Aberrant function of learning and cognitive control networks underlie inefficient cognitive flexibility in anorexia nervosa: a cross-sectional fMRI study

PLoS One. 2015 May 13;10(5):e0124027. doi: 10.1371/journal.pone.0124027. eCollection 2015.

Abstract

Objectives: People with Anorexia Nervosa exhibit difficulties flexibly adjusting behaviour in response to environmental changes. This has previously been attributed to problematic behavioural shifting, characterised by a decrease in fronto-striatal activity. Additionally, alterations of instrumental learning, which relies on fronto-striatal networks, may contribute to the observation of inflexible behaviour. The authors sought to investigate the neural correlates of cognitive flexibility and learning in Anorexia Nervosa.

Method: Thirty-two adult females with Anorexia Nervosa and thirty-two age-matched female control participants completed the Wisconsin Card Sorting Task whilst undergoing functional magnetic resonance imaging. Event-related analysis permitted the comparison of cognitive shift trials against those requiring maintenance of rule-sets and allowed assessment of trials representing learning.

Results: Although both groups performed similarly, we found significant interactions in the left middle frontal gyrus, precuneus and superior parietal lobule whereby blood-oxygenated-level dependent response was higher in Anorexia Nervosa patients during shifting but lower when maintaining rule-sets, as compared to healthy controls. During learning, posterior cingulate cortex activity in healthy controls decreased whilst increasing in the Anorexia Nervosa group, whereas the right precuneus exhibited the opposite pattern. Furthermore, learning was associated with lower blood-oxygenated-level dependent response in the caudate body, as compared to healthy controls.

Conclusions: People with Anorexia Nervosa display widespread changes in executive function. Whilst cognitive flexibility appears to be associated with aberrant functioning of the fronto-parietal control network that mediates between internally and externally directed cognition, fronto-striatal alterations, particularly within the caudate body, were associated with instrumental learning. Together, this shows how perseverative tendencies could be a substrate of multiple high-order processes that may contribute to the maintenance of Anorexia Nervosa.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anorexia Nervosa / pathology
  • Anorexia Nervosa / physiopathology*
  • Brain Mapping
  • Case-Control Studies
  • Cognition*
  • Corpus Striatum / pathology
  • Corpus Striatum / physiopathology*
  • Cross-Sectional Studies
  • Executive Function
  • Female
  • Frontal Lobe / pathology
  • Frontal Lobe / physiopathology*
  • Gyrus Cinguli / pathology
  • Gyrus Cinguli / physiopathology
  • Humans
  • Learning*
  • Magnetic Resonance Imaging
  • Nerve Net / pathology
  • Nerve Net / physiopathology
  • Neuropsychological Tests
  • Parietal Lobe / pathology
  • Parietal Lobe / physiopathology*

Grants and funding

This work was supported by the Swiss Anorexia Foundation, the Psychiatry Research Trust, the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, King's College London. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.