaptation to starvation warrants consideration.…”

Emergency room presentations of people with anorexia nervosa

“…Malnutrition has been shown to affect the brain in a variety of ways including causing increased obsession with food, depression, apathy, and impulsivity, all of which can reinforce AN cognitions and cloud decisionmaking [18][19][20]. And, ambivalence regarding treatment is common, which may adversely impact an individual's decision-making regarding necessary treatment for their AN [21][22][23][24].…”