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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 ,
B. J. Sahakian ,
A. M. Owen  and
I. M. Marks
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.
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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
Information
Psychological Medicine , Volume 26 , Issue 6 , November 1996 , pp. 1261 - 1269
Copyright
Copyright © Cambridge University Press 1996

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