Meta-analysis of neurocognitive deficits in unaffected relatives of obsessive-compulsive disorder (OCD): comparison with healthy controls and patients with OCD

Abstract

BackgroundObsessive-compulsive disorder (OCD) has been associated with cognitive deficits, particularly with executive functions. These findings support fronto-striatal dysfunction in OCD. However, it is not certain whether these findings are trait features of OCD. In recent years, a number of studies have investigated cognitive functions in unaffected relatives of OCD (OCDrel) but the findings of these studies are contradictory.MethodsA systematic review in Pubmed and Scopus databases was performed until 18 March 2019, to locate the studies comparing cognitive functions of OCDrel with healthy controls and OCD patients (OCDpt). A random-effects meta-analysis was conducted.ResultsCurrent meta-analysis included 16 studies including 527 OCDrel, 445 OCDpt and 639 healthy controls. Healthy controls overperformed OCDpt in all cognitive domains (d = 0.36–0.86). OCDrel underperformed healthy controls in inhibition (d = 0.58, CI = 0.29–0.86), planning (d = 0.45, CI = 0.28–0.63), decision-making (d = 0.58, CI = 0.19–0.98). OCDrel also had small-sized deficits in set-shifting (d = 0.37, CI = 0.04–0.69) and visual memory (d = 0.28, CI = 0.08–0.49). OCDpt underperformed OCDrel in visual memory (d = 0.45, CI = 0.22–0.67) and set-shifting (d = 0.23, CI = 0.04–0.42).ConclusionsCurrent findings suggest that abnormalities in inhibition, planning/problem solving and reward-based decision-making are shared features of OCDrel and OCDpt and might be trait markers related to vulnerability for developing OCD. Visual memory and set-shifting deficits might potentially be biomarkers of incipient illness or subthreshold OCD presentation among OCDrel. Further exploration of cognitive heterogeneity in OCDrel and investigating the effects of the subtypes of OCD in probands on cognitive impairment in OCDrel are needed.

Aberrant Resting-State Cerebellar-Cerebral Functional Connectivity in Unmedicated Patients With Obsessive-Compulsive Disorder

“…This result means that the aberrant rsFC between the cerebellum and DMN is not associated directly with the obsessive-compulsive symptoms. DMN relates to response inhibition (66,67), planning (68), and decision-making (69), which are trait markers for OCD (70). Our results, therefore, might show that this aberrant rsFC is not a state but a trait of OCD patients.…”

Abnormal brain functional network dynamics in obsessive–compulsive disorder patients and their unaffected first‐degree relatives

“…A number of studies have identified shared features between OCD and their UFDR. For instance, a meta‐analysis of OCD suggested that abnormalities in inhibition, planning/problem solving, and reward‐based decision‐making are shared features of OCD and their UFDR and might be trait markers related to vulnerability for developing OCD (Bora, 2020 ). Dong and colleagues found that the same changes in effective connectivity were present in both OCD patients and their unaffected first‐degree relatives (Dong et al, 2020 ).…”

The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management

“…Neurocognition represents one of the key mechanisms by which changes in brain structure and function ultimately give rise to clinical signs and symptoms. Lying closer to the putative biological substrate and being measurable on objective tests, neurocognitive markers may be more reliable, consistent and enduring than the variably expressed symptoms of a disorder [118][119][120] . Neurocognitive testing in patients with OCD and related disorders, for example, has been used to characterize abnormalities of fronto-striatal circuitry compared to controls 121 , as well as to identify putative subtypes with different brain structure, function and connectedness 122 .…”