Neural basis of impaired cognitive flexibility in patients with anorexia nervosa

PLoS One. 2013 May 10;8(5):e61108. doi: 10.1371/journal.pone.0061108. Print 2013.


Background: Impaired cognitive flexibility in anorexia nervosa (AN) causes clinical problems and makes the disease hard to treat, but its neural basis has yet to be fully elucidated. The purpose of this study was to evaluate the brain activity of individuals with AN while performing a task requiring cognitive flexibility on the Wisconsin Card Sorting Test (WCST), which is one of the most frequently used neurocognitive measures of cognitive flexibility and problem-solving ability.

Methods: Participants were 15 female AN patients and 15 age- and intelligence quotient-matched healthy control women. Participants completed the WCST while their brain activity was measured by functional magnetic resonance imaging during the task. Brain activation in response to set shifting error feedback and the correlation between such brain activity and set shifting performance were analyzed.

Results: The correct rate on the WCST was significantly poorer for AN patients than for controls. Patients showed poorer activity in the right ventrolateral prefrontal cortex and bilateral parahippocampal cortex on set shifting than controls. Controls showed a positive correlation between correct rate and ventrolateral prefrontal activity in response to set shifting whereas patients did not.

Conclusion: These findings suggest dysfunction of the ventrolateral prefrontal cortex and parahippocampal cortex as a cause of impaired cognitive flexibility in AN patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anorexia Nervosa / physiopathology*
  • Brain Mapping
  • Case-Control Studies
  • Cognitive Dysfunction*
  • Female
  • Functional Laterality
  • Humans
  • Magnetic Resonance Imaging
  • Neuropsychological Tests
  • Prefrontal Cortex / physiopathology
  • Problem Solving
  • Psychomotor Performance
  • Young Adult

Grants and funding

This study was funded by Research Grant No. 17B-1 for Nervous and Mental Disorders from the Ministry of Health, Labor and Welfare of Japan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors disclose no financial arrangement (e.g., consultancies, stock ownership, equity interests, parent-licensing arrangements, research support, major honoraria) they may have with a company whose product figures prominently in the submitted manuscript.