Modulations of cognitive flexibility in obsessive compulsive disorder reflect dysfunctions of perceptual categorization

App-Based Mindfulness Meditation Training and an Audiobook Intervention Reduce Symptom Severity but Do Not Modify Backward Inhibition in Adolescent Obsessive-Compulsive Disorder: Evidence from an EEG Study

(1) Background: 1–2% of children and adolescents are affected by Obsessive-Compulsive Disorder (OCD). The rigid, repetitive features of OCD and an assumed disability to inhibit recent mental representations are assumed to have led to a paradoxical advantage in that the Backward Inhibition (BI) effect was recently found to be lower in adolescents with OCD as compared to healthy controls. It was hypothesized that app-based mindfulness meditation training could reduce the disability to inhibit recent mental representations and thus increase the BI-effect by adapting cognitive flexibility and inhibition abilities according to healthy controls. (2) Methods: 58 adolescents (10–19 years) with OCD were included in the final sample of this interviewer-blind, randomized controlled study. Participants were allocated to an intervention group (app-based mindfulness meditation training) or an (active) control group (app-based audiobook) for eight weeks. Symptom (CY-BOCS), behavioral (reaction times and mean accuracy), and neurophysiological changes (in EEG) of the BI-effect were analyzed in a pre-post design. (3) Results: The intervention and the control group showed an intervention effect (Reliable Change Index: 67%) with a significant symptom reduction. Contrary to the hypothesis, the BI-effect did not differ between pre vs. post app-based mindfulness meditation training. In addition, as expected the audiobook application showed no effects. Thus, we observed no intervention-specific differences with respect to behavioral (reaction times and mean accuracy) or with respect to neurophysiological (perceptual [P1], attentional [N1], conflict monitoring [N2] or updating and response selection [P3]) processes. However, in an exploratory approach, we revealed that the BI-effect decreased in participants who did not benefit from using an app, regardless of group. (4) Conclusions: Both listening to an app-based mindfulness meditation training and to an audiobook reduce symptom severity in adolescent OCD as measured by the CY-BOCS; however, they have no specific effect on BI. The extent of the baseline BI-effect might be considered as an intra-individual component to predict the benefit of both mindfulness meditation training and listening to an audiobook.

Imbalance between the caudate and putamen connectivity in obsessive-compulsive disorder

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The imbalance between the caudate and putamen connectivity in OCD patient arises from the abnormal connection of caudate.

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The abnormal caudate connectivity mainly results from the outward extension of cortico-striato-thalamo-cortical loop.

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The caudate connectivity of OCD patients is negatively associated with their task-switch performance.

Background

Compulsive behaviors in obsessive–compulsive disorder (OCD) have been suggested to result from an imbalance in cortico-striatal connectivity. However, the nature of this impairment, the relative involvement of different striatal areas, their imbalance in genetically related but unimpaired individuals, and their relationship with cognitive dysfunction in OCD patients, remain unknown.

Methods

In the current study, striatal (i.e., caudate and putamen) whole-brain connectivity was computed in a sample of OCD patients (OCD, n = 62), unaffected first-degree relatives (UFDR, n = 53) and healthy controls (HC, n = 73) by ROI-based resting-state functional magnetic resonance imaging (rs-fMRI). A behavioral task switch paradigm outside of the scanner was also performed to measure cognitive flexibility in OCD patients.

Results

There were significantly increased strengths (Z-transformed Pearson correlation coefficient) in caudate connectivity in OCD patients. A significant correlation between the two types of connectivity strengths in the relevant regions was observed only in the OCD patient group. Furthermore, the caudate connectivity of patients was negatively associated with their task-switch performance.

Conclusions

The imbalance between the caudate and putamen connectivity, arising from the abnormal increase of caudate activity, may serve as a clinical characteristic for obsessive–compulsive disorder.

The metacontrol hypothesis as diagnostic framework of OCD and ADHD: A dimensional approach based on shared neurobiological vulnerability

Obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) are multi-faceted neuropsychiatric conditions that in many aspects appear to be each other's antipodes. We suggest a dimensional approach, according to which these partially opposing disorders fall onto a continuum that reflects variability regarding alterations of cortico-striato-thalamo-cortical (CSTC) circuits and of the processing of neural noise during cognition. By using theoretical accounts of human cognitive metacontrol, we develop a framework according to which OCD can be characterized by a chronic bias towards exaggerated cognitive persistence, equivalent to a high signal-to-noise ratio (SNR)-which facilitates perseverative behaviour but impairs mental flexibility. In contrast, ADHD is characterized by a chronic bias towards inflated cognitive flexibility, equivalent to a low SNR-which increases behavioural variability but impairs the focusing on one goal and on relevant information. We argue that, when pharmacology is not feasible, novel treatments of these disorders may involve methods to manipulate the signal-to-noise ratio via non-invasive brain stimulation techniques, in order to normalize the situational imbalance between cognitive persistence and cognitive flexibility.

Neural Correlates of Executive Functioning in Anorexia Nervosa and Obsessive-Compulsive Disorder

Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are commonly reported to co-occur and present with overlapping symptomatology. Executive functioning difficulties have been implicated in both mental health conditions. However, studies directly comparing these functions in AN and OCD are extremely limited. This review provides a synthesis of behavioral and neuroimaging research examining executive functioning in AN and OCD to bridge this gap in knowledge. We outline the similarities and differences in behavioral and neuroimaging findings between AN and OCD, focusing on set shifting, working memory, response inhibition, and response monitoring. This review aims to facilitate understanding of transdiagnostic correlates of executive functioning and highlights important considerations for future research. We also discuss the importance of examining both behavioral and neural markers when studying transdiagnostic correlates of executive functions.

Multi-level decoding of task sets in neurophysiological data during cognitive flexibility

Cognitive flexibility is essential to achieve higher level goals. Cognitive theories assume that the activation/deactivation of goals and task rules is central to understand cognitive flexibility. However, how this activation/deactivation dynamic is implemented on a neurophysiological level is unclear. Using EEG-based multivariate pattern analysis (MVPA) methods, we show that activation of relevant information occurs parallel in time at multiple levels in the neurophysiological signal containing aspects of stimulus-related processing, response selection, and motor response execution, and relates to different brain regions. The intensity with which task sets are activated and processed dynamically decreases and increases. The temporal stability of these activations could, however, hardly explain behavioral performance. Instead, task set deactivation processes associated with left orbitofrontal regions and inferior parietal regions selectively acting on motor response task sets are relevant. The study shows how propositions from cognitive theories stressing the importance task set activation/deactivation during cognitive flexibility are implemented on a neurophysiological level.

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Stimulus-related, motor, and response selection aspects of task set were decoded

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Activation of task rule information occurs at multiple neurophysiological levels

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Activation and deactivation of rule sets contributes to cognitive flexibility

Nucleus Accumbens Stimulation Modulates Inhibitory Control by Right Prefrontal Cortex Activation in Obsessive-Compulsive Disorder

Inhibitory control is considered a compromised cognitive function in obsessive-compulsive (OCD) patients and likely linked to corticostriatal circuitry disturbances. Here, 9 refractory OCD patients treated with deep brain stimulation (DBS) were evaluated to address the dynamic modulations of large-scale cortical network activity involved in inhibitory control after nucleus accumbens (NAc) stimulation and their relationship with cortical thickness. A comparison of DBS "On/Off" states showed that patients committed fewer errors and exhibited increased intraindividual reaction time variability, resulting in improved goal maintenance abilities and proactive inhibitory control. Visual P3 event-related potentials showed increased amplitudes during Go/NoGo performance. Go and NoGo responses increased cortical activation mainly over the right inferior frontal gyrus and medial frontal gyrus, respectively. Moreover, increased cortical activation in these areas was equally associated with a higher cortical thickness within the prefrontal cortex. These results highlight the critical role of NAc DBS for preferentially modulating the neuronal activity underlying sustained speed responses and inhibitory control in OCD patients and show that it is triggered by reorganizing brain functions to the right prefrontal regions, which may depend on the underlying cortical thinning. Our findings provide updated structural and functional evidence that supports critical dopaminergic-mediated frontal-striatal network interactions in OCD.

Visuomotor Activation of Inhibition-Processing in Pediatric Obsessive Compulsive Disorder: A Magnetoencephalography Study

Background: Response inhibition engages the cortico-striato-thalamo-cortical (CSTC) circuit, which has been implicated in children, and youth with obsessive compulsive disorder (OCD). This study explored whether CSTC engagement during response inhibition, measured using magnetoencephalography (MEG), differed in a sample of medication-naïve youth with OCD, compared to typically developing controls (TDC). Methods: Data was analyzed in 17 medication-naïve children and youth with OCD (11.7 ± 2.2 SD years) and 13 TDC (12.6 ± 2.2 SD years). MEG was used to localize and characterize neural activity during a Go/No-Go task. Task performance on Go/No-Go conditions and regional differences in amplitude of activity during Go and No-Go condition between OCD vs. TDC were examined using two-sample t-tests. Post-hoc analysis with Bayesian t-tests was used to estimate the certainty of outcomes. Results: No differences in Go/No-Go performance were found between OCD and TDC groups. In response to the visual cue presented during the Go condition, participants with OCD showed significantly increased amplitude of activity in the primary motor (MI) cortex compared to TDC. In addition, significantly reduced amplitude of PCu was found following successful stopping to No-Go cues in OCD vs. TDC during No-Go task performance. Bayesian t-tests indicated high probability and large effect sizes for the differences in MI and PCu amplitude found between groups. Conclusion: Our preliminary study in a small medication-naïve sample extends previous work indicating intact response inhibition in pediatric OCD. While altered neural response in the current study was found during response inhibition performance in OCD, differences localized to regions outside of the CSTC. Our findings suggest that additional imaging research in medication-naïve samples is needed to clarify regional differences associated with OCD vs. influenced by medication effects, and suggest that MEG may be sensitive to detecting such differences.

Hippocampal functional network: The mediating role between obsession and anxiety in adult patients with obsessive-compulsive disorder

OBJECTIVES

Anxiety is a very common symptom and closely related to obsessive-compulsive symptoms in obsessive-compulsive disorder (OCD). However, the association between anxiety and obsessive-compulsive symptoms at the hippocampus network level remains unclear.

METHODS

This study enrolled 42 patients with OCD and 42 healthy controls (HCs), who underwent resting-state functional magnetic resonance imaging (fMRI) and clinical evaluation. Multiple linear regression analysis was performed to investigate the behavioural significance and interactive effects of obsessive-compulsive and anxiety symptoms on the hippocampus functional connectivity (HFC). The mediation analysis model was used to explore whether the hippocampus functional connectivity (FC) network indirectly mediated the relationship between obsessive-compulsive symptoms and anxiety.

RESULTS

Results showed that the FCs with the cerebellum, middle temporal gyrus (MTG) and anterior cingulate gyrus (ACG) were increased in the hippocampus FC network in patients with OCD compared with those in HCs. The regions of interactive effects between anxiety and obsession, which are mainly located in the prefrontal cortex and MTG, were positively correlated. The mediation effect is 0.018 between obsession and anxiety on the HFC networks in patients with OCD.

CONCLUSIONS

The FC between the hippocampus and MTG plays a key role in the relationship between anxiety and obsession.

Towards a computational psychiatry of juvenile obsessive-compulsive disorder

Obsessive-Compulsive Disorder (OCD) most often emerges during adolescence, but we know little about the aberrant neural and cognitive developmental mechanisms that underlie its emergence during this critical developmental period. To move towards a computational psychiatry of juvenile OCD, we review studies on the computational, neuropsychological and neural alterations in juvenile OCD and link these findings to the adult OCD and cognitive neuroscience literature. We find consistent difficulties in tasks entailing complex decision making and set shifting, but limited evidence in other areas that are altered in adult OCD, such as habit and confidence formation. Based on these findings, we establish a neurocomputational framework that illustrates how cognition can go awry and lead to symptoms of juvenile OCD. We link these possible aberrant neural processes to neuroimaging findings in juvenile OCD and show that juvenile OCD is mainly characterised by disruptions of complex reasoning systems.

Are candidate neurocognitive endophenotypes of OCD present in paediatric patients? A systematic review

To-date it has been difficult to ascertain the exact cognitive profile of childhood OCD as studies report variable results. Adult OCD research lately utilises the endophenotype approach; studying cognitive traits that are present in both patients and their unaffected first-degree relatives, and are thought to lie closer to the genotype than the full-blown disorder. By observing whether candidate endopenotypes of adult OCD are present in child patients, we can determine whether the two subtypes show cognitive overlap. We conducted a systematic review of the paediatric OCD literature focussing on proposed neurocognitive endophenotypes of OCD: cognitive flexibility, response inhibition, memory, planning, decision-making, action monitoring, and reversal learning. We found that paediatric patients present robust increases in brain error related negativity associated with abnormal action monitoring, impaired decision-making under uncertainty, planning, and visual working memory, but there is less evidence for deficits in other cognitive domains. This implies that children with OCD show some cognitive similarities with adult patients, but other dysfunctions may only manifest later in the disorder trajectory.

Effects of aging on sequential cognitive flexibility are associated with fronto-parietal processing deficits

Albeit cognitive flexibility is well known to decline in aging, it has not been considered that this ability often requires sequential task control. That is, one may re-use tasks that have previously been abandoned in favor of another task. It is unclear whether sequential cognitive flexibility is affected in aging and what neurophysiological mechanisms and functional neuroanatomical structures are associated with these effects. We examined this question in a system neurophysiological study using EEG and source localization in healthy and elderly adults. We show that elderly people reveal deficient sequential cognitive flexibility. Elderly people encounter increased costs to overcome the inhibition of the lately abandoned task set that becomes relevant again and needs to be re-used. The neurophysiological (EEG) data show that differences in sequential cognitive flexibility between young and elderly people emerge as a consequence of two independent, dysfunctional processes: (i) the ability to suppress task-irrelevant information and (ii) the ability to re-implement a previously abandoned task set during response selection. These independent processes were associated with activation differences in inferior frontal and inferior parietal regions. The study reveals a new facet of cognitive flexibility dysfunctions in healthy elderlies.

The neurophysiological basis of developmental changes during sequential cognitive flexibility between adolescents and adults

Cognitive flexibility is a major facet of executive functions and often refers to sequential task control; that is, it is very likely that one may re-encounter a task that has previously been abandoned to carry out a different task. In the context of sequential cognitive flexibility, the "backward inhibition (BI) effect" has been studied quite extensively. Here we ask whether there are age-related differences between adolescents and adults to overcome BI and what system-neurophysiological mechanisms underlie these modulations. This was examined using a system neurophysiological study procedure combining event-related potentials data with source localization and EEG signal decomposition methods. We show that sequential cognitive flexibility, and the ability overcome backward inhibition, is inferior in adolescents compared with adults. Accounting for intra-individual variability in the neurophysiological data, this data suggest that two partly inter-related processes underlie the differences between adolescents than adults to overcome backward inhibition: One process refers to the suppression of the inhibitory effect of the n-1 trial on the n-2 trial during perceptual categorization of incoming information that is associated with right inferior frontal regions. The other process refers to immature response selection and conflict monitoring mechanisms associated with regions in the medial frontal cortex.

When repetitive mental sets increase cognitive flexibility in adolescent obsessive-compulsive disorder

BACKGROUND

A major facet of obsessive-compulsive disorder (OCD) is cognitive inflexibility. However, sometimes, cognitive flexibility can be needed to reuse recently abandoned mental sets. Therefore, cognitive flexibility can in certain cases be useful to reinstate some form of rigid, repetitive behavior characterizing OCD. We test the counterintuitive hypothesis that under such circumstances, cognitive flexibility is better in OCD patients than controls.

METHODS

We examined N = 20 adolescent OCD patients and N = 22 controls in a backward inhibition (BI) paradigm. This was combined with event-related potential (ERP) recordings and source localization. The BI effect describes the cost of overcoming the inhibition of a recently abandoned mental set that is relevant again. Therefore, a strong BI effect is disadvantageous for cognitive flexibility.

RESULTS

Compared to controls, OCD patients revealed a smaller backward inhibition effect. The EEG data revealed larger P1 amplitudes in backward inhibition trials in the OCD group, which was due to activation differences in the inferior frontal gyrus (BA47). The severity of clinical symptoms predicted these neurophysiological modulations. The power of the observed effects was about 95%.

CONCLUSIONS

The study shows that cognitive flexibility can be better in OCD than controls. This may be the case in situations where superior abilities in the reactivation of repeating mental sets and difficulties to process new ones coincide. This may be accomplished by intensified inhibitory control mechanisms. The results challenge the view on OCD, since OCD is not generally associated with cognitive inflexibility.

On the role of the prefrontal cortex in fatigue effects on cognitive flexibility - a system neurophysiological approach

Demanding tasks like cognitive flexibility show time-related deterioration of performance (i.e. fatigability effects). Fatigability has been associated with structural and functional properties of the prefrontal cortex. However, the electrophysiological underpinnings of these processes are not well understood. We examined n = 34 healthy participants with a task switching paradigm in which switches were either signaled by cues or needed to be maintained by working memory processes. We analyzed event-related potentials (ERPs) and performed residue iteration decomposition (RIDE) to account for effects of fatigue on intra-individual variability of neurophysiological data. This was combined with source localization methods. We show that task switching is affected by time on task (TOT) effects mostly when working memory processes are needed. On a neurophysiological level, this effect could not be observed in standard ERPs, but only after accounting for intra-individual variability using RIDE. The RIDE data suggests that during task switching, fatigability specifically affects response recoding processes that are associated with functions of the middle frontal gyrus (MFG; BA10). The results underline propositions of the ‘opportunity cost model’, which states that fatigability effects of executive functions depend on the degree to which tasks engage similar prefrontal regions - in this case working memory and task switching mechanisms.

On the relevance of the alpha frequency oscillation's small-world network architecture for cognitive flexibility

Cognitive flexibility is a major requirement for successful behavior. nNeural oscillations in the alpha frequency band were repeatedly associated with cognitive flexibility in task-switching paradigms. Alpha frequencies are modulated by working memory load and are used to process information during task switching, however we do not know how this oscillatory network communication is modulated. In order to understand the mechanisms that drive cognitive flexibility, ERPs, oscillatory power and how the communication within these networks is organized are of importance. The EEG data show that during phases reflecting preparatory processes to pre-activate task sets, alpha oscillatory power but not the small world properties of the alpha network architecture was modulated. During the switching only the N2 ERP component showed clear modulations. After the response, alpha oscillatory power reinstates and therefore seems to be important to deactivate or maintain the previous task set. For these reactive control processes the network architecture in terms of small-world properties is modulated. Effects of memory load on small-world aspects were seen in repetition trials, where small-world properties were higher when memory processes were relevant. These results suggest that the alpha oscillatory network becomes more small-world-like when reactive control processes during task switching are less complex.