Cognitive flexibility, central coherence, and quality of life in anorexia nervosa

Abstract

Background Anorexia nervosa (AN) has consistently been found to be associated with poor cognitive flexibility and central coherence. These two cognitive functions have been considered important maintenance factors in AN and are addressed by specific treatment approaches such as cognitive remediation therapy. While there is clear empirical evidence that difficulties in such cognitive functions are related to impaired daily functioning in schizophrenia and bipolar disorder, this potential association has received only little attention in AN research so far. Therefore, the aim of this study was to examine potential relationships between weak cognitive flexibility, central coherence, and poor quality of life (QoL) in AN. Methods Cognitive flexibility and central coherence were measured by both neuropsychological (i.e., performance based) and self-report measures alongside with self-reported QoL in a sample of 138 adult patients with AN. Results Self-report but not performance based measures of cognitive flexibility and central coherence were associated with QoL. Weaker cognitive flexibility and central coherence were correlated with poorer QoL. These associations were independent of comorbid depression. The link between weak central coherence and poor QoL was particularly strong in patients with the restricting subtype of AN. The link between cognitive flexibility and QoL, however, was independent of AN subtype. Conclusions Weak cognitive flexibility and central coherence are associated with low QoL in AN, especially in patients with the restrictive subtype. However, this relationship is dependent on the method of measurement, where self-report measures seem to be more relevant than performance based measures.

Using Electroencephalogram-Extracted Nonlinear Complexity and Wavelet-Extracted Power Rhythm Features during the Performance of Demanding Cognitive Tasks (Aristotle’s Syllogisms) in Optimally Classifying Patients with Anorexia Nervosa

“…The finding of a bias toward local information processing at the level of detail in a demanding visual search task is in accordance with the psychopathology of the disorder, reflecting difficulties in central coherence [ 38 ]. Impaired cognitive flexibility and weak central coherence (i.e., the ability to overview complex information) are intended as maintenance factors in AN and targeted in specialized therapies [ 39 ].…”

The Efficacy of Cognitive Remediation Therapy for Anorexia Nervosa: A Systematic Review of Systematic Reviews

“…Particularly, neuropsychological research has highlighted two main cognitive deficits in AN, i.e., cognitive inflexibility (or limited set-shifting) [10] and intense attention to detail (or reduced central coherence) that indicate reduced executive and visual-constructive functions [11][12][13]. Reduced set-shifting refers to cognitive difficulties in shifting attentional control upon different tasks and in using different cognitive strategies as environmental circumstances change, while reducing central coherence involves intense focus on details rather than thinking in a holistic processing of information [14][15][16]. Among individuals with AN, both weak set-shifting and reduced central coherence are typically observed through obsessions with food, body image, weight, and compulsive actions like monitoring Brain Sci.…”

“…It directs its attention toward cognitive processes rather than emotional aspects, thus addressing cognitive function defects rather than the psychopathology of ED [22,23]. It is also aimed at increasing individuals' motivation to change and overall quality of life [14,[24][25][26][27][28][29][30].…”

Psilocybin prevents activity-based anorexia in female rats by enhancing cognitive flexibility: contributions from 5-HT1A and 5-HT2A receptor mechanisms

“…Cognitive inflexibility may be a trait marker of vulnerability to AN, considering that dysfunction arises before the onset of symptoms 3 and persists after weight recovery 4 . Impairments in cognitive flexibility have been consistently seen in AN patients [5][6][7][8] , and are associated with low quality of life 9 , making this symptom a primary target for AN therapeutic intervention. Cognitive flexibility is a fundamental element of executive functioning that allows for behavioural adaptation to a variable environment, and as a consequence, is associated with favourable outcomes throughout the lifespan 10 .…”

“…Life time prevalence rates of AN are estimated at up to 4% in females and 0.5% in males 3 and while selective serotonin reuptake inhibitors (SSRIs) are the leading pharmacological treatment, they do not improve clinical symptoms in underweight individuals with AN 4 .Cognitive inflexibility may be a trait marker of vulnerability to AN, considering that dysfunction arises before the onset of symptoms 5 and persists after weight recovery 6 . Impairments in cognitive flexibility have been consistently seen in AN patients 7–10 , and are associated with low quality of life 11 , making this symptom a primary target for therapeutic intervention. Cognitive flexibility is a fundamental element of executive functioning that allows for behavioural adaptation to a variable environment, and as a consequence, is associated with favourable outcomes throughout the lifespan 12 .…”