Demographic and questionnaire measures for Anorexia Nervosa (AN) and Healthy Control (HC) groups.

<p>Score ranges: Hospital Anxiety and Depression Scale (HADS; 0–21), Eating Disorder Examination Questionnaire (EDE-Q; 0–6), Cognitive Flexibility Scale (CFS; 0–72)</p><p>(-) indicates where all participants scored 0</p><p>IQR = inter-quartile range; S.D. = standard deviation; BMI = body mass index; NART = national adult reading test</p><p>(*) indicates results that remain significant after Bonferroni multiple comparison correction</p><p>^a Data based on 31AN and 32HC</p><p>^b Data based on 28AN</p><p>Demographic and questionnaire measures for Anorexia Nervosa (AN) and Healthy Control (HC) groups.</p

fMRI results of cognitive flexibility comparisons.

<p>(A): Axial slices and line graphs showing significant group (Anorexia Nervosa, Healthy Control) x event (Efficient Shift [<i>Eff-Sh</i>], First Correct [<i>F-Corr</i>]) interactions of BOLD response (SSQ value) in the left middle frontal gyrus (BA9, Peak activation Talairach coordinates = -40, 22, 26, cluster size = 14, p = 0.0069), left inferior precuneus (BA7, Peak activation Talairach coordinates = -25, -56, 26, cluster size = 34, p = 0.0029) and left superior parietal lobule extending into the precuneus (BA7, Peak activation Talairach coordinates = -18, -67, 48, cluster size = 17, p = 0.0078). (B): Sagittal slices and bar charts illustrating the BOLD response during <i>SiS-P</i> and <i>Rec-P</i> and corresponding activity during <i>Eff-Sh</i> in the left middle frontal gyrus, left inferior precuneus and left superior parietal lobule. Functional data were thresholded to yield less than 1 false positive cluster per map and overlaid onto a high resolution single subject T1 structural image in Talairach space.</p

Regions showing a significant difference between Efficient Shift (<i>Eff-Sh)</i> and First Correct (<i>F-Corr</i>) trials.

<p>Efficient Shift <i>(Eff-Sh)</i>; First Correct <i>(F-Corr)</i>; Anorexia Nervosa (AN); Healthy Controls (HC)</p><p>All listed regions survived correction for multiple comparisons.</p><p>Regions showing a significant difference between Efficient Shift (<i>Eff-Sh)</i> and First Correct (<i>F-Corr</i>) trials.</p

Time course of a WCST trial and events of interest for behavioural and fMRI analysis.

<p>Each example presents the current rule chosen by the program (‘correct rule’) with concurrent trial-by-trial participant responses (‘chosen rule’), illustrating different WCST ‘event types’. Note that for event-related fMRI analysis, each event is modelled as the period between two consecutive responses and the ‘event type’ is defined by the combination of the two responses. EXAMPLE A: I) Efficient Shifts (<i>Eff-Sh</i>) were when participants changed sorting rules following negative feedback to one that had not been previously tested. II) Stuck-in-set perseverations (<i>SiS-P</i>) occurred if the same sorting rule that was incorrect in the previous trial was applied in the subsequent trial. III) First correct sort (<i>F-Corr</i>) of a new set. IV) Second correct sort (<i>S-Corr</i>) follows first correct sort. V) fMRI baseline (<i>Baseline</i>) was designated as trials 3–8 of a string of 8 consecutive correct sorts. EXAMPLE B: VI) Recurrent perseverations (<i>Rec-P</i>) constituted shifts to another sorting rule following incorrect feedback, but to one that had been tested two trials previously and already fed back as incorrect. EXAMPLE C: VII) Error Set trials (<i>Error Set</i>) were correct sorts not included as baseline trials due to occurrence of ‘loss of set’ errors within that particular set. VIII) Loss of set (<i>Loss of set</i>) trials are shifts to a different rule following positive feedback.</p

WCST performance and reaction time measures for Anorexia Nervosa (AN) and Healthy Control (HC) groups.

<p>IQR = inter-quartile range; S.D. = standard deviation</p><p>(*) indicates results that remain significant after Bonferroni multiple comparison correction</p><p>^a Data based on 16AN and 16HC; the remaining participants committed 0 errors</p><p>^b Data based on 11AN and 13HC; the remaining participants committed 0 errors</p><p>^c Data based on 26AN and 25HC; the remaining participants committed 0 errors</p><p>WCST performance and reaction time measures for Anorexia Nervosa (AN) and Healthy Control (HC) groups.</p

Evaluation of Enhanced Attention to Local Detail in Anorexia Nervosa Using the Embedded Figures Test; an fMRI Study

<div><p>The behavioural literature in anorexia nervosa and autism spectrum disorders has indicated an overlap in cognitive profiles. One such domain is the enhancement of local processing over global processing. While functional imaging studies of autism spectrum disorder have revealed differential neural patterns compared to controls in response to tests of local versus global processing, no studies have explored such effects in anorexia nervosa. This study uses functional magnetic resonance imaging in conjunction with the embedded figures test, to explore the neural correlates of this enhanced attention to detail in the largest anorexia nervosa cohort to date. On the embedded figures tests participants are required to indicate which of two complex figures contains a simple geometrical shape. The findings indicate that whilst healthy controls showed greater accuracy on the task than people with anorexia nervosa, different brain regions were recruited. Healthy controls showed greater activation in the precuneus whilst people with anorexia nervosa showed greater activation in the fusiform gyrus. This suggests that different cognitive strategies were used to perform the task, i.e. healthy controls demonstrated greater emphasis on visuospatial searching and people with anorexia nervosa employed a more object recognition-based approach. This is in accordance with previous findings in autism spectrum disorder using a similar methodology and has implications for therapies addressing the appropriate adjustment of cognitive strategies in anorexia nervosa.</p></div