Ist es doch die Willenskraft? Exekutivfunktionen bei Adipositas

A. Müller; E. Pauli; M. de Zwaan

doi:10.1055/s-0037-1618710

Adipositas - Ursachen, Folgeerkrankungen, Therapie, Table of Contents

Adipositas - Ursachen, Folgeerkrankungen, Therapie 2010; 04(03): 131-137
DOI: 10.1055/s-0037-1618710

Psychische Aspekte der Adipositas

Schattauer GmbH

Ist es doch die Willenskraft? Exekutivfunktionen bei Adipositas

Is it all about willpower? Executive functioning in obesity

A. Müller

¹Psychosomatische und Psychotherapeutische Abteilung, Universitätsklinikum Erlangen

,

E. Pauli

²Neurologische Klinik, Universitätsklinikum Erlangen

,

M. de Zwaan

¹Psychosomatische und Psychotherapeutische Abteilung, Universitätsklinikum Erlangen

› Author Affiliations

Abstract

Zusammenfassung

Das Konzept der Exekutivfunktionen umfasst mentale Prozesse höherer Ordnung, deren Zusammenspiel zielgerichtetes Verhalten und flexibles, angemessenes Reagieren auf neue Situationen und damit Selbstkontrolle gewährleistet. Exekutivfunktionen sind immer dann relevant, wenn mehrere Handlungsalternativen hinsichtlich ihrer Konsequenzen miteinander verglichen und Hypothesen über die Folgen des eigenen Handelns gegeneinander abgewogen werden müssen. Die bisherige Studienlage zeigt, dass exekutive Funktionen bei extrem übergewichtigen Patienten beeinträchtigt sind. Wahrscheinlich tragen reduzierte Exekutivfunktionen bzw. eine verringerte Selbstkontrolle zu den Problemen bei der Steuerung des Essverhaltens bei adipösen Patienten bei. Ungeklärt ist, ob extremes Übergewicht eine Ursache oder ein Resultat exekutiver Dysfunktion darstellt. Es besteht Forschungsbedarf, um die Zusammenhänge zwischen Adipositas und defizitären Exekutivfunktionen besser verstehen zu können. Zudem ist noch ungewiss, inwiefern eine nachhaltige, klinisch signifikante Gewichtsreduktion zur Verbesserung neurokognitiver Funktionen führt.

Summary

The concept of executive functioning includes higher-order cognitive abilities that are necessary to engage in goal-directed behaviour, respond in an adaptive manner in novel situations, and for self-control. Executive functions are relevant when alternative behaviours must be compared with each other and prioritized on the basis of their consequences. Research has provided evidence for an association between obesity and impaired executive functioning. Deficits in executive functioning and reduced self-control probably contribute to uncontrolled eating behaviour in obese patients. It is difficult to determine whether obesity is a cause or a result of executive dysfunction. Further research is needed to identify etiological mechanisms and underlying physiological processes that contribute to the association between obesity and impaired executive functioning. Furthermore, it remains unknown whether extreme weight loss would reverse cognitive deficits.

Schlüsselwörter

Exekutivfunktionen - kognitive Funktionen - Selbstkontrolle - Adipositas

Keywords

Executive function - cognitive functioning - self-control - obesity

Full Text

References

Literatur
1 Barkley RA. The executive functions and self-regulation: an evolutionary neuropsychological perspective. Neuropsychol Rev 2001; 11: 1-29.
2 Beutel ME, Klockenbrink P, Wiltink J. et al. (Attention and executive functions in patients with severe obesity. A controlled study using the Attention Network Test) Aufmerksamkeit und exekutive Funktionen bei Patienten mit Adipositas per magna. Nervenarzt 2006; 77: 1323-1324.
3 Boeka AG, Lokken KL. Neuropsychological performance of a clinical sample of extremely obese individuals. Arch Clin Neuropsychol 2008; 23: 467-474.
4 Bryan J, Tiggemann M. The effect of weight-loss dieting on cognitive performance and psychological well-being in overweight women. Appetite 2001; 36: 147-156.
5 Cournot M, Marquié JC, Ansiau D. et al. Relation between body mass index and cognitive function in healthy middle-aged men and women. Neurology 2006; 67: 1208-1214.
6 Cserjési R, Luminet O, Poncelet AS. et al. Altered executive function in obesity. Exploration of the role of affective states on cognitive abilities. Appetite 2009; 52: 535-539.
7 Davis C, Levitan RD, Muglia P. et al. Decision-making deficits and overeating: a risk model for obesity. Obes Res 2004; 12: 929-935.
8 Davis C, Patte K, Curtis C. et al. Immediate pleasures and future consequences. A neuropsychological study of binge eating and obesity. Appetite 2010; 54: 208-213.
9 Elias MF, Elias PK, Sullivan LM. et al. Lower cognitive function in the presence of obesity and hypertension: the Framingham heart study. Int J Obes Relat Metab Disord 2003; 27: 260-268.
10 Fergenbaum JH, Bruce S, Lou W. et al. Obesity and lowered cognitive performance in a Canadian First Nations population. Obesity 2009; 17: 1957-1963.
11 Gunstad J, Lhotsky A, Wendell CR. et al. Longitudinal Examination of Obesity and Cognitive Function: Results from the Baltimore Longitudinal Study of Aging. Neuroepidemiology 2010; 34: 222-229.
12 Gunstad J, Paul RH, Cohen RA. et al. Obesity is associated with memory deficits in young and middle-aged adults. Eat Weight Disord 2006; 11: 15-19.
13 Gunstad J, Paul RH, Cohen RA. et al. Elevated body mass index is associated with executive dysfunction in otherwise healthy adults. Compr Psychiatry 2007; 48: 57-61.
14 Gunstad J, Paul RH, Cohen RA. et al. Relationship between body mass index and brain volume in healthy adults. Int J Neurosci 2008; 118: 1582-1593.
15 Gustafson D, Lissner L, Bengtsson C. et al. A 24-year follow-up of body mass index and cerebral atrophy. Neurology 2004; 63: 1876-1881.
16 Harvey J. Leptin regulation of neuronal excitability and cognitive function. Curr Opin Pharmacol 2007; 07: 643-647.
17 Kretsch MJ, Green MW, Fong AK. et al. Cognitive effects of a long-term weight reducing diet. Int J Obes Relat Metab Disord 1997; 21: 14-21.
18 Kuo HK, Jones RN, Milberg WP. et al. Cognitive function in normal-weight, overweight, and obese older adults: an analysis of the Advanced Cognitive Training for Independent and Vital Elderly cohort. J Am Geriatr Soc 2006; 54: 97-103.
19 Lezak MD, Howieson DB, Loring DW. Neuropsychological Assessment, 4. Auflage. New York: Oxford University Press; 2004
20 Li Y, Dai Q, Jackson JC. et al. Overweight is associated with decreased cognitive functioning among school-age children and adolescents. Obesity 2008; 16: 1809-1815.
21 Lokken KL, Boeka AG, Austin HM. et al. Evidence of executive dysfunction in extremely obese adolescents: a pilot study. Surg Obes Relat Dis 2009; 05: 547-552.
22 Lokken KL, Boeka AG, Yellumahanthi K. et al. Cognitive performance of morbidly obese patients seeking bariatric surgery. Am Surg 2010; 76: 55-59.
23 Morrison CD. Leptin signaling in brain: A link between nutrition and cognition?. Biochim Biophys Acta 2009; 1792: 401-408.
24 Paulus K, Schulz C, Lehnert H. Central nervous effects of leptin and insulin on hippocampal leptin and insulin receptor expression following a learning task in Wistar rats. Neuropsychobiology 2005; 51: 100-106.
25 Pignatti R, Bertella L, Albani G. et al. Decision-making in obesity: a study using the Gambling Task. Eat Weight Disord 2006; 11: 126-132.
26 Rothemund Y, Preuschhof C, Bohner G. et al. Differential activation of the dorsal striatum by high-calorie visual food stimuli in obese individuals. Neuroimage 2007; 37: 410-421.
27 Sattler W. Funktionen frontaler Strukturen - Exekutivfunktionen. In: Lehrner J, Pusswald G, Fertl E, Kryspin-Exner I, Strubreither W. Hrsg. Klinische Neuropsychologie Grundlagen — Diagnostik — Rehabilitation. Wien: Springer; 2006: 475-490.
28 Sørensen TI, Sonne-Holm S, Christensen U. et al. Reduced intellectual performance in extreme overweight. Hum Biol 1982; 54: 765-775.
29 van den Berg E, Dekker JM, Nijpels G, Kessels RP, Kappelle LJ, de Haan EH, Heine RJ. et al. Cognitive functioning in elderly persons with type 2 diabetes and metabolic syndrome: the Hoorn study. Dement Geriatr Cogn Disord 2008; 26: 261-269.
30 Verdejo-García A, Pérez-Expósito M, Schmidt-Río-Valle J. et al. Selective Alterations Within Executive Functions in Adolescents With Excess Weight. Obesity. 2010 [Epub ahead of print].
31 Volkow ND, Wang GJ, Telang F. et al. Inverse association between BMI and prefrontal metabolic activity in healthy adults. Obesity 2009; 17: 60-65.
32 Volkow ND, Wang GJ, Telang F. et al. Low dopamine striatal D2 receptors are associated with prefrontal metabolism in obese subjects: possible contributing factors. Neuroimage 2008; 42: 1537-1543.
33 Waldstein SR, Katzel LI. Interactive relations of central versus total obesity and blood pressure to cognitive function. Int J Obes (Lond) 2006; 30: 201-207.
34 Walther K, Birdsill AC, Glisky EL. et al. Structural brain differences and cognitive functioning related to body mass index in older females. Hum Brain Mapp. 2009 [Epub ahead of print].
35 Wang GJ, Volkow ND, Logan J. Brain dopamine and obesity. Lancet 2001; 357: 354-357.
36 Wolf PA, Beiser A, Elias MF. et al. Relation of obesity to cognitive function: importance of central obesity and synergistic influence of concomitant hypertension. The Framingham Heart Study. Curr Alzheimer Res 2007; 04: 111-116.