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Review
. 2021 Mar 29;9(1):40.
doi: 10.1186/s40337-021-00392-x.

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

Kelly M Dann  1 , Phillipa Hay  2 , Stephen Touyz  3
Affiliations
Review

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

Kelly M Dann et al. J Eat Disord. .

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.

Keywords: Anorexia Nervosa; central coherence; cognition; cognitive flexibility; eating disorders; executive function; functional outcome; neuropsychology; quality of life; set-shifting.

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Conflict of interest statement

PH has prepared a report under contract for (July 2017) and received honoraria for education of psychiatrists from Takeda (formerly Shire) Pharmaceuticals.

ST has received travel grants, research grants and honoraria from Takeda for commissioned reports, public speaking and consultant work. He chairs their Australian Clinical Binge Eating Advisory Board.

KD has no conflict of interest.

Figures

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Fig. 1
PRISMA flow diagram for study selection
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