Executive functioning in older adults with hoarding disorder

Abstract

Background Hoarding disorder (HD) is a chronic and debilitating psychiatric condition. Midlife HD patients have been found to have neurocognitive impairment, particularly in areas of executive functioning, but the extent to which this is due to comorbid psychiatric disorders has not been clear. Aims/Method The purpose of the present investigation was to examine executive functioning in geriatric HD patients without any comorbid Axis I disorders (n = 42) compared with a healthy older adult comparison group (n = 25). We hypothesized that older adults with HD would perform significantly worse on measures of executive functioning (Wisconsin Card Sort Task [Psychological Assessment Resources, Lutz, Florida, USA] (Psychological Assessment Resources, 2003) and the Wechsler Adult Intelligence Scale-IV digit span and letter-number sequencing tests [Pearson, San Antonio, TX, USA]). Results Older adults with HD showed significant differences from healthy older controls in multiple aspects of executive functioning. Compared with healthy controls, older adults with HD committed significantly more total, non-perseverative errors and conceptual level responses on the Wisconsin Card Sort Task and had significantly worse performance on the Wechsler Adult Intelligence Scale-IV digit span and letter-number sequencing tests. Hoarding symptom severity was strongly correlated with executive dysfunction in the HD group. Conclusions Compared with demographically-matched controls, older adults with HD have dysfunction in several domains of executive functioning including mental control, working memory, inhibition, and set shifting. Executive dysfunction is strongly correlated with hoarding severity and is not because of comorbid psychiatric disorders in HD patients. These results have broad clinical implications suggesting that executive functioning should be assessed and taken into consideration when developing intervention strategies for older adults with HD.

Comparison of brain activation patterns during executive function tasks in hoarding disorder and non-hoarding OCD

“…Individuals with hoarding behaviors exhibit deficits on measures of executive function such as categorization, set-shifting (Ayers et al, 2013; Mackin et al, 2011; Mackin et al, 2016; McMillan et al, 2013; Morein-Zamir et al, 2014), and sustained attention and inhibition (Blom et al, 2011; Raines et al, 2014; Tolin et al, 2011). In several studies, the severity of these executive function deficits was associated with the severity of hoarding symptoms (Ayers et al, 2013; Raines et al, 2014; Tolin et al, 2011), although the data are not always consistent across studies (Grisham et al, 2010; Tolin et al, 2011). …”

Psychometric Evaluation of the Saving Inventory-Revised in Older Adults

“…Convergent validity of the SI-R in geriatric populations has been demonstrated through significant associations between the SI-R and impairment in activities of daily living (Ayers et al, 2012) and impairment in executive functioning (Ayers, Wetherell, Schiehser, Almklov, & Saxena, 2013) in older adults with HD. The SI-R has demonstrated sensitivity to change in response to interventions for geriatric HD, including cognitive-behavioral therapy (Ayers, Wetherell, Golshan, & Saxena, 2011) and cognitive rehabilitation and exposure therapy (Ayers et al, 2014).…”

Novel Treatment for Geriatric Hoarding Disorder: An Open Trial of Cognitive Rehabilitation Paired with Behavior Therapy

“…These findings are supported by evidence that poor executive functioning (e.g., planning, categorization, decision making, working memory, cognitive flexibility) are characteristic of HD across the lifespan. 12–15 Neurocognitive impairment is associated with poorer response to CBT in other geriatric psychiatric populations, 16 which may explain the poor outcomes seen with CBT in geriatric hoarding participants. 9,10 …”