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Neurocognitive functioning in bulimia nervosa: the role of neuroendocrine, personality and clinical aspects

Published online by Cambridge University Press:  01 July 2010

S. Galderisi ,
P. Bucci ,
A. Mucci ,
L. Bellodi ,
G. B. Cassano ,
P. Santonastaso ,
S. Erzegovesi ,
A. Favaro ,
M. Mauri  and
P. Monteleone
...Show all authors
S. Galderisi*
Affiliation:
Department of Psychiatry, University of Naples SUN, Italy
P. Bucci
Affiliation:
Department of Psychiatry, University of Naples SUN, Italy
A. Mucci
Affiliation:
Department of Psychiatry, University of Naples SUN, Italy
L. Bellodi
Affiliation:
Department of Neuropsychiatric Sciences, Vita-Salute University, Istituto Scientifico HS Raffaele, Milan, Italy
G. B. Cassano
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, University of Pisa, Italy
P. Santonastaso
Affiliation:
Department of Neurosciences, University of Padua, Italy
S. Erzegovesi
Affiliation:
Department of Neuropsychiatric Sciences, Vita-Salute University, Istituto Scientifico HS Raffaele, Milan, Italy
A. Favaro
Affiliation:
Department of Neurosciences, University of Padua, Italy
M. Mauri
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, University of Pisa, Italy
P. Monteleone
Affiliation:
Department of Psychiatry, University of Naples SUN, Italy
M. Maj
Affiliation:
Department of Psychiatry, University of Naples SUN, Italy
*
*Address for correspondence: Professor S. Galderisi, Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138Naples, Italy. (Email: sgalderi@tin.it)
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Abstract

Background

Studies investigating neurocognitive impairment in subjects with eating disorders (EDs) have reported heterogeneous patterns of impairment and, in some instances, no dysfunction. The present study aimed to define the pattern of neurocognitive impairment in a large sample of bulimia nervosa (BN) patients and to demonstrate that neuroendocrine, personality and clinical characteristics influence neurocognitive performance in BN.

Method

Attention/immediate memory, set shifting, perseveration, conditional and implicit learning were evaluated in 83 untreated female patients with BN and 77 healthy controls (HC). Cortisol and 17β-estradiol plasma levels were assessed. Cloninger's Temperament and Character Inventory – Revised (TCI-R), the Bulimic Investigation Test Edinburgh (BITE) and the Montgomery–Asberg Depression Rating Scale (MADRS) were administered.

Results

No impairment of cognitive performance was found in subjects with BN compared with HC. Cortisol and ‘Self-directedness’ were associated with better performance on conditional learning whereas 17β-estradiol had a negative influence on this domain; ‘Reward dependence’ was associated with worse performance on implicit learning; and depressive symptomatology influenced performance on the Wisconsin Card Sorting Test (WCST) negatively.

Conclusions

No cognitive impairment was found in untreated patients with BN. Neuroendocrine, personality and clinical variables do influence neurocognitive functioning and might explain discrepancies in literature findings.

Keywords

Co-morbiditycognitive functionseating disordersneuroendocrine indicesreward dependence
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 4 , April 2011 , pp. 839 - 848
Copyright
Copyright © Cambridge University Press 2010

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References

Alhaj, HA, Massey, AE, McAllister-Williams, RH (2006). Effects of DHEA administration on episodic memory, cortisol and mood in healthy young men: a double-blind, placebo-controlled study. Psychopharmacology 188, 541–551.CrossRefGoogle Scholar
Barrett-Connor, E, Goodman-Gruen, D, Patay, B (1999). Endogenous sex hormones and cognitive function in older men. Journal of Clinical Endocrinology and Metabolism 84, 3681–3685.Google ScholarPubMed
Blair, C, Granger, D, Peters Razza, R (2005). Cortisol reactivity is positively related to executive function in preschool children attending Head Start. Child Development 76, 554–567.CrossRefGoogle ScholarPubMed
Brand, M, Franke-Sievert, C (2007). Neuropsychological correlates of decision making in patients with bulimia nervosa. Neuropsychology 21, 742–750.CrossRefGoogle ScholarPubMed
Cloninger, CR (1999). The Temperament and Character Inventory – Revised. Center for Psychobiology of Personality, Washington University: St Louis, MI.Google Scholar
Cullen, B, Coen, RF, Lynch, CA, Cunningham, CJ, Coakley, D, Robertson, IH, Lawlor, BA (2005). Repetitive behaviour in Alzheimer's disease: description, correlates and functions. International Journal of Geriatric Psychiatry 20, 686–693.CrossRefGoogle ScholarPubMed
Duff, SJ, Hampson, E (2000). A beneficial effect of estrogen on working memory in postmenopausal women taking hormone replacement therapy. Hormones and Behavior 38, 262–276.CrossRefGoogle ScholarPubMed
Erberk-Ozen, N, Birol, A, Boratav, C, Kocak, M (2006). Executive dysfunctions and depression in Behçet's disease without explicit neurological involvement. Psychiatry and Clinical Neurosciences 60, 465–472.CrossRefGoogle ScholarPubMed
Fassino, S, Amianto, F, Gramaglia, C, Facchini, F, Abbate Daga, G (2004). Temperament and character in eating disorders: ten years of studies. Eating and Weight Disorders: EWD 9, 81–90.CrossRefGoogle ScholarPubMed
Fassino, S, Pierò, A, Daga, GA, Leombruni, P, Mortara, P, Rovera, GG (2002). Attentional biases and frontal functioning in anorexia nervosa. International Journal of Eating Disorders 31, 274–283.CrossRefGoogle ScholarPubMed
Ferraro, FR, Wonderlich, S, Jocic, Z (1997). Performance variability as a new theoretical mechanism regarding eating disorders and cognitive processing. Journal of Clinical Psychology 53, 117–121.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
Fichter, MM, Pirke, KM, Pöllinger, J, Wolfram, G, Brunner, E (1990). Disturbances in the hypothalamo-pituitary-adrenal and other neuroendocrine axes in bulimia. Biological Psychiatry 27, 1021–1037.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). Biometrics Research: New York.Google Scholar
Galderisi, S, Mucci, A, Catapano, F, Colucci D'Amato, A, Maj, M (1995). Neuropsychological slowness in obsessive compulsive patients: is it confined to tests involving the fronto-subcortical system? British Journal of Psychiatry 167, 394–398.CrossRefGoogle Scholar
Galderisi, S, Mucci, A, Mignone, ML, Bucci, P, Maj, M (1999). Hemispheric asymmetry and psychopathological dimensions in drug-free patients with schizophrenia. International Journal of Psychophysiology 34, 293–301.CrossRefGoogle ScholarPubMed
Galderisi, S, Mucci, A, Monteleone, P, Sorrentino, D, Piegari, G, Maj, M (2003). Neurocognitive functioning in subjects with eating disorders: the influence of neuroactive steroids. Biological Psychiatry 53, 921–927.CrossRefGoogle ScholarPubMed
Gruber, S, Rathgeber, K, Bräunig, P, Gauggel, S (2007). Stability and course of neuropsychological deficits in manic and depressed bipolar patients compared to patients with major depression. Journal of Affective Disorders 104, 61–71.CrossRefGoogle ScholarPubMed
Halmi, KA, Sunday, SR, Strober, M, Kaplan, A, Woodside, DB, Fichter, M, Treasure, J, Berrettini, WH, Kaye, WH (2000). Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. American Journal of Psychiatry 157, 1799–1805.CrossRefGoogle ScholarPubMed
Hammar, A (2003). Automatic and effortful information processing in unipolar major depression. Scandinavian Journal of Psychology 44, 409–413.CrossRefGoogle ScholarPubMed
Henderson, M, Freeman, CPL (1987). A self-rating scale for bulimia: the BITE. British Journal of Psychiatry 15, 18–24.CrossRefGoogle Scholar
Holliday, J, Tchanturia, K, Landau, S, Collier, D, Treasure, J (2005). Is impaired set shifting an endophenotype of anorexia nervosa? American Journal of Psychiatry 162, 2269–2275.CrossRefGoogle ScholarPubMed
Hotta, M, Shibasaki, T, Masuda, A, Imaki, T, Demura, H, Ling, N, Shizume, K (1986). The responses of plasma adrenocorticotropin and cortisol to corticotropin-releasing hormone (CRH) and cerebrospinal fluid immunoreactive CRH in anorexia nervosa patients. Journal of Clinical Endocrinology and Metabolism 62, 319–324.CrossRefGoogle ScholarPubMed
Jones, BP, Duncan, CC, Brouwers, P, Mirsky, AF (1991). Cognition in eating disorders. Journal of Clinical and Experimental Neuropsychology 13, 711–728.CrossRefGoogle ScholarPubMed
Klein, DA, Mayer, LE, Schebendach, JE, Walsh, BT (2007). Physical activity and cortisol in anorexia nervosa. Psychoneuroendocrinology 32, 539–547.CrossRefGoogle ScholarPubMed
Laessle, RG, Fischer, M, Fichter, MM, Pirke, KM, Krieg, JC (1992). Cortisol levels and vigilance in eating disorder patients. Psychoneuroendocrinology 17, 475–484.CrossRefGoogle ScholarPubMed
Lauer, CJ, Gorzewski, B, Gerlinghoff, M, Backmund, H, Zihl, J (1999). Neuropsychological assessments before and after treatment in patients with anorexia nervosa and bulimia nervosa. Journal of Psychiatric Research 33, 129–138.CrossRefGoogle ScholarPubMed
LeBlanc, ES, Janowsky, J, Chan, BK, Nelson, HD (2001). Hormone replacement therapy and cognition: systematic review and meta-analysis. Journal of the American Medical Association 285, 1489–1499.CrossRefGoogle ScholarPubMed
León-Carrión, J, Atutxa, AM, Mangas, MA, Soto-Moreno, A, Pumar, A, Leon-Justel, A, Martín-Rodriguez, JF, Venegas, E, Domínguez-Morales, MR, Leal-Cerro, A (2009). A clinical profile of memory impairment in humans due to endogenous glucocorticoid excess. Clinical Endocrinology 70, 192–200.CrossRefGoogle ScholarPubMed
Li, G, Cherrier, MM, Tsuang, DW, Petrie, EC, Colasurdo, EA, Craft, S, Schellenberg, GD, Peskind, ER, Raskind, MA, Wilkinson, CW (2006). Salivary cortisol and memory function in human aging. Neurobiology of Aging 27, 1705–1714.CrossRefGoogle ScholarPubMed
Lupien, S, Lecours, AR, Lussier, I, Schwartz, G, Nair, NP, Meaney, MJ (1994). Basal cortisol levels and cognitive deficits in human aging. Journal of Neuroscience 14, 2893–2903.CrossRefGoogle ScholarPubMed
Lupien, SJ, de Leon, M, de Santi, S, Convit, A, Tarshish, C, Nair, NP, Thakur, M, McEwen, BS, Hauger, RL, Meaney, MJ (1998). Cortisol levels during human aging predict hippocampal atrophy and memory deficits. Nature Neuroscience 1, 69–73.CrossRefGoogle ScholarPubMed
McKay, SE, Humphries, LL, Allen, ME, Clawson, DR (1986). Neuropsychological test performance of bulimic patients. International Journal of Neuroscience 30, 73–80.CrossRefGoogle ScholarPubMed
Milner, B (1978). Clues to the cerebral organization of memory. In Cerebral Correlates of Conscious Experience (ed. Buser, P. and Rougeul-Buser, A.), pp. 139–153. Elsevier: Amsterdam.Google Scholar
Mobbs, O, Van der Linden, M, d'Acremont, M, Perroud, A (2008). Cognitive deficits and biases for food and body in bulimia: investigation using an affective shifting task. Eating Behaviors 9, 455–461.CrossRefGoogle ScholarPubMed
Monteleone, P, Luisi, M, Colurcio, B, Casarosa, E, Monteleone, P, Ioime, R, Genazzani, AR, Maj, M (2001). Plasma levels of neuroactive steroids are increased in untreated women with anorexia nervosa or bulimia nervosa. Psychosomatic Medicine 63, 62–68.CrossRefGoogle ScholarPubMed
Monteleone, P, Luisi, M, Martiadis, V, Serritella, C, Longobardi, N, Casarosa, E, Genazzani, AR, Maj, M (2006). Impaired reduction of enhanced levels of dehydroepiandrosterone by oral dexamethasone in anorexia nervosa. Psychoneuroendocrinology 31, 537–542.CrossRefGoogle ScholarPubMed
Monteleone, P, Maes, M, Fabrazzo, M, Tortorella, A, Lin, A, Bosmans, E, Kenis, G, Maj, M (1999). Immunoendocrine findings in patients with eating disorders. Neuropsychobiology 40, 115–120.CrossRefGoogle ScholarPubMed
Montgomery, SA, Asberg, M (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.CrossRefGoogle ScholarPubMed
Must, A, Szabó, Z, Bódi, N, Szász, A, Janka, Z, Kéri, S (2006). Sensitivity to reward and punishment and the prefrontal cortex in major depression. Journal of Affective Disorders 90, 209–215.CrossRefGoogle ScholarPubMed
Owen, AM, Roberts, AC, Hodges, JR, Summers, BA, Polkey, CE, Robbins, TW (1993). Contrasting mechanisms of impaired attentional set-shifting in patients with frontal lobe damage or Parkinson's disease. Brain 116, 1159–1175.CrossRefGoogle ScholarPubMed
Petrides, M (1985). Deficits on conditional associative-learning tasks after frontal- and temporal-lobe lesions in man. Neuropsychologia 23, 601–614.CrossRefGoogle ScholarPubMed
Petrides, M, Milner, B (1982). Deficits on subject-ordered tasks after frontal- and temporal-lobe lesions in man. Neuropsychologia 20, 249–262.CrossRefGoogle ScholarPubMed
Rothamsted, V, Barnett, V, Lewis, T (1994). Outliers in Statistical Data. Wiley: Chichester.Google Scholar
Sapolsky, RM (1996). Why stress is bad for your brain. Science 273, 749–750.CrossRefGoogle ScholarPubMed
Seed, JA, Dixon, RA, McCluskey, SE, Young, AH (2000). Basal activity of the hypothalamic-pituitary-adrenal axis and cognitive function in anorexia nervosa. European Archives of Psychiatry and Clinical Neuroscience 250, 11–15.CrossRefGoogle ScholarPubMed
Sheehan, D, Lecrubier, Y, Janavs, J, Knapp, E, Weiller, E, Bonora, LI, Amorim, P, Lepine, JP, Sheehan, MF, Baker, RR, Sheehan, KH (1994). Mini-International Neuropsychiatric Interview (MINI). University of South Florida Institute for Research in Psychiatry: Tampa, FL.Google Scholar
Squire, LR (1992). Memory and the hippocampus: a synthesis from findings with rats, monkeys, and humans. Psychological Review 99, 195–231.CrossRefGoogle ScholarPubMed
Steinglass, JE, Walsh, BT, Stern, Y (2006). Set shifting deficit in anorexia nervosa. Journal of the International Neuropsychological Society 12, 431–435.CrossRefGoogle ScholarPubMed
Strupp, BJ, Weingartner, H, Kaye, W, Gwirtsman, H (1986). Cognitive processing in anorexia nervosa. A disturbance in automatic information processing. Neuropsychobiology 15, 89–94.CrossRefGoogle ScholarPubMed
Tchanturia, K, Anderluh, MB, Morris, RG, Rabe-Hesketh, S, Collier, DA, Sanchez, P, Treasure, JL (2004). Cognitive flexibility in anorexia nervosa and bulimia nervosa. Journal of the International Neuropsychological Society 10, 513–520.CrossRefGoogle ScholarPubMed
Tchanturia, K, Davies, H, Campbell, IC (2007). Cognitive remediation therapy for patients with anorexia nervosa: preliminary findings. Annals of General Psychiatry 6, 14–19.CrossRefGoogle ScholarPubMed
Tchanturia, K, Morris, RG, Surguladze, S, Treasure, J (2002). An examination of perceptual and cognitive set shifting tasks in acute anorexia nervosa and following recovery. Eating and Weight Disorders 7, 312–315.CrossRefGoogle ScholarPubMed
van Niekerk, JK, Huppert, FA, Herbert, J (2001). Salivary cortisol and DHEA: association with measures of cognition and well-being in normal older men, and effects of three months of DHEA supplementation. Psychoneuroendocrinology 26, 591–612.CrossRefGoogle ScholarPubMed
Winterer, J, Gwirtsman, HE, George, DT, Kaye, WH, Loriaux, DL, Cutler, GB Jr. (1985). Adrenocorticotropin-stimulated adrenal androgen secretion in anorexia nervosa: impaired secretion at low weight with normalization after long-term weight recovery. Journal of Clinical Endocrinology and Metabolism 61, 693–697.CrossRefGoogle ScholarPubMed
Zakzanis, KK, Campbell, Z, Polsinelli, A (2010). Quantitative evidence for distinct cognitive impairment in anorexia nervosa and bulimia nervosa. Journal of Neuropsychology 4, 89–106.CrossRefGoogle ScholarPubMed
Zumoff, B, Walsh, BT, Katz, JL, Levin, J, Rosenfeld, RS, Kream, J, Weiner, H (1983). Subnormal plasma dehydroisoandrosterone to cortisol ratio in anorexia nervosa: a second hormonal parameter of ontogenic regression. Journal of Clinical Endocrinology and Metabolism 56, 668–672.CrossRefGoogle ScholarPubMed
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