Abstract
BackgroundThere is increasing interest in associations between cognitive impairments and clinical symptoms in Anorexia Nervosa (AN), however, the relationship with everyday function is unclear. The current review synthesizes existing data regarding associations between scores on tests of set-shifting and central coherence and functional outcome measures for individuals with AN.MethodA systematic electronic database search yielded 13 studies which included participants with current or lifetime AN where scores on a neuropsychological test of set-shifting or central coherence were directly or indirectly compared to a functional outcome measure.ResultsAssociations between set-shifting and central coherence performance measures and functional outcomes were limited in number and noted only in adult or mixed-age cohorts. Associations were noted at subscale level, suggesting they are specific in nature. In younger cohorts, assessments of executive functioning in everyday life appear sensitive to cognitive-behavioral flexibility issues.ConclusionsAssociations between cognitive performance and functional outcome have not been as systematically assessed in AN as in other psychiatric disorders. Key factors to address in future research include: (a) the use of function measures which are sensitive to both the level of impairment, and specific rather than general impairments (b) the ecological validity of measures, (c) the task impurity problem, especially in regard to cognitive flexibility assessment, and (d) the need to measure both cognitive deficits and strengths, because tests of specific cognitive processes may underestimate the ability to function in daily life due to compensatory strategies.
Highlights
There is increasing interest in associations between cognitive impairments and clinical symptoms in Anorexia Nervosa (AN), the relationship with everyday function is unclear
Plain English summary The current review gathers existing evidence regarding whether poor performance on tests of cognitive flexibility and detail-oriented processing are associated with difficulties in everyday function for people with Anorexia Nervosa
Participants with AN Restricting subtype (AN-R) have been noted to score to healthy controls on a subjective quality of life (QoL) scale, possibly because items may be interpreted differently by AN patients whose concerns are not associated with low weight, and where weight increases towards a healthy range may be associated with a reduction in QoL ratings [58]
Summary
There is increasing interest in associations between cognitive impairments and clinical symptoms in Anorexia Nervosa (AN), the relationship with everyday function is unclear. A focus on detail at the expense of overall conceptual and contextual understanding, is an attentional bias known as weak central coherence [37] Poor performance in these two areas forms a cognitive profile of inflexible, detail-focused processing which is consistent with clinical observations of cognitivebehavioral rigidity in individuals with AN. The Cognitive-Interpersonal Maintenance Model for AN [72] proposes poor set-shifting and weak central coherence underlie obsessive-compulsive traits, and together with socio-emotional avoidance, are key risk factors in both the aetiology and maintenance of the disorder. This inflexible cognitive style is further suggested to contribute to poor treatment engagement and response [84]
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