Volume 49, Issue 9 , Pages 944-953, September 2010
Cognitive Inflexibility and Frontal-Cortical Activation in Pediatric Obsessive-Compulsive Disorder
Objective
Deficits in cognitive flexibility and response inhibition have been linked to perturbations in cortico-striatal-thalamic circuitry in adult obsessive-compulsive disorder (OCD). Although similar cognitive deficits have been identified in pediatric OCD, few neuroimaging studies have been conducted to examine its neural correlates in the developing brain. In this study, we tested hypotheses regarding group differences in the behavioral and neural correlates of cognitive flexibility in a pediatric OCD and a healthy comparison (HC) sample.
Method
In this functional magnetic resonance imaging (fMRI) study, a pediatric sample of 10- to 17-year-old subjects, 15 with OCD and 20 HC, completed a set-shifting task. The task, requiring an extradimensional shift to identify a target, examines cognitive flexibility. Within each block, the dimension (color or shape) that identified the target either alternated (i.e., mixed) or remained unchanged (i.e., repeated).
Results
Compared with the HC group, the OCD group tended to be slower to respond to trials within mixed blocks. Compared with the HC group, the OCD group exhibited less left inferior frontal gyrus/BA47 activation in the set-shifting contrast (i.e., HC > OCD, mixed versus repeated); only the HC group exhibited significant activation in this region. The correlation between set shifting-induced right caudate activation and shift cost (i.e., reaction time differential in response to mixed versus repeated trials) was significantly different between HC and OCD groups, in that we found a positive correlation in HC and a negative correlation in OCD.
Conclusions
In pediatric OCD, less fronto-striatal activation may explain previously identified deficits in shifting cognitive sets.
Key Words: anxiety, set-shifting, fMRI, inferior frontal gyrus, striatum
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This article was reviewed under and accepted by Ad Hoc Editor David R. Rosenberg, M.D.
This research was supported by the David Judah Fund (J.C.B., S.E.S.) and in part by the Intramural Research Program of the National Institutes of Health and the National Institute of Mental Health (J.C.B., D.S.P., E.L.).
Disclosure: Dr. Rauch has received funds for research through Massachusetts General Hospital (MGH) from Medtronics, Cyberonics, and Cephalon. He has received honoraria from Novartis, Neurogen, Sepracor, Primedia, and Medtronics, Inc. Dr. Rauch is a trustee at McLean Hospital and serves on the Board at the Massachusetts Society for Medical Research (MSMR) as well as on the National Foundation of Mental Health (NFMH) Board. Dr. Killgore works as a part-time contract researcher at the Department of Defense Contractor, GovSource, Inc., and does contract work for the Brain Institute, University of Utah. He has a U.S. Army Medical Research and Material Command grant and a patent pending: The Sleep History and Readiness Predictor (SHARP), a computer program developed for predicting cognitive performance from sleep and circadian rhythms. Dr. Killgore is affiliated with the U.S. Army Reserve. Dr. Pauls has obtained funds from the following sources: National Institutes of Health (National Institute of Neurological Disorders and Stroke, and National Institute of Mental Health), Autism Consortium, Ellison Foundation, Anonymous Donor, and has received an honorarium from the Mayo Clinic for giving course lectures. Drs. Britton, Rosso, Ragan, Chosak, Pine, Leibenluft, Jenike, and Stewart, and Ms. Price, and Ms. Hezel report no biomedical financial interests or potential conflicts of interest.
PII: S0890-8567(10)00416-8
doi:10.1016/j.jaac.2010.05.006
© 2010 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Volume 49, Issue 9 , Pages 944-953, September 2010
