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Specific cognitive deficits in tests sensitive to frontal lobe dysfunction in obsessive–compulsive disorder

Published online by Cambridge University Press:  09 July 2009

D. M. Veale
Affiliation:
Institute of Psychiatry and the University Department of Psychiatry, Royal Free Hospital, London; Department of Psychiatry, University of Cambridge
B. J. Sahakian*
Affiliation:
Institute of Psychiatry and the University Department of Psychiatry, Royal Free Hospital, London; Department of Psychiatry, University of Cambridge
A. M. Owen
Affiliation:
Institute of Psychiatry and the University Department of Psychiatry, Royal Free Hospital, London; Department of Psychiatry, University of Cambridge
I. M. Marks
Affiliation:
Institute of Psychiatry and the University Department of Psychiatry, Royal Free Hospital, London; Department of Psychiatry, University of Cambridge
*
1Address for correspondence: Dr Barbara J. Sahakian, University of Cambridge, Department or Psychiatry, Addenbrooke's Hospital (Box 189), Cambridge CB2 2QQ.

Synopsis

Forty patients with obsessive–compulsive disorder (OCD) were compared to matched healthy controls on neuropsychological tests which are sensitive to frontal lobe dysfunction. On a computerized version of the Tower of London test of planning, the patients were no different from healthy controls in the accuracy of their solutions. However, when they made a mistake, they spent more time than the controls in generating alternative solutions or checking that the next move would be correct. The results suggest that OCD patients have a selective deficit in generating alternative strategies when they make a mistake. In a separate attentional set-shifting task, OCD patients were impaired in a simple discrimination learning task and showed a continuous cumulative increase in the number who failed at each stage of the task, including the crucial extra-dimensional set shifting stage. This suggests that OCD patients show deficits in both acquiring and maintaining cognitive sets.

The cognitive deficits in OCD may be summarized as: (i) being easily distracted by other competing stimuli; (ii) excessive monitoring and checking of the response to ensure a mistake does not occur; and (iii) when a mistake does occur, being more rigid at setting aside the main goal and planning the necessary subgoals. Both studies support the evidence of fronto-striatal dysfunction in OCD and the results are discussed in terms of an impaired Supervisory Attentional System.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1996

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References

Alexander, G. E., De Long, M. R. & Strick, P. L. (1986). Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annual Review of Neuroscience 9, 357381.Google Scholar
American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. Revised. American Psychiatric Association: Washington. DC.Google Scholar
Baxter, L. R., Schwartz, J. M., Mazziotta, J. C. & Phelps, M. E. (1988). Cerebral glucose metabolic rates in nondepressed patients with obsessive–compulsive disorder. American Journal of Psychiatry 145, 15601563.Google ScholarPubMed
Baxter, L. R., Schwartz, J. M., Phelps, M. E. & Mazziotta, J. C. (1989). Reduction of prefrontal cortex glucose metabolism common to three types of depression. Archives of General Psychiatry 46, 243250.CrossRefGoogle ScholarPubMed
Baxter, L. R., Schwartz, J. M. & Guze, B. H. (1991). The brain imaging: toward a neuroanatomy of OCD. The Psychobiology of Obsessive Compulsive Disorder (ed. Zohar, J., Insel, T. and Rasmussen, S.), pp. 101125. Springer: New York.Google Scholar
Beats, B., Sahakian, B. J. & Levy, R. (1996). Memory, planning and executive function in depression in old age. Psychological Medicine 26, 591603.CrossRefGoogle Scholar
Behar, D., Rapoport, J. L., Berg, C. J., Denkla, M. B., Mann, L., Cox, C. S., Fedio, P., Zahn, T. & Wolfman, M. G. (1984). Computerized tomography and neuropsychological test measures in adolescents with Obsessive Compulsive Disorder. American Journal of Psychiatry 141, 363369.Google Scholar
Boller, F., Passafume, D., Keefe, N. C., Rogers, K., Morrow, L. & Kim, Y. (1984). Visuospatial impairment in Parkinson's disease: role of perceptual and motor factors. Archives of Neurology 41, 485490.CrossRefGoogle ScholarPubMed
Boone, K. B., Ananth, J., Philpott, L., Kaur, A. & Djenderedjian, A. (1991). Neuro-psychological characteristics of non-depressed adults with obsessive compulsive disorder. Neuropsychiatry, Neuropsychotogy and Behavioral Neurology 4, 96109.Google Scholar
Cox, C. S., Fedio, P. & Rapoport, J. L. (1989). Neuropsychological testing of obsessive compulsive adolescents. Obsessive Compulsive Disorder in Children and Adolescents (ed. Rapoport, J. L.), pp. 7385. American Psychiatric Association: Washington, DC.Google Scholar
Dias, R., Robbins, T. W. & Roberts, A. C. (1996). Dissociation in prefrontal cortex of affective and attentional shifts. Nature 380, 6972.CrossRefGoogle ScholarPubMed
Downes, J. D., Roberts, A. C., Sahakian, B. J., Evenden, J. L. & Robbins, T. W. (1989). Impaired extra-dimensional shift performance in medicated and unmedicated Parkinson's disease: evidence for a specific attentional dysfunction. Neuropsychologia 27, 13291343.CrossRefGoogle ScholarPubMed
Elliott, R., Sahakian, B. J., McKay, A. P., Herrod, J. J., Robbins, T. W. & Paykel, E. S. (1996). Neuropsychological impairments in unipolar depression: the role of perceived failure on subsequent performance. Psychological Medicine 26, 975989.Google Scholar
Flor-Henry, P., Yeudall, L. T., Koles, Z. J. & Howarth, B. G. (1979). Neuropsychological and power spectral EEG investigations of the obsessive compulsive syndrome. Biological Psychiatry 14, 119130.Google ScholarPubMed
Head, D., Bolton, D. & Hymas, N. (1989). Deficit in cognitive shifting ability in patients with obsessive–compulsive disorder. Biological Psychiatry 25, 929937.CrossRefGoogle ScholarPubMed
Hymas, N. F. S.Kees, A. J., Bolton, D., Epps, K. & Head, D. (1991). The neurology of obsessional slowness. Brain 114, 22032233.Google Scholar
Kullback, S. (1968). Information Theory and Statistics. Dover: New York.Google Scholar
Luxenberg, J. S., Swedo, S. E., Flament, M. F. & Friedland, R. P. (1988). Neuroanatomical abnormalities in obsessive–compulsive disorder detected with quantitative X-ray computed tomography. American Journal of Psychiatry 145, 10891093.Google Scholar
Marks, I. M. (1986). Behavioural Psychotherapy – Maudsley Pocket Book of Clinical Management. Wright: Bristol.Google Scholar
Morris, R. G., Downes, J. J., Sahakian, B. J., Evenden, J. L., Heald, A. & Robbins, T. W. (1988). Planning and spatial working memory in Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry 51, 757766.Google Scholar
Nelson, H. E. (1982). National Adult Reading Test (NART): Test Manual. NFER-Nelson: Windsor.Google Scholar
Nie, N. H., Hadlai, H. C., Jenkins, J. G., Steinbrenner, K. & Bent, D. H. (1970). Statistical Package for the Social Sciences. McGraw-Hill: New York.Google Scholar
Nordahl, T. E., Benkelfat, C., Semple, W. E. & Gross, M. (1989). Cerebral glucose metabolic rates in obsessive compulsive disorder. Neuropsychopharmacology 2, 2328.CrossRefGoogle ScholarPubMed
Norman, D. A. & Shallice, T. (1980). Attention to action: willed and automatic control of behaviour. Centre for Human Information Processing Technical Report. No. 99. University of California: San Diego.Google Scholar
Owen, A. M., Downes, J. D., Sahakian, B. J., Polkey, C. E. & Robbins, T. (1990). Planning and spatial working memory following frontal lobe lesions in man. Neuropsychologia 28, 10211034.CrossRefGoogle ScholarPubMed
Owen, A. M., James, M., Leigh, P. N., Summers, B. A., Marsden, C. D., Quinn, N. P., Lange, K. W. & Robbins, T. W. (1992). Fronto-striatal cognitive deficits at different stages of Parkinson's disease. Brain 115, 17271751.CrossRefGoogle ScholarPubMed
Petrides, M. (1994). Frontal lobes and working memory: evidence from investigations of the effects of cortical excisions in nonhuman primates. In Handbook of Neuropsychology Vol. 9 (ed. Boller, F. and Grafman, J.), pp. 5981. Elsevier Science BV: Amsterdam.Google Scholar
Robbins, T. W. (1977). A critique of the methods available for the measurement of spontaneous motor activity. The Handbook of Psychopharmacology (ed. Iversen, L. L., Iversen, S. D. and Snyder, S. H.), pp. 3782. Plenum Press: New York.CrossRefGoogle Scholar
Robbins, T. W. & Sahakian, B. J. (1983). Behavioral effects of psychomotor stimulant drugs: clinical and neuropsychological implications. Stimulants: Neurochemical. Behavioral and Clinical Perspectives (ed. Creese, I.), pp. 301338. Raven Press: New York.Google Scholar
Roberts, A. C., De Salvia, M., Muir, J. L., Wilkinson, L. S., Everitt, B. J. & Robbins, T. W. (1991). The effects of selective prefrontal dopamine lesions on cognitive tests of frontal function in primates. Society Neurosciences Abstracts 17, 198.5.Google Scholar
Robinson, D., Wu, H., Munne, R.Ashtari, M., Alvir, J., Lerner, G., Koreen, A., Cole, K. & Bogerts, B. (1995). Reduced caudate nucleus volume in obsessive–compulsive disorder. Archives of General Psychiatry 52, 393398.Google Scholar
Sahakian, B. J., Downes, J. D., Eagger, S., Evenden, J. L., Levy, R., Philpot, M. P., Roberts, A. C. & Robbins, T. W. (1990). Sparing of attentional relative to mnemonic function in a sub-group of patients with dementia of the Alzheimer type. Neuropsychologia 28, 11971213.CrossRefGoogle Scholar
Salkovskis, P. M., Richards, C. & Forrester, E. (1995). The relationship between obsessional problems and intrusive thoughts. Behavioural and Cognitive Psychotherapy 23, 281299.CrossRefGoogle Scholar
Sandson, J. & Albert, M. L. (1984). Varieties of perseveration. Neuropsychologia 22, 715732.CrossRefGoogle ScholarPubMed
Sawle, G. V., Hymas, N. F., Lees, A. J. & Frackowiak, R. S. (1991). Obsessional slowness. Functional studies with positron emission tomography. Brain 114, 21912202.CrossRefGoogle ScholarPubMed
Shallice, T. (1982). Specific impairments of planning. Philosophical Transactions of the Royal Society of London Series B 298, 199209.Google Scholar
Swedo, S. E., Schapiro, M. B., Grady, C. L. & Cheslow, D. L. (1989). Cerebral glucose metabolism in childhood-onset obsessive–compulsive disorder. Archives of General Psychiatry 46, 518523.Google Scholar
Veale, D. (1993). Classification and treatment of obsessional slowness. British Journal of Psychiatry 162, 198203.CrossRefGoogle ScholarPubMed
Veale, D. (1995). Cognitive deficits in obsessive compulsive disorder in tests which are sensitive to frontal lobe dysfunction. M. D. thesis. University of London.Google Scholar
Wechsler, D. (1981). Wechsler Adult Intelligence Scale – Revised (WAIS – R). The Psychological Corporation: New York.Google Scholar
Winer, B. J. (1971). Statistical Principles in Experimental Design. McGraw Hill: New York.Google Scholar
Wise, S. P. & Rapoport, J. L. (1989). Obsessive compulsive disorder – is it basal ganglia dysfunction? Obsessive Compulsive Disorder in Children and Adolescents (ed. Rapoport, J. L.), pp. 327346. American Psychiatric Association: Washington, DC.Google Scholar
Zielinski, C. M., Taylor, M. A. & Juzwin, K. R. (1991). Neuropsychological deficits in obsessive–compulsive disorder. Neuropsychiatry, Neuropsychology and Behavioral Neurology 4, 110126.Google Scholar