Neural correlates of impaired cognitive-behavioral flexibility in anorexia nervosa.
OBJECTIVE
Impaired cognitive-behavioral flexibility is regarded as a trait marker in anorexia nervosa patients. The authors sought to investigate the neural correlates of this deficit in executive functioning in anorexia nervosa.


METHODS
Fifteen women with anorexia nervosa and 15 age-matched healthy comparison women underwent event-related functional MRI while performing a target-detection task. The task distinguished between shifts in behavioral response and shifts in cognitive set. It involved infrequent target and non-target distractor stimuli embedded in a sequence of prepotent standard stimuli.


RESULTS
Relative to comparison subjects, anorexia nervosa patients showed a significantly higher error rate in behavioral response shifting, independent of whether those runs also involved cognitive set shifting. During behavioral response shifting, patients showed reduced activation in the left and right thalamus, ventral striatum, anterior cingulate cortex, sensorimotor brain regions, and cerebellum that differed significantly from the comparison group but showed dominant activation in frontal and parietal brain regions. These differential activations in patients and comparison subjects were specific to shifts in behavioral response: except for thalamic activation, they were not observed in response to non-target distractor trials that required no alteration in behavioral response.


CONCLUSIONS
Impaired behavioral response shifting in anorexia nervosa seems to be associated with hypoactivation in the ventral anterior cingulate-striato-thalamic loop that is involved in motivation-related behavior. In contrast, anorexia nervosa patients showed predominant activation of frontoparietal networks that is indicative of effortful and supervisory cognitive control during task performance.
Zastrow
Arne
A
Centre for Psychosocial Medicine, University Hospital Heidelberg, Department of Psychosomatic and General Internal Medicine, Thibautstr. 2, 69115 Heidelberg, Germany.
Kaiser
Stefan
S
Stippich
Christoph
C
Walther
Stephan
S
Herzog
Wolfgang
W
Tchanturia
Kate
K
Belger
Aysenil
A
Weisbrod
Matthias
M
Treasure
Janet
J
Friederich
Hans-Christoph
HC
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003342:Corpus Striatum / Q000503:physiopathology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009042:Motivation; D009415:Nerve Net / Q000503:physiopathology; D009483:Neuropsychological Tests; D010296:Parietal Lobe / Q000503:physiopathology; D012720:Severity of Illness Index; D013788:Thalamus / Q000503:physiopathology*; D055815:Young Adult