Abstract
Patients with anorexia nervosa (AN) are characterised by increased self-control, cognitive rigidity and impairments in set-shifting, but the underlying neural mechanisms are poorly understood. Here we used functional magnetic resonance imaging (fMRI) to elucidate the neural correlates of behavioural adaptation to changes in reward contingencies in young acutely ill AN patients. Thirty-six adolescent/young adult, non-chronic female AN patients and 36 age-matched healthy females completed a well-established probabilistic reversal learning task during fMRI. We analysed hemodynamic responses in empirically-defined regions of interest during positive feedback and negative feedback not followed/followed by behavioural adaptation and conducted functional connectivity analyses. Although overall task performance was comparable between groups, AN showed increased shifting after receiving negative feedback (lose-shift behaviour) and altered dorsal anterior cingulate cortex (dACC) responses as a function of feedback. Specifically, patients had increased dACC responses (which correlated with perfectionism) and task-related coupling with amygdala preceding behavioural adaption. Given the generally preserved task performance in young AN, elevated dACC responses specifically during behavioural adaption is suggestive of increased monitoring for the need to adjust performance strategies. Higher dACC-amygdala coupling and increased adaptation after negative feedback underlines this interpretation and could be related to intolerance of uncertainty which has been suggested for AN.
Highlights
Patients with anorexia nervosa (AN) are characterised by increased self-control, cognitive rigidity and impairments in set-shifting, but the underlying neural mechanisms are poorly understood
Further support has come from recent functional magnetic resonance imaging studies showing abnormal neural responses in brain regions implicated in cognitive control including subregions of the anterior cingulate cortex (ACC) and the dorsolateral prefrontal cortices (DLPFC)[14] during simple target detection[15], reward processing[16,17,18], response inhibition[19,20,21], set-shifting[22] and working memory[23]
Deficient response inhibition has been associated with weight gain[28], Another study suggested that the orbitofrontal cortex (OFC) integrates competing goal values when choosing between healthy versus tasty food and that this process is modulated by the DLPFC – one of the core areas of the cognitive control system[29]
Summary
Patients with anorexia nervosa (AN) are characterised by increased self-control, cognitive rigidity and impairments in set-shifting, but the underlying neural mechanisms are poorly understood. Personality characteristics like perfectionism, low impulsivity, intolerance of uncertainty and high harm avoidance are common and often seen already premorbidly in individuals with AN1–3 These cognitive styles and behavioural schemata may have adverse effects on AN patients’ decision making capacity, e.g. they may interfere with the ability to learn from experience[4]. Further support has come from recent functional magnetic resonance imaging (fMRI) studies showing abnormal neural responses in brain regions implicated in cognitive control including subregions of the anterior cingulate cortex (ACC) and the dorsolateral prefrontal cortices (DLPFC)[14] during simple target detection[15], reward processing[16,17,18], response inhibition[19,20,21], set-shifting[22] and working memory[23]. In line with this seemingly extraordinary will power, patients were reported to have a tendency to delay immediate but smaller for larger rewards in the future (decreased delay discounting30) – the latter finding has not been replicated using other delay discounting tasks[31,32,33]
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