The improvement in neurocognitive functioning in anorexia nervosa adolescents throughout the integrative model of psychotherapy including cognitive remediation therapy

K Kucharska, D Kulakowska, M Starzomska, F Rybakowski, K Biernacka, K Kucharska, D Kulakowska, M Starzomska, F Rybakowski, K Biernacka

Abstract

Background: Patients with anorexia nervosa (AN) experience difficulties in neurocognitive functioning in the acute phase of illness which might be related to clinical presentation, but also in the apparently remitted state after weight recovery. Among the most commonly reported persistent deficits is cognitive inflexibility, which can be interpreted as a vulnerability trait or a "neuropsychological scar" reflecting the detrimental effect of prolonged semi-starvation in patients with a long duration of illness. Studies of adolescent samples with a relatively short clinical course may enable avoiding the effect of prolonged illness and help to determine whether neuropsychological deficits are trait or state dependent. The aim of this study is to assess cognitive functioning in adolescents with AN before and after the inpatient treatment programme, including cognitive remediation therapy (CRT).

Methods: Forty-seven adolescent female inpatients with AN diagnosed according to DSM-5 and fifty healthy female adolescents matched for the education level and age were recruited. The patients underwent a multimodal treatment including a ten-week CRT. The standardized and cross-validated neuropsychological (Trail Making Test - TMT A and B, Color-Word Stroop Task - CWST, Ruff Figural Fluency Test - RFFT) and clinical measurements (Beck Depression Inventory - BDI, Eating Attitude Test - EAT-26, Yale-Brown Obsessive Compulsive Scale - Y-BOCS) were used to assess both clinical (in the acute phase and after partial weight recovery) and control subjects.

Results: Initially, AN patients performed significantly worse compared to the controls, but afterwards, inpatient treatment improvement was noted on all examined measures. In a few subtests (TMT, CWST) performance of AN patients after the programme was still significantly poorer than in HC.

Conclusions: Cognitive inflexibility in adolescent AN patients, as measured with TMT, CWST, and RFFT tends to improve after therapy. Nevertheless, a few neuropsychological subtests which did not show complete normalization may warrant attention in subsequent studies. Further research including control intervention is needed to conclude whether CRT intervention affects the outcome.

Keywords: Anorexia nervosa; Cognitive remediation therapy; Neurocognition; Psychotherapy.

Conflict of interest statement

Ethics approval and consent to participate

Study was conducted at the Department of Child and Adolescent Psychiatry in The Institute of Psychiatry and Neurology in Warsaw, Poland; Principal Investigator—Prof. K. Kucharska.

Patients were assessed after giving informed written consent. Informed written consent of participation in the study were obtained from all participants (or their parent or legal guardian in the case of children under 16). Approval for the study was obtained from the ethics committee of the Institute of Psychiatry and Neurology in Warsaw, Poland on 26th February 2015 (reference number 7/2015 KB IPiN).

Competing interests

The authors declare that they have no competing interests.

This research is supported by National Centre of Science (NCN) (Grant No. 2014/15/B/HS6/01847).

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Clinical data for three subject groups. BDI - Beck Depression Inventory, EAT-26 - Eating Attitude Test-26, Y-BOCS - Yale–Brown Obsessive Compulsive Scale. AN1 - patients with anorexia nervosa before therapy, AN2-– patients with anorexia nervosa after therapy, HC - healthy controls
Fig. 2
Fig. 2
Neurocognitive test results in three subject groups. TMT - Trail Making Test, CWST - Color-Word Stroop Task, RFFT - Ruff Figural Fluency Test. AN1 - patients with anorexia nervosa before therapy, AN2 - patients with anorexia nervosa after therapy, HC– healthy controls

References

    1. DSM-5 Diagnostic and statistical manual of mental disorders 5: A quick glance. Indian J Psychiatry. 2013;55(3):220–223.
    1. CJ MA, Smith W. Neural correlates of eating disorders: translational potential. Neurosci Neuroecon. 2015;4:35–49.
    1. Hamsher Kde S, Halmi KA, Benton AL. Prediction of outcome in anorexia nervosa from neuropsychological status. Psychiatry Res. 1981;4(1):79–88.
    1. Boersma GJ, Treesukosol Y, Cordner ZA, Kastelein A, Choi P, Moran TH, Tamashiro KL. Exposure to activity-based anorexia impairs contextual learning in weight-restored rats without affecting spatial learning, taste, anxiety, or dietary-fat preference. Int J Eat Disord. 2016;49(2):167–179.
    1. Lang K, Lloyd S, Khondoker M, Simic M, Treasure J, Do Children TK. Adolescents with Anorexia Nervosa Display an Inefficient Cognitive Processing Style? PLoS One. 2015;10(7):e0131724.
    1. Lang K, Treasure J, Tchanturia K. Is inefficient cognitive processing in anorexia nervosa a familial trait? A neuropsychological pilot study of mothers of offspring with a diagnosis of anorexia nervosa. World J Biol Psychiatry. 2016;17(4):258–265.
    1. Lao-Kaim NP, Fonville L, Giampietro VP, Williams SCR, Simmons A, Tchanturia K. Aberrant function of learning and cognitive control networks underlie inefficient cognitive flexibility in anorexia nervosa: a cross-sectional fmri study. PLoS ONE. 2015;10(5):e0124027.
    1. Oltra-Cucarella J, Espert R, Rojo L, Jacas C, Guillén V, Moreno S. Neuropsychological impairments in anorexia nervosa: a spanish sample pilot study. Appl Neuropsychol Adult. 2014;21(3):161–175.
    1. Renwick B, Musiat P, Lose A, DeJong H, Broadbent H, Kenyon M, Loomes R, Watson C, Ghelani S, Serpell L, Richards L, Johnson-Sabine E, Boughton N, Treasure J, Schmidt U. Neuro- and social-cognitive clustering highlights distinct profiles in adults with anorexia nervosa. Int J Eat Disord. 2015;48(1):26–34.
    1. Talbot A, Hay P, Buckett G, Touyz S. Cognitive deficits as an endophenotype for anorexia nervosa: an accepted fact or a need for re-examination? Int J Eat Disord. 2015;48(1):15–25.
    1. Kułakowska D, Biernacka K, Wilkos E, Rybakowski F, Kucharska-Pietura K. Neurocognitive and social cognition deficits in patients with anorexia nervosa. Psychiatr Pol. 2014;48(3):465–475.
    1. Allen KL, Byrne SM, Hii H, van Eekelen A, Mattes E, Foster JK. Neurocognitive functioning in adolescents with eating disorders: a population-based study. Cogn Neuropsychiatry. 2013;18(5):355–375.
    1. Giombini L, Moynihan J, Turco M, Nesbitt S. Evaluation of individual cognitive remediation therapy (CRT) for the treatment of young people with anorexia nervosa. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 2017;22(4):667–673.
    1. Kucharska K, Wilkos E, Stefanski R, Makowicz G, Ryglewicz D, Slawinska K, Piatkowska-Janko E. Psychological and physiological changes in cognitive functioning in thalamic lesion throughout the rehabilitation process. J Neurol Neurophysiol. 2014;6(5):1–7.
    1. Lopez C, Tchanturia K, Stahl D, Treasure J. Central coherence in eating disorders: a systematic review. Psychol Med. 2008;38(10):1393–1404.
    1. Roberts M, Tchanturia K, Treasure J. Exploring the neurocognitive signature of poor set-shifting in anorexia and bulimia nervosa. J Psychiatr Res. 2010;44(14):964–970.
    1. Roberts M, Tchanturia K, Treasure J. Is attention to detail a similarly strong candidate endophenotype for anorexia and bulimia nervosa? World J Biol Psychiatry. 2013;14(6):452–463.
    1. Happé F, Frith U. The weak coherence account: detail-focused cognitive style in autism spectrum disorders. J Autism Dev Disord. 2006;36(1):5–25.
    1. Wu M, Brockmeyer T, Hartmann M, Skunde M, Herzog W, Friederich HC. Set-shifting ability across the spectrum of eating disorders and in overweight and obesity: a systematic review and meta-analysis. Psychol Med. 2014;44(16):3365–85.
    1. Dahlgren CL, Rø Ø. A systematic review of cognitive remediation therapy for anorexia nervosa – development, current state and implications for future research and clinical practice. J Eat Disord. 2014;2(1):26.
    1. Lang K, Lopez C, Stahl D, Tchanturia K, Treasure J. Central coherence in eating disorders: an updated systematic review and meta-analysis. World J Biol Psychiatry. 2014;15(8):586–598.
    1. Leppanen J, Adamson J, Tchanturia K. Impact of cognitive remediation therapy on neurocognitive processing in anorexia nervosa. Frontiers in Psychiatry. 2018;9(96):1–5.
    1. Tchanturia K, Lang K. A systematic review of central coherence in young people with anorexia nervosa. J Child Adolesc Behav. 2014;2(3):2.
    1. Tchanturia K, Larsson E, Adamson J. How anorexia nervosa patients with high and low autistic traits respond to group Cognitive Remediation Therapy. BMC Psychiatry. 2016;16(1):334.
    1. Tchanturia K, Larsson E, Brown A. Benefits of group cognitive remediation therapy in anorexia nervosa: case series. Neuropsychiatrie. 2016;30(1):42–49.
    1. Tchanturia K, Davies H, Reeder C, Wykes T. Cognitive Remediation Therapy for Anorexia Nervosa. 2010.
    1. Weider S, Indredavik MS, Lydersen S, Hestad K. Neuropsychological function in patients with anorexia nervosa or bulimia nervosa. Int J Eat Disord. 2015;48(4):397–405.
    1. Kucharska K, Jeschke J, Mafi R. Intact social cognitive processes in outpatients with anorexia nervosa: a pilot study. Annals of General Psychiatry. 2016;15:24.
    1. Danner UN, Sanders N, Smeets PA, van Meer F, Adan RA, Hoek HW, van Elburg AA. Neuropsychological weaknesses in anorexia nervosa: set-shifting, central coherence, and decision making in currently ill and recovered women. Int J Eat Disord. 2012;45(5):685–694.
    1. Harrison A, Tchanturia K, Treasure J. Measuring state trait properties of detail processing and global integration ability in eating disorders. World J Biol Psychiatry. 2011;12(6):462–472.
    1. Tchanturia K, Davies H, Harrison A, Roberts M, Nakazato M, Schmidt U, Treasure J, Morris R. Poor cognitive flexibility in eating disorders: examining the evidence using the wisconsin cart sorting task. PLoS One. 2012;7(1):e28331.
    1. Green MW, Rogers PJ. Impairments in working memory associated with spontaneous dieting behaviour. Psychol Med. 1998;28(5):1063–1070.
    1. Kingston K, Szmukler G, Andrewes D, Tress B, Desmond P. Neuropsychological and structural brain changes in anorexia nervosa before and after refeeding. Psychol Med. 1996;26(1):15–28.
    1. Holliday J, Tchanturia K, Landau S, Collier D, Treasure J. Is impaired set-shifting an endophenotype of anorexia nervosa? Am J Psychiatry. 2005;162(12):2269–2275.
    1. Brockmeyer T, Ingenerf K, Walther S, Wild B, Hartmann M, Herzog W, Bents H, Friederich HC. Training cognitive flexibility in patients with anorexia nervosa: a pilot randomized controlled trial of cognitive remediation therapy. Int J Eat Disord. 2013;47(1):24–31.
    1. Dingemans AE, Danner UN, Donker JM, Aardoom JJ, van Meer F, Tobias K, van Elburg AA, van Furth EF. The effectiveness of cognitive remediation therapy in patients with a severe or enduring eating disorder: a randomized controlled trial. Psychother Psychosom. 2014;83(1):29–36.
    1. Lock J, Agras WS, Fitzpatrick KK, Bryson SW, Jo B, Tchanturia K. Is outpatient cognitive remediation therapy feasible to use in randomized clinical trials for anorexia nervosa? Int J Eat Disord. 2013;46(6):567–575.
    1. Dahlgren CL, van Noort BM, Lask B. Cognitive Remediation Therapy for Children and Adolescents with Anorexia Nervosa - The CRT Recource Pack. Oslo University Hospital, Ulleål HF. 2015. Available from:. Accessed 8 Jan 2019.
    1. Dahlgren CL, Lask B, Landrø NI, Rø Ø. Developing and evaluating cognitive remediation therapy (CRT) for adolescents with anorexia nervosa: a feasibility study. Clin Child Psychol Psychiatry. 2014;19(3):476–487.
    1. Giombini L, Moynihan J, Turco M, Nesbitt S. Evaluation of individual cognitive remediation therapy (CRT) for the treatment of young people with anorexia nervosa. Eat Weight Disord. 2016;22(4):667–73.
    1. Giombini L, Nesbitt S, Waples L, Finazzi E, Easter A, Tchanturia K. Young people’s experience of individual cognitive remediation therapy (CRT) in an inpatient eating disorder service: A qualitative study. Eat Weight Disord. 2017;23:499–505.
    1. van Noort BM, Pfeiffer E, Lehmkuhl U, Kappel V. Cognitive remediation therapy for children with anorexia nervosa. Z Kinder Jugendpsychiatr Psychother. 2015;43(5):351–355.
    1. Zaitsoff S, Pullmer R, Cyr M, Aime H. The role of the therapeutic alliance in eating disorder treatment outcomes: a systematic review. Eat Disord. 2015;23(2):99–114.
    1. Abbate-Daga G, Buzzichelli S, Amianto F, Rocca G, Marzola E, McClintock SM, Fassino S. Cognitive flexibility in verbal and nonverbal domains and decision making in anorexia nervosa patients: a pilot study. BMC Psychiatry. 2011;11:162.
    1. Tchanturia K, Giombini L, Leppanen J, Kinnaird E. Evidence for Cognitive Remediation Therapy in young people with anorexia nervosa: Systematic Review and Meta-analysis of the literature. EEDR. 2017;25:227–236.
    1. Abbate-Daga G, Buzzichelli S, Marzola E, Amianto F, Fassino S. Clinical investigation of set-shifting subtypes in anorexia nervosa. Psychiatry Res. 2014;219(3):592–597.
    1. Aloi M, Rania M, Caroleo M, Bruni A, Palmieri A, Cauteruccio MA, De Fazio P, Segura-Garcia C. Decision making, central coherence and set-shifting: a comparison between Binge Eating Disorder, Anorexia Nervosa and Healthy Controls. BMC Psychiatry. 2015;15:6.
    1. Fonville L, Giampietro V, Davies H, Lounes N, Simmons A, Williams S, Tchanturia K. Cognitive remediation, brain function and central coherence: an anorexia nervosa pilot study. Ann Gen Psychiatry. 2014;13:25.
    1. Lindner SE, Fichter MM, Quadflieg N. Central coherence in full recovery of anorexia nervosa. Eur Eat Disord Rev. 2013;21(2):115–120.
    1. Lopez C, Tchanturia K, Stahl D, Booth R, Holliday J, Treasure J. An examination of the concept of central coherence in women with anorexia nervosa. Int J Eat Disord. 2008;41(2):143–152.
    1. Lopez C, Tchanturia K, Stahl D, Treasure J. Weak central coherence in eating disorders: a step towards looking for an endophenotype of eating disorders. J Clin Exp Neuropsychol. 2009;31(1):117–125.
    1. Tchanturia K, Campbell I, Morris R, Treasure J. Neuropsychological studies in anorexia nervosa. Int J Eat Disord. 2005;37(suppl):S72–S76.
    1. Tchanturia K, Happé F, Godley F, Treasure J, Bara-Carril F, Schmidt U. Theory of mind in anorexia nervosa. Eur Eat Disord Rev. 2004;12(6):361–366.
    1. Zakzanis KK, Campbell Z, Polsinelli A. Quantitative evidence for distinct cognitive impairment in anorexia nervosa and bulimia nervosa. J Neuropsychol. 2010;4(1):89–106.
    1. Aspen V, Darcy A, Lock J. A review of attention biases in women with eating disorders. Cogn Emot. 2013;27(5):820–838.
    1. Camacho Ruiz EJ, Escoto Ponce de León C, Mancilla-Díaz JM. Neuropsychological evaluation in patients with eating disorders. Salud Ment. 2008;31(6):441–446.
    1. Dobson KS, Dozois DJ. Attentional biases in eating disorders: a meta-analytic review of Stroop performance. Clin Psychol Rev. 2004;23(8):1001–1022.
    1. Jáuregui-Lobera I. Neuropsychology of eating disorders: 1995–2012. Neuropsychiatr Dis Treat. 2013;9:415–430.
    1. Johansson L, Ghaderi A, Andersson G. Stroop interference for food- and body-related words: a meta-analysis. Eat Behav. 2005;6(3):271–281.
    1. King JA, Geisler D, Ritschel F, Boehm I, Seidel M, Roschinski B, Soltwedel L, Zwipp J, Pfuhl G, Marxen M, Roessner V, Ehrlich S. Global cortical thinning in acute anorexia nervosa normalizes following long-term weight restoration. Biol Psychiatry. 2015;77(\):624–632.
    1. Mainz V, Schulte-Rüther M, Fink GR, Herpertz-Dahlmann B, Konrad K. Structural brain abnormalities in adolescent anorexia nervosa before and after weight recovery and associated hormonal changes. Psychosom Med. 2012;74(6):574–582.
    1. Connan F, Murphy F, Connor SE, Rich P, Murphy T, Bara-Carill N, Landau S, Krljes S, Ng V, Williams S, Morris RG, Campbell IC, Treasure J. Hippocampal volume and cognitive function in anorexia nervosa. Psychiatry Res. 2006;146(2):117–125.
    1. McCormick LM, Keel PK, Brumm MC, Bowers W, Swayze V, Andersen A, Andreasen N. Implications of starvation-induced change in right dorsal anterior cingulate volume in anorexia nervosa. Int J Eat Disord. 2008;41(7):602–10.
    1. Owen I, Lindvall Dahlgren C, & Lask B. Cognitive Remediation Therapy. In B. Lask & R. Bryant-Waugh (Eds.), Eating Disorders in Childhood and Adolescence. New York: Routledge, 2013.
    1. Lindner SE, Fichter MM, Quadflieg N. Set-shifting and its relation to clinical and personality variables in full recovery of anorexia nervosa. Eur Eat Disord Rev. 2014;22(4):252–259.
    1. Treasure J, Schmidt U. The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. Journal of Eating Disorders. 2013;1:13.
    1. Mandy W, Tchanturia K. Do women with eating disorders who have social and flexibility difficulties really have autism? A case series. Mol Autism. 2015;13:6.
    1. Kidd A, Steinglass J. What can cognitive neuroscience teach us about anorexia nervosa? Curr Psychiatry Rep. 2012;14(4):415–420.
    1. Easter A, Tchanturia K. Therapists’ experiences of cognitive remediation therapy for anorexia nervosa: implications for working with adolescents. Clin Child Psychol Psychiatr. 2011;16(2):233–46.
    1. van Noort BM, Kraus MK, Pfeiffer E, Lehmkuhl U, Kappel V. Neuropsychological and behavioural short-term effects of cognitive remediation therapy in adolescent anorexia nervosa: a pilot study. Eur Eat Disord Rev. 2016;24(1):69–74.
    1. van Noort BM, Pfeiffer E, Ehrlich S, Lehmkuhl U, Kappel V. Cognitive performance in children with acute early-onset anorexia nervosa. Eur Child Adolesc Psychiatry. 2016;25(11):1233–1244.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅