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Table 2 Review of the literature of set-shifting, central coherence and decision-making in individuals recovered from anorexia nervosa. The articles are presented chronologically according to year of publication

From: Set-shifting, central coherence and decision-making in individuals recovered from anorexia nervosa: a systematic review

Authors Neuropsychological function Tests Aim of study Sample Age
Mean (SD)
Main findings Effect size (test) Conclusion
Tchanturia et al., 2002 [10] Set-shifting Fixed set task To examine perceptual and cognitive set-shifting AN = 30 AN = 25.2 (6.7) Significant differences between AN/AN-REC compared to HC d = 1.37 (Fixed set task) Impaired set-shifting could represent a vulnerability factor for AN
Cognitive shift task AN-REC = 16 AN-REC = 30.0 (6.0)
HC = 23 d = 0.72 (Cognitive shift task, perseverations)
HC = 27.6 (6.4)
Tchanturia et al., 2004 [15] Set-shifting TMT To investigate set-shifting in current and past AN patients AN = 34 AN = 27.2 (8.3) Set-shifting difficulties was observed in the AN group, and to a lesser degree in the AN-REC group d = 0.87 (Picture set test) Some aspects of set-shifting in AN appear to be a trait rather than state marker
Brixton test AN-REC = 18 AN-REC = 28.4 (6.8)
Picture set test HC = 36 d = 0.88 (illusions)
Cat bat tests HC = 25.9 (4.8)
Uznadze illusion task
Holliday et al., 2005 [16] Set-shifting Haptic illusion task To investigate whether set-shifting difficulties are familial 47 pairs of sisters disconcordant for AN: AN-REC = 23 AN (AN-REC + AN+ AN-WR) = 26.3 (10.2) Set-shifting difficulties persists after recovery N/A Suggest that set-shifting difficulties are trait characteristics and may inform the search for the endophenotype of AN
Brixton Test
TMT
CatBat task HS = 27.6 (9.6)
AN = 21
AN-WR = 3 HC = 26.5 (6.1)
HS = 47
HC = 47
Tchanturia et al., 2007 [17] Decision making IGT To determine whether decision-making is impaired in AN-REC AN = 29 AN = 28.5 (9.17) No differences between AN-REC and HC. AN grop did poorer than AN-REC and HC Impaired IGT performance could be a consequence of starvation
HC = 29 HC = 26.3 (7.9)
AN-REC = 14 AN-REC = 28.9 (7.4)
Lopez et al., 2009 [19] Central coherence Embedded figures test Unsegmented/segmented block design To examine whether AN-REC women have weak central coherence AN-REC = 42 AN-REC = 25 Weak central coherence in the AN-REC group d = 0.53 (Rey order) Suggest that weak central coherence is a stable trait and an endophenotype for AN
HC = 42 HC = 26
d = 0.73 (Style)
RCFT d = 0.57 (CC Index)
SCT
d = 1.15 (SCT)
Homograph reading task
Nakazato et al., 2009 [18] Set-shifting WCST To establish whether set-shifting difficulties are present in AN and AN-REC AN = 29 AN = 28.3 (11.0) No significant differences between AN-REC and HC Strongly suggest that impairment in set-shifting normalizes with recovery
AN-REC = 18 AN-REC = 32.2 (11.1)
HC = 28
HC = 26.9 (5.8)
Nakazato et al., 2010 [20] Set-shifting WCST
TMT
Determine whether serum glutamine is associated with set-shifting ability AN = 27 AN = 27.7 (10.6) No differences between AN-REC and HC Serum concentrations does not appear to be associated with executive functions
AN-REC = 32.2 (11.1)
HC = 26.9 (5.8)
AN-REC = 18
HC = 28
Roberts et al., 2010 [21] Set-shifting TMT To add clarity to set-shifting in EDs AN-R = 35 AN-R = 23.71 (6.39) Some evidence for poorer set shifting in AN – REC d = 0.64 (WCST) It is likely a familial trait, and related to the maintenance of the illness
WCST AN-BP = 33
Brixton test BN = 30 AN-BP = 25.58 (7.64)
Haptic illusion AN-REC = 30
BN = 26.43 (6.84)
AN sister = 30
BN sister =20 AN-REC = 32.13 (11.64)
HC = 88
AN sister = 24.23 (6.44)
BN sister = 27.60 (8.71)
HC = 28.43 (8.47)
Tenconi et al., 2010 [14] Set-shifting Central coherence WCST To explore suitability for endophenotypes in ED AN = 60 AN = 26.2 (6.9) No differences between AN and AN-REC Impaired set-shifting and low central coherence might be an endophenotype of AN
TMT AN-WR = 63 HC = 27.4 (4.5)
RCFT AN-REC = 30
HC = 120
Harrison et al., 2011 [13] Central coherence RCFT
GEFT
FPT
To replicate findings of weak central coherence AN = 50 ED group = 27.13 (9.3) Superior detail processing skills was associated with having an ED and recovered from AN d = 0.58 (RCFT) AN-REC are skilled at detailed processing. Weak central coherence may be a factor that perpetuates ED behaviors
d = 0.31 (GEFT)
BN = 48
AN-REC = 35 AN-REC = 29.00 (10.62)
HC = 89
HC = 28.5 (9.93)
Bühren et al., 2012 [12] Set-shifting Visual set-shifting task To investigate set-shifting in AN before and after weight gain AN = 28 AN = 15.6 (1.5) No deficits in set-shifting abilities. Speculate that findings could be related to short duration of illness
HC = 27 HC = 15.0 (1.7)
Danner et al., 2012 [22] Set-shifting Central coherence Decision making BCST To examine set-shifting in women AN-REC AN = 16 AN = 25.63 (5.41) Poor set-shifting and decision making in AN-REC compared to HC. No differences between the groups in central coherence d = 1.16 (BCST perseverative errors) Suggest that impaired decision-making and set-shifting is a stable trait in AN
RCFT AN-REC = 15
IGT HC = 15 AN-REC = 24.33 (4.72)
d = 1.14 (BCST total errors
HC = 25.8 (4.69)
d = 1.05 (BCST categories completed)
d = 1.36 (Total IGT score)
Favaro et al., 2012 Central coherence RCFT To explore functional connectivity of networks involved in visuospatial and somatosensory processing AN = 29 AN = 25.8 (6.9) No differences between AN-REC and HC in central coherence Results could be due to a milder form of the illness in the AN-REC group, measures by minimum BMI and duration of illness
AN-REC = 16 AN-REC = 23.8 (4.8)
HC = 26
HC = 26.7 (6.7)
Harrison et al., 2012 [24] Set-shifting WCST To explore cognitive and social emotional functioning ED = 100
ED-REC = 35
HC = 90
N/A ED-REC did not differ from the acute group. Suggest that cognitive style is a trait.
Central coherence Brixton task
FPT
RCFT
Lindner et al., 2012 [25] Decision making IGT To examine decision-making and planning in AN-REC AN-REC = 100 AN-REC = 34.49 (7.13) AN-REC did better in decision-making d = 0.35 (IGT) Findings are in contrast to previous findings of impaired decision making in AN-REC
HC = 100
HC = 34.53 (7.26)
Tchanturia et al., 2012 [26] Set-shifting WCST To explore WCST performance and other clinical outcomes AN = 171 AN = 25.4 (8.2) AN-REC showed better performance than AN, but did more perseverative errors than HC d = 0.50 (WCST perseverative errors) This large dataset supports previous studies which indicate poor cognitive flexibility in people with EDs.
BN = 82 BN = 27.3 (8.3)
AN-REC = 90 AN-REC = 30.7 (11.1)
HC = 199
HC = 27.7 (8.8)
Lindner et al., 2013 [27] Central coherence RCFT To examine central coherence as a possible endophenotype in AN AN-REC = 100 AN-REC = 34.49 (7.13) AN-REC group showed better accuracy in the copy condition d = 0.46 (RCFT copy condition) No inefficiencies in global processing but a superior local processing
HC = 100
HC = 34.53 (7.26)
Lindner et al., 2014 [28] Set-shifting BCST To explore whether set-shifting is inefficient after full recovery of AN AN-REC = 100 AN-REC = 34.49 (7.13) AN-REC achieved fewer categories, more perseverations and spent less time for shifting set d = 0.39 (BCST categories) Suggest that set-shifting is inefficient after full recovery
HC = 100
HC = 34.53 (7.26) d = 0.35 (BCST perseverations)
d = 0.36 (BCST reaction time)
Ritschel et al., 2015 [29] Decision making Intertemporal choice task To investigate delay discounting in ill and recovered AN AN = 34 AN = 15.29 (2.7) No group differences in delay discounting Suggest that delay discounting is not a trait marker for AN
AN-REC = 33 AN-REC = 21.67 (3.1)
HC = 54
HC = 18.75 (4.4)
Talbot et al., 2015 [9] Set-shifting and central coherence WCST
Matching familiar figures test
RCFT
To investigate whether impaired set-shifting and weak central coherence represent state or trait AN = 24 AN = 21.0 (18- Poorer set- d = 0.79 (WCST) This study found no
AN-WR = 10 27)a shifting in AN –REC and AN-WR compared to HC.   support that weak central coherence is an endophenotype for AN
AN-REC = 15 AN-WR = 21.5 (19–25) a
HC = 43
AN-REC = 24.0 (21–32) a No differences between the groups on measures of local and global processing
HC = 19.0 (18–25) a
Ely et al., 2016 [30] Set shifting Color-Word interference test To identify deficits specific to inhibition or task-switching AN-REC = 47 AN-REC = 26.68 (1.83) Differences between the groups trended toward – but was not – significant Suggest that cognitive control impairments in AN is related to anxiety, and not a neuropsychological deficit
HC = 24
HC = 25.08 (6.11)
Sultson et al., 2016 [31] Set-shifting BCST To investigate whether activation in frontal and parietal regions is associated with set-shifting ability AN = 16 AN = 25.57 (5.8) No differences between AN-REC and HC, but a trend towards more perseverative errors and completing less categories than HC Higher activation in frontal regions involved in self-referential processing and cognitive control is associated with poor set-shifting ability in AN-REC
AN-REC = 15 AN-REC = 24.79 (4.5)
HC = 15
HC = 25.80 (4.7)
Bentz et al., 2017 [11] Set shifting and local processing TMT To investigate impairments of social functioning and potential associations with neurocognitive functions AN = 43 AN = 16.1 (1.5) No differences between the groups on neurocognitive functions Young AN and AN-REC did not differ from HC
GEFT AN-REC = 28 AN-REC = 18.4 (1.6)
HC = 41
HC = 17.7 (2.2)
  1. Effect sizes for significant differences between AN-REC and HC. Cohen’s d effect size: small (d = 0.2), medium (d = 0.5) and large (d = 0.8)
  2. AN anorexia nervosa, AN – REC anorexia nervosa recovered, AN – WR anorexia nervosa weight restored, BN bulimia nervosa, BCST Berg’s Card Sorting Test, ED’s eating disorders, CC index Central Coherence index, ED-REC eating disorders recovered, FPT Fragmented pictures task, GEFT Group Embedded Figures Test, HC healthy controls, HS Healthy sister, IGT Iowa Gambling Task, N/A Not applicable, RCFT Rey Complex Figure Test, SCT Sentence completion task, TMT Trail making test, WCST Wisconsin Card Sorting Test. The main findings represents significant differences in the experimental group (AN-REC) compared to a healthy control group
  3. a Median values with upper and lower quartiles