The Role of Working Memory for Cognitive Control in Anorexia Nervosa versus Substance Use Disorder

Abstract

Prefrontal cortex executive functions, such as working memory (WM) interact with limbic processes to foster impulse control. Such an interaction is referred to in a growing body of publications by terms such as cognitive control, cognitive inhibition, affect regulation, self-regulation, top-down control, and cognitive–emotion interaction. The rising trend of research into cognitive control of impulsivity, using various related terms reflects the importance of research into impulse control, as failure to employ cognitions optimally may eventually result in mental disorder. Against this background, we take a novel approach using an impulse control spectrum model – where anorexia nervosa (AN) and substance use disorder (SUD) are at opposite extremes – to examine the role of WM for cognitive control. With this aim, we first summarize WM processes in the healthy brain in order to frame a systematic review of the neuropsychological, neural and genetic findings of AN and SUD. In our systematic review of WM/cognitive control, we found n = 15 studies of AN with a total of n = 582 AN and n = 365 HC participants; and n = 93 studies of SUD with n = 9106 SUD and n = 3028 HC participants. In particular, we consider how WM load/capacity may support the neural process of excessive epistemic foraging (cognitive sampling of the environment to test predictions about the world) in AN that reduces distraction from salient stimuli. We also consider the link between WM and cognitive control in people with SUD who are prone to ‘jumping to conclusions’ and reduced epistemic foraging. Finally, in light of our review, we consider WM training as a novel research tool and an adjunct to enhance treatment that improves cognitive control of impulsivity.

Intact value-based decision-making during intertemporal choice in women with remitted anorexia nervosa? An fMRI study

“…43,44 The current (null) findings in weight-recovered participants are generally supportive of this conclusion when considered in conjunction with the group differences previously observed in acutely underweight patients with anorexia nervosa 18 using the same task. Functional neuroimaging studies of simple reward processing and cognitive control have documented persistent alterations in weight-recovered patients with anorexia nervosa, 4,45,46 but few fMRI studies in the domain of rewardrelated decision-making (other than delay discounting studies discussed below) have focused on this population. Similar to the current findings of no group differences in dACC function in weight-recovered patients with anorexia nervosa, Ritschel and colleagues 47 found (in contrast to acutely underweight patients 48,49 ) no group differences in dACC response to negative feedback in a decision-making task that required participants to adapt choice behaviour to changing reward contingencies.…”

“…Although many people have difficulty avoiding temptation from unhealthy foods and sticking to a nutritious diet, people with anorexia nervosa seem to resist hunger and restrict caloric intake with relative ease. This unusual ability is often assumed to reflect an excessive (self-destructive) amount of self-control (defined as the capacity to inhibit inappropriate or undesired responses in the pursuit of long-term goals 1 ), and/or a generalized reward sensitivity, [2][3][4] both of which may contribute to maintenance of the disorder. 5 To understand the seemingly exaggerated self-control and paradoxical reward-related decision-making in anorexia nervosa, studies have employed delay-discounting (or "intertemporal choice") paradigms.…”

Altered Processing and Integration of Multisensory Bodily Representations and Signals in Eating Disorders: A Possible Path Toward the Understanding of Their Underlying Causes

“…However, as we have just seen, these different sources are all shaped by the process of predictive multisensory integration. More, we know that different processes (i.e., working memory), neurotransmitters (i.e., serotonin) and brain areas related to multisensory integration (i.e., frontal and parietal lobes) are impaired in individuals with EDs (Gaudio et al, 2016 ; Riva, 2016 ; Brooks et al, 2017 ).…”

Cognitive remediation therapy of working memory in addictive disorders: An individualized, tailored, and recovery-oriented approach

“…More specifically, many individuals with SUD present neurocognitive deficits across a wide range of functions, including planning, attention, memory, response inhibition, emotion recognition, and decision making [8][9][10]. In particular, several core executive functions, such as working memory (the ability to maintain and manipulate limited amounts of information to serve current goals), are frequently impaired in SUD [11]. Such impairments have been linked to poor self-regulation and decision making [12], which are hallmarks of addictive disorders.…”