Dataset Information

Impaired cognitive plasticity and goal-directed control in adolescent obsessive-compulsive disorder.

ABSTRACT:

Background

Youths with obsessive-compulsive disorder (OCD) experience severe distress and impaired functioning at school and at home. Critical cognitive domains for daily functioning and academic success are learning, memory, cognitive flexibility and goal-directed behavioural control. Performance in these important domains among teenagers with OCD was therefore investigated in this study.

Methods

A total of 36 youths with OCD and 36 healthy comparison subjects completed two memory tasks: Pattern Recognition Memory (PRM) and Paired Associates Learning (PAL); as well as the Intra-Extra Dimensional Set Shift (IED) task to quantitatively gauge learning as well as cognitive flexibility. A subset of 30 participants of each group also completed a Differential-Outcome Effect (DOE) task followed by a Slips-of-Action Task, designed to assess the balance of goal-directed and habitual behavioural control.

Results

Adolescent OCD patients showed a significant learning and memory impairment. Compared with healthy comparison subjects, they made more errors on PRM and PAL and in the first stages of IED involving discrimination and reversal learning. Patients were also slower to learn about contingencies in the DOE task and were less sensitive to outcome devaluation, suggesting an impairment in goal-directed control.

Conclusions

This study advances the characterization of juvenile OCD. Patients demonstrated impairments in all learning and memory tasks. We also provide the first experimental evidence of impaired goal-directed control and lack of cognitive plasticity early in the development of OCD. The extent to which the impairments in these cognitive domains impact academic performance and symptom development warrants further investigation.

SUBMITTER: Gottwald J

PROVIDER: S-EPMC6088771 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Publications

Impaired cognitive plasticity and goal-directed control in adolescent obsessive-compulsive disorder.

Gottwald Julia J de Wit Sanne S Apergis-Schoute Annemieke M AM Morein-Zamir Sharon S Kaser Muzaffer M Cormack Francesca F Sule Akeem A Limmer Winifred W Morris Anna Conway AC Robbins Trevor W TW Sahakian Barbara J BJ

Psychological medicine 20180122 11

<h4>Background</h4>Youths with obsessive-compulsive disorder (OCD) experience severe distress and impaired functioning at school and at home. Critical cognitive domains for daily functioning and academic success are learning, memory, cognitive flexibility and goal-directed behavioural control. Performance in these important domains among teenagers with OCD was therefore investigated in this study.<h4>Methods</h4>A total of 36 youths with OCD and 36 healthy comparison subjects completed two memor ...[more]

PMID: 29353562

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Project description:BackgroundA recent hypothesis has suggested that core deficits in goal-directed behavior in obsessive-compulsive disorder (OCD) are caused by impaired frontostriatal function. We tested this hypothesis in OCD patients and control subjects by relating measures of goal-directed planning and cognitive flexibility to underlying resting-state functional connectivity.MethodsMultiecho resting-state acquisition, combined with micromovement correction by blood oxygen level-dependent sensitive independent component analysis, was used to obtain in vivo measures of functional connectivity in 44 OCD patients and 43 healthy comparison subjects. We measured cognitive flexibility (attentional set-shifting) and goal-directed performance (planning of sequential response sequences) by means of well-validated, standardized behavioral cognitive paradigms. Functional connectivity strength of striatal seed regions was related to cognitive flexibility and goal-directed performance. To gain insights into fundamental network alterations, graph theoretical models of brain networks were derived.ResultsReduced functional connectivity between the caudate and the ventrolateral prefrontal cortex was selectively associated with reduced cognitive flexibility. In contrast, goal-directed performance was selectively related to reduced functional connectivity between the putamen and the dorsolateral prefrontal cortex in OCD patients, as well as to symptom severity. Whole-brain data-driven graph theoretical analysis disclosed that striatal regions constitute a cohesive module of the community structure of the functional connectome in OCD patients as nodes within the basal ganglia and cerebellum were more strongly connected to one another than in healthy control subjects.ConclusionsThese data extend major neuropsychological models of OCD by providing a direct link between intrinsically abnormal functional connectivity within dissociable frontostriatal circuits and those cognitive processes underlying OCD symptoms.

Project description:ImportanceDimensional definitions of transdiagnostic mental health problems have been suggested as an alternative to categorical diagnoses, having the advantage of capturing heterogeneity within diagnostic categories and similarity across them and bridging more naturally psychological and neural substrates.ObjectiveTo examine whether a self-reported compulsivity dimension has a stronger association with goal-directed and related higher-order cognitive deficits compared with a diagnosis of obsessive-compulsive disorder (OCD).Design, setting, and participantsIn this cross-sectional study, patients with OCD and/or generalized anxiety disorder (GAD) from across the United States completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments from October 8, 2015, to October 1, 2017. Follow-up data were collected to test for replicability.Main outcomes and measuresPerformance was measured on a test of goal-directed planning and cognitive flexibility (Wisconsin Card Sorting Test [WCST]) and a test of abstract reasoning. Clinical variables included DSM-5 diagnosis of OCD and GAD and 3 psychiatric symptom dimensions (general distress, compulsivity, and obsessionality) derived from a factor analysis.ResultsOf 285 individuals in the analysis (mean [SD] age, 32 [12] years; age range, 18-77 years; 219 [76.8%] female), 111 had OCD; 82, GAD; and 92, OCD and GAD. A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (? [SE], -0.02 [0.02]; P?=?.18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (? [SE], -0.05 [0.02]; P?=?.003). Results for abstract reasoning task and WCST mirrored this pattern; the compulsivity dimension was associated with abstract reasoning (? [SE], 2.99 [0.63]; P?<?.001) and several indicators of WCST performance (eg, categories completed: ? [SE], -0.57 [0.09]; P?<?.001), whereas OCD diagnosis was not (abstract reasoning: ? [SE], 0.39 [0.66]; P?=?.56; categories completed: ? [SE], -0.09 [0.10]; P?=?.38). Other symptom dimensions relevant to OCD, obsessionality, and general distress had no reliable association with goal-directed performance, WCST, or abstract reasoning. Obsessionality had a positive association with requiring more trials to reach the first category on the WCST at baseline (? [SE], 2.92 [1.39]; P?=?.04), and general distress was associated with impaired goal-directed performance at baseline (? [SE],-0.04 [0.02]; P?=?.01). However, unlike the key results of this study, neither survived correction for multiple comparisons or was replicated at follow-up testing.Conclusions and relevanceDeficits in goal-directed planning in OCD may be more strongly associated with a compulsivity dimension than with OCD diagnosis. This result may have implications for research assessing the association between brain mechanisms and clinical manifestations and for understanding the structure of mental illness.

Dataset Information

Impaired cognitive plasticity and goal-directed control in adolescent obsessive-compulsive disorder.

Background

Methods

Results

Conclusions

Publications

Impaired cognitive plasticity and goal-directed control in adolescent obsessive-compulsive disorder.

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