Are poor set-shifting and central coherence associated with everyday function in anorexia nervosa? A systematic review

Abstract Background There 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. Method A 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. Results Associations 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. Conclusions Associations 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.

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Is set-shifting and central coherence in anorexia nervosa influenced by body mass index, anxiety or depression? A systematic review

BMC Psychiatry ◽

10.1186/s12888-021-03120-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tone Seim Fuglset

Keyword(s):

Systematic Review ◽

Body Mass Index ◽

Anorexia Nervosa ◽

Body Mass ◽

Treatment Strategies ◽

Central Coherence ◽

Future Research ◽

Neuropsychological Function ◽

Set Shifting ◽

Neuropsychological Impairments

Abstract Background Anorexia nervosa (AN) is a severe eating disorder, recognized by a relentless pursuit for thinness and extreme low body weight. The disorder is often accompanied by comorbid disorders such as anxiety and depression, and altered neuropsychological function in terms of poor set-shifting and reduced central coherence. The aim of this review was to evaluate whether neuropsychological impairments in AN are influenced by body mass index, anxiety or depression. Method A systematic review approach was used, following the PRISMA guidelines for systematic reviews. Literature was identified via searches in PubMed, PsychInfo and Embase database, by using the search words [anorexia nervosa] AND [central coherence], and [anorexia nervosa] AND [set-shifting]. Studies were included if they were written in English, peer-reviewed, included individuals with AN, included tests measuring set-shifting and/or central coherence, investigated associations between set-shifting/central coherence with anxiety and/or depression and/or BMI. Risk of bias was assessed by using a critical appraisal checklist from the Joanna Briggs Institute. Results were summarized in a narrative synthesis. Results Although results are heterogeneous, the majority of studies report that neither body mass index (BMI), anxiety or depression is associated with altered central coherence and set-shifting in individuals with AN. Conclusions Findings indicate that BMI, depression and anxiety does not influence neuropsychological function in AN, suggesting that it could be a characteristic of the disorder. A complete understanding of predisposing, precipitating and maintaining factors in AN needs to be addressed in future research. This could contribute to the development of better and more targeted treatment strategies.

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Differences in set-shifting and central coherence across anorexia nervosa subtypes in children and adolescents

European Eating Disorders Review ◽

10.1002/erv.2605 ◽

2018 ◽

Vol 26 (5) ◽

pp. 499-507 ◽

Cited By ~ 5

Author(s):

Laura Herbrich ◽

Viola Kappel ◽

Betteke Maria van Noort ◽

Sibylle Winter

Keyword(s):

Anorexia Nervosa ◽

Children And Adolescents ◽

Central Coherence ◽

Set Shifting

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Contribution of executive functions to eating behaviours in obesity and eating disorders

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465820000260 ◽

2020 ◽

Vol 48 (6) ◽

pp. 725-733 ◽

Cited By ~ 2

Author(s):

Mara Segura-Serralta ◽

Sonia Ciscar ◽

Lorena Blasco ◽

Javier Oltra-Cucarella ◽

María Roncero ◽

...

Keyword(s):

Decision Making ◽

Eating Disorders ◽

Executive Functions ◽

Iowa Gambling Task ◽

Clinical Symptoms ◽

Wisconsin Card Sorting Test ◽

Central Coherence ◽

Healthy Controls ◽

Set Shifting ◽

Eating Behaviours

AbstractBackground:Patients with eating disorders (ED) or obesity show difficulties in tasks assessing decision-making, set-shifting abilities and central coherence.Aims:The aim of this study was to explore executive functions in eating and weight-related problems, ranging from restricting types of ED to obesity.Method:Two hundred and eighty-eight female participants (75 with obesity; 149 with ED: 76 with restrictive eating, 73 with bingeing-purging symptoms; and 64 healthy controls) were administered the Wisconsin Card Sorting Test, the Iowa Gambling Task, and the Group Embedded Figures Test to assess set-shifting, decision-making and central coherence, respectively.Results:Participants with either obesity or ED performed poorly on tests measuring executive functioning compared with healthy controls, even after controlling for age and intelligence. Both participants with obesity and participants with ED showed a preference for global information processing.Conclusions:The findings suggest that treatments for obesity and ED would benefit from addressing difficulties in cognitive functioning, in addition to the more evident clinical symptoms related to eating, body weight and shape.

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