Cognitive Function in Adults with Enduring Anorexia Nervosa

Abstract

Anorexia Nervosa (AN) is a severe and often enduring disorder characterized by restriction of food intake, low body weight, fear of weight gain, and distorted body image. Investigations on cognition performance in AN patients have yielded conflicting results. Using an established and sensitive computerized cognitive test battery, we aimed to assess core aspects of cognitive function, including attention span, information processing, reasoning, working and episodic memory, in AN patients and controls. Patients were recruited from the Danish Prospective Longitudinal all-comer inclusion study in Eating Disorders (PROLED). Included were 26 individuals with AN and 36 healthy volunteers (HV). All were tested with CogTrack (an online cognitive assessment system) at baseline, and AN patients were tested again at a follow-up time point after weight increase (n = 13). At baseline, AN patients showed faster reaction times in the attention tasks, as well as increased accuracy in grammatical reasoning compared to HV. There were no differences in cognitive function between AN patients and HV in the other cognitive domains measured (sustained attention, working and episodic memory, speed of retrieval, and speed of grammatical reasoning). No differences were visible in the AN sample between baseline and follow-up. Performance did not correlate with any clinical variables in the AN sample. These findings supplement results from other studies suggesting increased concentration and reasoning accuracy in patients suffering from AN, who showed increased performance in cognitive tasks despite their illness.

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

“…The difference in findings from the study by Seidel et al ( 2021 ) and the analysis from the current review may be explained by those with a more severe and enduring illness adapting to these impairments over time (with the original study containing individuals with a less chronic presentation, with illness duration M = 9.19, SD = 5.35). For the analysis conducted in the current study, the inclusion criteria required participants to have a minimum illness duration of 7 years, therefore comprising a more severe and enduring sample.…”

“…The second study by Seidel et al ( 2021 ) utilised the CogTrack TM system, which is a program comprising of online cognitive tasks that assesses major aspects of cognitive functioning (Wesnes et al, 2017 ). Measures relating to memory that were assessed included the Quality of Memory score as well as the following three index scores: Working Memory Capacity Index (comprised of accuracy scores from the “Spatial Working Memory” and “Numeric Working Memory” tasks); Episodic Memory Capacity Index (comprised of accuracy scores from the “Word Recognition,” “Immediate Word Recall,” “Delayed Word Recall,” and the “Pattern Separation” tasks with consideration for the number of errors); and Speed of Retrieval Index (comprised of the reaction time scores for “Numeric Working Memory,” “Spatial Working Memory,” “Word Recognition,” and “Pattern Separation” tasks).…”

“…Attention is a cognitive process that involves focusing the mind in a clear and vivid manner on one task or object at the expense of others (Cohen, 2014 ). Two studies assessed attention with Seidel et al ( 2021 ) using the CogTrack TM internet-based system (Wesnes et al, 2017 ) and Hemmingsen et al ( 2020 ) using the d2R Test of Attention – Revised (Brickenkamp et al, 2010 ). For the study by Seidel et al ( 2021 ), three tasks created two composite scores for attention.…”

“…Two studies assessed attention with Seidel et al ( 2021 ) using the CogTrack TM internet-based system (Wesnes et al, 2017 ) and Hemmingsen et al ( 2020 ) using the d2R Test of Attention – Revised (Brickenkamp et al, 2010 ). For the study by Seidel et al ( 2021 ), three tasks created two composite scores for attention. The first was an Attentional Intensity Index (comprised of the sum of the reaction time scores for the “Simple Reaction Time,” “Digit Vigilance,” and “Choice Reaction Time” tasks), with an independent samples t- test revealing no significant differences between the severe and enduring proportion of the AN sample ( M = 1234.33, SD = 156.98) and the healthy control participants ( M = 1241.50, SD = 119.15; t (51) = −0.18 (two-tailed), p = 0.85, mean difference between groups = −7.17, CI [−85.27, 70.93]).…”

“…Reasoning is a multi-stage process whereby the combination of prior knowledge and new information allows for inferences to be drawn that will guide new thought patterns and/or human behaviour (Adolphs et al, 1996 ; Krawczyk, 2018 ). A study by Seidel et al ( 2021 ) explored Grammatical Reasoning using the CogTrack TM system (Wesnes et al, 2017 ), which was measured by an Overall Accuracy and Speed score. An independent samples t -test was conducted with no statistically significant difference in the Grammatical Reasoning Overall Accuracy between the severe and enduring proportion of the AN participants ( M = 89.89, SD = 11.24) and the healthy control sample ( M = 83.42, SD = 15.07; t (51) = 1.57 (two-tailed), p = 0.12, mean difference between groups = 6.47, CI [−1.79, 14.73]).…”