Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 18;40(2):330-344.
doi: 10.1093/arclin/acae072.

A Systematic Review to Explore a Neuropsychological Profile that Predates Anorexia Nervosa

Rachel Noon  1 , Tayeem Pathan  2
Affiliations

A Systematic Review to Explore a Neuropsychological Profile that Predates Anorexia Nervosa

Rachel Noon et al. Arch Clin Neuropsychol. .

Abstract

Objective: Research demonstrates reduced cognitive flexibility and weak central coherence during acute illness and following recovery from anorexia nervosa (AN). This systematic review investigated if these impairments are present in first-degree relatives of individuals with AN, representing a possible neuropsychological risk profile.

Methods: A systematic review of electronic databases was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search ended on July 14, 2023. Established search terms and inclusion criteria identified relevant research. Risk of bias was assessed using the Critical Appraisal Skills Program. The review was registered with Prospero international prospective register of systematic reviews (No. CRD42023401268). Study selection, descriptive data, critical appraisal, and risk of bias are presented in tables and figures.

Results: The search yielded 10 studies. The included studies conducted neuropsychological assessments of discordant AN relatives and lifetime longitudinal study participants. Most studies found cognitive flexibility and central coherence to be significantly reduced in participants with AN and their relatives compared with controls. One study found decision making to be significantly impaired in AN participants and relatives. Effect sizes were moderate to large.

Discussion: Reduced cognitive flexibility and weak central coherence appear to be endophenotypes of AN. Further research is required with relatives concordant for AN to establish whether these biomarkers co-segregate with AN within families. These findings suggest a possibility of developing screeners to identify individuals at risk of AN allowing for early intervention.

Keywords: Anorexia nervosa; Endophenotype; Neuropsychology; Systematic review.

PubMed Disclaimer

Conflict of interest statement

None to declare.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram of study selection.
Fig. 2
Fig. 2
Risk of bias of included studies.
See this image and copyright information in PMC

References

    1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Publishing.
    1. Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724–731. 10.1001/archgenpsychiatry.2011.74. - DOI - PubMed
    1. Benau, E. M., Orloff, N. C., Janke, E. A., Serpell, L., & Timko, C. A. (2014). A systematic review of the effects of experimental fasting on cognition. Appetite, 77, 52–61. 10.1016/j.appet.2014.02.014. - DOI - PubMed
    1. Berg, E. A. (1948). A simple objective test for measuring flexibility in thinking. Journal of General Psychology, 39(1), 15–22. 10.1080/00221309.1948.9918159. - DOI - PubMed
    1. Bissonette, G. B., Powell, E. M., & Roesch, M. R. (2013). Neural structures underlying set-shifting: Roles of medial prefrontal cortex and anterior cingulate cortex. Behavioural Brain Research, 250, 91–101. 10.1016/j.bbr.2013.04.037. - DOI - PMC - PubMed

Publication types