Checking-in on the memory deficit and meta-memory deficit theories of compulsive checking

Neurocomputational model of compulsivity: deviating from an uncertain goal-directed system

Despite a theory that an imbalance in goal-directed versus habitual systems serve as building blocks of compulsions, research has yet to delineate how this occurs during arbitration between the two systems in obsessive-compulsive disorder. Inspired by a brain model in which the inferior frontal cortex selectively gates the putamen to guide goal-directed or habitual actions, this study aimed to examine whether disruptions in the arbitration process via the fronto-striatal circuit would underlie imbalanced decision-making and compulsions in patients. Thirty patients with obsessive-compulsive disorder [mean (standard deviation) age = 26.93 (6.23) years, 12 females (40%)] and 30 healthy controls [mean (standard deviation) age = 24.97 (4.72) years, 17 females (57%)] underwent functional MRI scans while performing the two-step Markov decision task, which was designed to dissociate goal-directed behaviour from habitual behaviour. We employed a neurocomputational model to account for an uncertainty-based arbitration process, in which a prefrontal arbitrator (i.e. inferior frontal gyrus) allocates behavioural control to a more reliable strategy by selectively gating the putamen. We analysed group differences in the neural estimates of uncertainty of each strategy. We also compared the psychophysiological interaction effects of system preference (goal-directed versus habitual) on fronto-striatal coupling between groups. We examined the correlation between compulsivity score and the neural activity and connectivity involved in the arbitration process. The computational model captured the subjects' preferences between the strategies. Compared with healthy controls, patients had a stronger preference for the habitual system (t = -2.88, P = 0.006), which was attributed to a more uncertain goal-directed system (t = 2.72, P = 0.009). Before the allocation of controls, patients exhibited hypoactivity in the inferior frontal gyrus compared with healthy controls when this region tracked the inverse of uncertainty (i.e. reliability) of goal-directed behaviour (P = 0.001, family-wise error rate corrected). When reorienting behaviours to reach specific goals, patients exhibited weaker right ipsilateral ventrolateral prefronto-putamen coupling than healthy controls (P = 0.001, family-wise error rate corrected). This hypoconnectivity was correlated with more severe compulsivity (r = -0.57, P = 0.002). Our findings suggest that the attenuated top-down control of the putamen by the prefrontal arbitrator underlies compulsivity in obsessive-compulsive disorder. Enhancing fronto-striatal connectivity may be a potential neurotherapeutic approach for compulsivity and adaptive decision-making.

Opening new vistas on obsessive-compulsive disorder with the observing response task

Obsessive-compulsive disorder (OCD), a highly prevalent and debilitating disorder, is incompletely understood in terms of underpinning behavioural, psychological, and neural mechanisms. This is attributable to high symptomatic heterogeneity; cardinal features comprise obsessions and compulsions, including clinical subcategories. While obsessive and intrusive thoughts are arguably unique to humans, dysfunctional behaviours analogous to those seen in clinical OCD have been examined in nonhuman animals. Genetic, ethological, pharmacological, and neurobehavioural approaches all contribute to understanding the emergence and persistence of compulsive behaviour. One behaviour of particular interest is maladaptive checking, whereby human patients excessively perform checking rituals despite these serving no purpose. Dysfunctional and excessive checking is the most common symptom associated with OCD and can be readily operationalised in rodents. This review considers animal models of OCD, the neural circuitries associated with impairments in habit-based and goal-directed behaviour, and how these may link to the compulsions observed in OCD. We further review the Observing Response Task (ORT), an appetitive instrumental learning procedure that distinguishes between functional and dysfunctional checking, with translational application in humans and rodents. By shedding light on the psychological and neural bases of compulsive-like checking, the ORT has potential to offer translational insights into the underlying mechanisms of OCD, in addition to being a platform for testing psychological and neurochemical treatment approaches.

Investigating Retrospective and Prospective Metamemory Judgments During Episodic Memory in Patients With Obsessive-Compulsive Disorders

It is clear evidence that individuals diagnosed with obsessive-compulsive disorder (OCD) lack confidence in their memory and have low metamemory performance (judgment and accuracy). However, it is still unclear whether low metamemory performance is specific to first, domain general or domain specific, and second, to stimulus domain. To address these issues, we compared individuals diagnosed with OCD and healthy controls (HCs) on recognition, retrospective (judgments of learning [JOL]) and prospective (feeling of knowing [FOK]) metamemory judgments and under three different episodic memory tasks, which consisted of symptom-free, familiar and unfamiliar stimuli (word, scene, and face photo). OCD patients showed lower recognition performance, JOL and FOK judgments, and accuracy in all tasks than HCs. Also, OCD patients were slower than HCs during all cognitive performances. In both groups, metamemory performances were lower in familiar items than unfamiliar items. However, recognition performances were not affected by stimulus type. Our results support the idea of general episodic memory and a metamemory deficit in OCD. Moreover, metamemory deficits in OCD are domain general.

Strategic regulation of memory in dsyphoria: a quantity-accuracy profile analysis

The mechanisms underlying a tendency among individuals with depression to report personal episodic memories with low specificity remain to be understood. We assessed a sample of undergraduate students with dysphoria to determine whether depression relates to a broader dysregulation of balancing accuracy and informativeness during memory reports. Specifically, we investigated metamnemonic processes using a quantity-accuracy profile approach. Recall involved three phases with increasing allowance for more general, or coarse-grained, responses: (a) forced-precise responding, requiring high precision; (b) free-choice report with high and low penalty incentives on accuracy; (c) a lexical description phase. Individuals with and without dysphoria were largely indistinguishable across indices of retrieval, monitoring, and control aspects of metamemory. The results indicate intact metacognitive processing in young individuals with dysphoria and provide no support for the view that impaired metacognitive control underlies either memory deficits or bias in memory reports that accompany dysphoria.

The memory deficit hypothesis of compulsive checking in OCD: what are we really talking about? A narrative review

We reviewed studies that have specifically explored the memory deficit hypothesis of Obsessive Compulsive Disorder (OCD) checking, highlighting the methodological differences between these studies that may explain inconsistencies regarding memory deficits in OCD checkers. Based on Conway's proposition that one function of episodic memories is to keep an adaptive record of recent goal processing in order to check that actions have actually been accomplished, we suggest that impaired autonoetic consciousness -one of the main features of episodic memory- may be at the heart of the issue of checking compulsion. Autonoetic consciousness, that can be experimentally assessed by the Remember/Know/Guess paradigm,could be impaired in OCD checkers leading them to be unable to mentally relive their actions in order to be assured that they have been accomplished (e.g., having locked the door). We make methodological suggestions to improve the assessment of autonoetic consciousness deficit in OCD checkers and understand its role in the etiology and maintenance of compulsive checking.

Free operant observing in humans: a translational approach to compulsive certainty seeking

Excessive checking is reported in non-clinical populations and is a pervasive symptom in obsessive compulsive disorder (OCD). We implemented a free-operant task in humans, previously used in rats, wherein participants can "check" to reduce uncertainty. Participants can press an observing key to ascertain which of two main keys will, if pressed, currently lead to rewards. Over a series of experiments, we found that punishment robustly increased observing in non-clinical participants and that observing persisted long after punishment was removed. Moreover, participants appeared insensitive to the initial costs of checking, and a threefold increase in the effort required to observe served to deter participants only to a limited degree. We also assessed observing in OCD patients with no known comorbidities. The patients observed more than control participants and were abnormally insensitive to the introduction of punishment. These findings support the translational value of the task, with similar behaviours in humans and rodents. This paradigm may serve as a unifying platform, promoting interaction between different approaches to analyse adaptive and maladaptive certainty seeking behaviours. Specifically, we demonstrate how seemingly disparate theoretical and empirical approaches can be reconciled synergistically to promote a combined behavioural and cognitive account of certainty seeking.

Prospective memory, retrospective memory, and individual differences in cognitive abilities, personality, and psychopathology

Although individual differences in processing speed, working memory, intelligence, and other cognitive functions were found to explain individual differences in retrospective memory (RetM), much less is known about their relationship with prospective memory (ProM). Moreover, the studies that investigated the relationship between ProM and cognitive functions arrived to contradictory conclusions. The relationship between ProM, personality, and psychopathology is similarly unsettled. Meta-analytic reviews of the relationships of ProM with aging and personality suggest that the contradictory findings may be due to widespread methodological problems plaguing ProM research including the prevalent use of inefficient, unreliable binary measures; widespread ceiling effects; failure to distinguish between various ProM subdomains (e.g., episodic ProM versus vigilance/monitoring); various confounds; and, importantly, small sample sizes, resulting in insufficient statistical power. Accordingly, in a large scale study with nearly 1,200 participants, we investigated the relationship between episodic event-cued ProM, episodic RetM, and fundamental cognitive functions including intelligence, personality, and psychopathology, using reliable continuous measures of episodic event-cued ProM. Our findings show that (a) continuous measures of episodic event-cued ProM were much more reliable than binary measures, (b) episodic event-cued ProM was associated with measures of processing speed, working memory, crystallized and fluid intelligence, as well as RetM, and that such associations were similar for ProM and RetM, (c) personality factors did not improve prediction of neither ProM nor RetM beyond the variance predicted by cognitive ability, (d) symptoms of psychopathology did not improve the prediction of ProM although they slightly improved the prediction of RetM, and (e) participants' sex was not associated with ProM but showed small correlations with RetM. In addition to advancing our theoretical understanding of ProM, our findings highlight the need to avoid common pitfalls plaguing ProM research.

A novel cognitive intervention for compulsive checking: Targeting maladaptive beliefs about memory

BACKGROUND AND OBJECTIVES

Compulsive checking is one of the most common symptoms of obsessive-compulsive disorder (OCD). Recently it has been proposed that those who check compulsively may believe their memory is poor, rather than having an actual memory impairment. The current study sought to develop and assess a brief cognitive intervention focused on improving maladaptive beliefs about memory, as they pertain to both checking symptoms and memory performance.

METHODS

Participants (N = 24) with a diagnosis of OCD and clinical levels of checking symptomatology were randomly assigned either to receive two weekly 1-hour therapy sessions or to self-monitor during a similar waitlist period. Time spent checking, checking symptoms, maladaptive beliefs about memory, and visuospatial memory were assessed both pre- and post-treatment/waitlist.

RESULTS

Results showed that compared to the waitlist condition, individuals in the treatment condition displayed significant decreases in their maladaptive beliefs about memory and checking symptoms from pre- to post-intervention. They also exhibited increased recall performance on a measure of visuospatial memory. Changes in beliefs about memory were predictors of reduced post-intervention checking, but were not predictive of increased post-intervention memory scores.

LIMITATIONS

The lack of long term follow-up data and use of a waitlist control leave questions about the stability and specificity of the intervention.

CONCLUSIONS

Findings provide preliminary evidence that strategies targeting beliefs about memory may be worthy of inclusion in cognitive-behavioural approaches to treating compulsive checking.

Stove checking behaviour in people with OCD vs. anxious controls

BACKGROUND AND OBJECTIVES

A growing body of research suggests that the repetition of an action degrades memory for that action, as well as confidence that is has been done correctly. This has important implications for understanding the compulsive repetition of actions characteristic of obsessive compulsive disorder (OCD). At this time, though, much of the research has been conducted on analogue or nonclinical OCD samples in comparison to healthy controls and often using virtual, as opposed to actual, threat stimuli. Furthermore, although it has been argued that people with OCD are overly attentive to threat stimuli, the research on actual attention to threat is scant.

METHODS

People with a principal diagnosis of OCD (n = 30) and people with a clinically significant diagnosis of an anxiety disorder, but no OCD (n = 18) completed measures of memory confidence and responsibility and then underwent a stove-checking task in a functioning kitchen while wearing a portable eye tracking device. Pre- and post-task ratings of harm and responsibility were taken, along with post-task ratings of memory and certainty.

RESULTS

People with OCD did not exhibit poorer memory confidence than the anxious control (AC) group, but did report greater trait and state responsibility for harm. The OCD group checked longer than did the AC group and check duration predicted post-task ratings of harm, but to the same extent in both groups. People with OCD attended to threat items less than did the AC group. Greater visual attention to the stove during the checking period was associated with greater post-task ratings of responsibility and harm and with less certainty in and memory for the check - but only for the AC group.

LIMITATIONS

The sample size was modest, women were over-represented and problems with the eye tracking device reduced the amount of reliable data available for analysis.

CONCLUSIONS

Compulsions are complex actions that are mediated by many trait, state and contextual factors. People with OCD may be able to circumvent self-perpetuating checking processes under certain circumstances. Future research should explore the factors that determine whether or not self-perpetuating mechanisms are activated.

Checking Behaviours, Prospective Memory and Executive Functions

Explanations implicating memory in the causes and severity of checking symptoms have focused primarily on retrospective memory, and relatively little attention has been paid to prospective memory. Limited research has examined the relationship between prospective memory and executive functions. We assessed whether impairments in prospective memory and executive function predict checking symptoms in a sample of 106 adults. Checking symptoms were assessed using the Padua Inventory Washington State University Revision (PI-WSUR). All participants completed the prospective memory questionnaire (PMQ) and four computerised executive function tasks from the CANTAB, measuring inhibition, planning, attention set-shifting and working memory. Prospective memory and inhibition predicted checking symptom severity. Importantly, there were no correlations between internally cued prospective memory and inhibition or between prospective memory aiding strategies and inhibition. These variables appear to have an independent role in checking. The current findings highlight prospective memory and inhibition as key contributors to the checking symptom profile and provide the first evidence that these cognitive processes may independently contribute to checking symptoms. These findings have implications for a model in which memory performance is thought to be secondary to impairments in executive functions.

Neuropsychological differences between obsessive-compulsive washers and checkers: a systematic review and meta-analysis

Inconsistent results in neuropsychological research of obsessive-compulsive disorder (OCD) may be the result of the heterogeneous nature of OCD symptoms. The most frequently investigated symptoms are contamination/cleaning and doubt/checking. The aim of this review was to determine whether OCD washers and checkers differ in their neuropsychological performance. We conducted a meta-analysis of 13 studies (including 535 patients) comprising tests in 10 different neuropsychological domains. Washers showed significant better task performance than checkers in 8 of 10 cognitive domains. Large effect sizes were found in planning/problem solving and response inhibition. Effect size in set shifting was medium, whereas effect sizes in attention, processing speed, encoding, verbal memory and nonverbal memory were small. Limitations consisted in a relatively small number of primary studies. In line with current neurobiological findings, the results provide further evidence for the validity of different symptom dimensions in OCD. Clinical and theoretical implications are discussed.

Is obsessive-compulsive symptomatology a risk factor for Alzheimer-type dementia?

In the present study, we hypothesized that lifetime Obsessive-Compulsive (OC) symptomatology would be risk factors for the development of Alzheimer׳s disease (AD). For this aim, first we compared 39 patients with AD and 30 age and gender matched control subjects. We have found that lifetime and current OC symptoms (OCs) and comorbid diagnosis of Obsessive-Compulsive Personality Disorder in AD patients were significantly more prevalent than in control group. AD patients had more likely to have lifetime and current hoarding, and checking obsessions compared to controls. The rate of lifetime and current hoarding, and checking compulsions also appeared to be higher in AD patients in comparison to control subjects. Hoarding and checking obsessions, and compulsions seemed to proceed through the dementia in contrast to other OCs. The mean number of lifetime compulsions seemed to predict the diagnosis of AD. When we compared AD patients with and without OCs, we have found that OC symptomatology prior to AD did not cause an earlier onset of dementia and more severe cognitive impairment. Further longitudinal clinical, genetic and neuroimaging investigations are required to determine if lifetime presence of OCs would predispose to the development of later AD.

Differential role of visuospatial working memory in the propensity toward uncertainty in patients with obsessive-compulsive disorder and in healthy subjects

BACKGROUND

Obsessive-compulsive disorder (OCD) is associated with visuospatial working memory deficits. Intolerance of uncertainty is thought to be a core component of OCD symptoms. Recent findings argue for a possible relationship between abilities in visuospatial memory and uncertainty. However, this relationship remains unclear in both OCD patients and healthy subjects. To address this issue, we measured performance in visuospatial working memory and the propensity to express uncertainty during decision making. We assessed their relationship and the temporal direction of this relationship in both OCD patients and healthy subjects.

METHOD

Baseline abilities in visuospatial working memory were measured with the Corsi block-tapping test. A delayed matching-to-sample task was used to identify explicit situations of certainty, uncertainty and ignorance and to assess continuous performance in visuospatial working memory. Behavioural variables were recorded over 360 consecutive trials in both groups.

RESULTS

Baseline scores of visuospatial working memory did not predict the number of uncertain situations in OCD patients whereas they did in healthy subjects. Uncertain trials led to reduced abilities in visuospatial working memory to 65% of usual performance in OCD patients whereas they remained stable in healthy subjects.

CONCLUSIONS

The present findings show an opposite temporal direction in the relationship between abilities in working memory and uncertainty in OCD patients and healthy subjects. Poor working memory performance contributes to the propensity to feel uncertainty in healthy subjects whereas uncertainty contributes to decreased continuous performance in working memory in OCD patients.

Prevalence of obsessive-compulsive disorder in relation to depression and cognition in an elderly population

OBJECTIVES

We examined the 1-month prevalence of obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS) not fulfilling OCD criteria in relation to sex, age, social and mental function, comorbid depression, and cognitive functioning in an elderly nondemented population.

SETTINGS AND PARTICIPANTS

Population-based sample (N = 900), stratified into two age groups: 70-year-olds (335 women and 224 men) and those aged 78 and above (341 women).

MEASUREMENTS

Semi-structured interviews. Psychiatric symptoms were assessed with the Comprehensive Psychopathological Rating Scale and Mini-International Neuropsychiatric Interview, mental and social function with the GAF-scale, memory function with the Word Recall Task and general cognition with MMSE. OCD and Depression were diagnosed according to DSM-IV.

RESULTS

The one-month prevalence of OCD was 2.9%; a further 21% had OCS. Among 70-year-olds, the prevalence of OCD was 1.3% in men and 4.5% in women. Depression was more common among those with OCD (34.6%) than among those with (12.7%) and without (8.0%) OCS. GAF-score was lower among those with OCD (74.8) and OCS (82.9) compared with individuals without obsessions and compulsions (88.2). The association between OCD and GAF-score remained after adjustment for age, sex, and depression. The OCD subgroup with checking behavior had more memory and concentration problems and did worse on Word Recall Task than other groups in our sample.

CONCLUSIONS

We found that OCD and OCS are common among the elderly. Both conditions are related to depression and poorer mental and social functioning. Physicians who meet elderly patients need to be aware of OCD as it is potentially treatable.

Diminished confidence in prospective memory causes doubts and urges to check

BACKGROUND AND OBJECTIVES

Correlational research has demonstrated links between prospective memory and checking compulsions. These findings suggest that negative beliefs and diminished confidence in prospective memory may contribute to intrusive doubts that tasks were not completed and ultimately to checking behavior. The present study represents the first experimental test of the hypothesis that diminished confidence in prospective memory causes increased doubt and urges to check.

METHODS

Participants completed several tests and questionnaires assessing prospective memory. Participants were randomly assigned to receive either false positive or false negative feedback about their prospective memory. They subsequently completed additional prospective memory tests and their doubts and urges to check that each of those tests was properly performed were assessed.

RESULTS

Participants who received false negative feedback about their prospective memory reported significantly higher levels of doubt and urges to check compared to those who received false positive feedback.

LIMITATIONS

A non-clinical sample was used and participants with severe levels of depression and anxiety were excused before the feedback phase to avoid causing them further distress.

CONCLUSIONS

The results provide further support for memory confidence models of checking compulsions by indicating that diminished confidence in prospective memory can cause increased doubt and urges to check.

Exploring metacognitive components of confidence and control in individuals with obsessive-compulsive tendencies

BACKGROUND AND OBJECTIVES

Obsessive-compulsive (OC) patients typically display reduced metacognitive confidence, but findings regarding the scope of this phenomenon and factors that mediate it have been inconsistent. This study aimed to further the understanding of reduced metacognitive confidence in obsessive-compulsive disorder (OCD) by exploring the relationship between metacognitive processes and OC tendencies.

METHODS

High and low OC participants answered a general-knowledge questionnaire, rated their confidence in each answer, and decided whether or not to report each answer.

RESULTS

High and low OC participants did not differ either in their performance (general knowledge) or in their subjective estimations or confidence regarding their performance. The two groups also did not differ in the effectiveness of their metacognitive monitoring or in the relationship between monitoring and report-control decisions (control sensitivity). However, the two groups did differ in response criterion, with high OC participants less willing to report answers held with low-to-medium levels of subjective confidence.

LIMITATIONS

The study was conducted with non-clinical participants, which limits generalization to OCD.

CONCLUSIONS

These results suggest that conservative response criterion among OC individuals might be the critical factor underlying feelings of doubt and uncertainty endemic in OCD.

Comparison of checking behavior in adults with or without checking symptom of obsessive-compulsive disorder using a novel computer-based measure

Easy to administer behavioral measures of checking are needed to improve the assessment of this hallmark feature of OCD. We recently developed a new computer-based behavioral assessment of OCD in a previous study. As a follow-up experiment for this method, the goal of this study was to examine whether the new computer-based behavioral assessment would be capable of differentiating behaviors in adults with OCD characterized by checking behavior from those without checking behavior. We compared 22 OCD patients with compulsive checking behaviors (OCD checkers), 17 OCD controls without checking behavior (OCD controls), and 31 healthy controls (HCs) on a novel computer-based behavioral measure of checking behavior. Despite similar levels of successfully completed tasks, OCD checkers demonstrated longer duration of checking behaviors than OCD controls or HCs. Interestingly, no differences were found between OCD controls and HCs in any of the dependent variables. Our new behavioral measure offers a novel, objective, and ecologically valid measure of checking behaviors in a sample of adults with OCD.

Mechanisms underlying the link between cannabis use and prospective memory

While the effects of cannabis use on retrospective memory have been extensively examined, only a limited number of studies have focused on the links between cannabis use and prospective memory. We conducted two studies to examine the links between cannabis use and both time-based and event-based prospective memory as well as potential mechanisms underlying these links. For the first study, 805 students completed an online survey designed to assess cannabis consumption, problems with cannabis use indicative of a disorder, and frequency of experiencing prospective memory failures. The results showed small to moderate sized correlations between cannabis consumption, problems with cannabis use, and prospective memory. However, a series of mediation analyses revealed that correlations between problems with cannabis use and prospective memory were driven by self-reported problems with retrospective memory. For the second study, 48 non-users (who had never used cannabis), 48 experimenters (who had used cannabis five or fewer times in their lives), and 48 chronic users (who had used cannabis at least three times a week for one year) were administered three objective prospective memory tests and three self-report measures of prospective memory. The results revealed no objective deficits in prospective memory associated with chronic cannabis use. In contrast, chronic cannabis users reported experiencing more internally-cued prospective memory failures. Subsequent analyses revealed that this effect was driven by self-reported problems with retrospective memory as well as by use of alcohol and other drugs. Although our samples were not fully characterized with respect to variables such as neurological disorders and family history of substance use disorders, leaving open the possibility that these variables may play a role in the detected relationships, the present findings indicate that cannabis use has a modest effect on self-reported problems with prospective memory, with a primary problem with retrospective memory appearing to underlie this relationship.

Evidence of Impaired Event-Based Prospective Memory in Clinical Obsessive–Compulsive Checking

Based on findings from subclinical OCD checking samples (Cuttler & Graf, 2007; 2008), Cuttler and Graf (2009) suggested that checking may develop to compensate for prospective memory failures. The present study provides the first evidence of prospective memory problems in a clinical sample of OCD checkers (n = 26) compared to a group of healthy controls (n = 26). Consistent with earlier work with subclinical samples, the OCD checkers performed more poorly on an event-based, but not a time-based, prospective memory task. However, the OCD checkers did not report more subjective prospective memory failures than controls and their confidence in prospective memory accuracy was higher than that of controls. An explanation of the inconsistent findings with regard to metamemory in clinical and subclinical OCD checking is provided. Further research assessing both subjective memory performance and the strategies understood to support memory is needed to clarify the contribution of prospective memory to OCD checking.

Investigating multitasking in high-functioning adolescents with autism spectrum disorders using the Virtual Errands Task

Using a modified version of the Virtual Errands Task (VET; McGeorge et al. in Presence-Teleop Virtual Environ 10(4):375-383, 2001), we investigated the executive ability of multitasking in 18 high-functioning adolescents with ASD and 18 typically developing adolescents. The VET requires multitasking (Law et al. in Acta Psychol 122(1):27-44, 2006) because there is a limited amount of time in which to complete the errands. ANCOVA revealed that the ASD group completed fewer tasks, broke more rules and rigidly followed the task list in the order of presentation. Our findings suggest that executive problems of planning inflexibility, inhibition, as well as difficulties with prospective memory (remembering to carry out intentions) may lie behind multitasking difficulties in ASD.

Distinct neuropsychological profiles of three major symptom dimensions in obsessive-compulsive disorder

Recent neuroimaging studies have suggested that different symptom dimensions are mediated by partially distinct neural systems in obsessive-compulsive disorder (OCD). However, the correlations between neuropsychological profiles and symptom dimensions in OCD are unknown. The aim of this study was to examine the extent to which OCD symptom dimensions were associated with episodic memory and attention and executive functions. The symptom dimensions of 63 patients with OCD were assessed using both the Padua Inventory and the Y-BOCS symptom checklist. Then, we administered the Logical Memory (LM) subset of the Wechsler Memory Scale-Revised (WMR-R) test and evaluated inhibition (Stroop test, Trail Making test) and cognitive flexibility (Digit Symbol test, Letter Fluency, and Category Fluency). While associations were observed between scores on the contamination/cleaning dimension and better performances on the LM and Trail Making tests, associations were also observed between scores on the aggressive/checking dimension and poorer performances on the Trail Making test. In addition, we found that scores on the symmetry/ordering dimension were associated with poorer performances on the LM and Trail Making tests. Our results support the hypothesis that different symptoms may represent distinct and partially overlapping neurocognitive networks in OCD patients.

Impaired executive functioning in subclinical compulsive checking with ecologically valid stimuli in a working memory task

We previously showed that working memory (WM) performance of subclinical checkers can be affected if they are presented with irrelevant but misleading information during the retention period (Harkin and Kessler, 2009, 2011). The present study differed from our previous research in the three crucial aspects. Firstly, we employed ecologically valid stimuli in form of electrical kitchen appliances on a kitchen countertop in order to address previous criticism of our research with letters in locations as these may not have tapped into the primary concerns of checkers. Secondly, we tested whether these ecological stimuli would allow us to employ a simpler (un-blocked) design while obtaining similarly robust results. Thirdly, in Experiment 2 we improved the measure of confidence as a metacognitive variable by using a quantitative scale (0–100), which indeed revealed more robust effects that were quantitatively related to accuracy of performance. The task in the present study was to memorize four appliances, including their states (on/off), and their locations on the kitchen countertop. Memory accuracy was tested for the states of appliances in Experiment 1, and for their locations in Experiment 2. Intermediate probes were identical in both experiments and were administered during retention on 66.7% of the trials with 50% resolvable and 50% irresolvable/misleading probes. Experiment 1 revealed the efficacy of the employed stimuli by revealing a general impairment of high- compared to low checkers, which confirmed the ecological validity of our stimuli. In Experiment 2 we observed the expected, more differentiated pattern: High checkers were not generally affected in their WM performance (i.e., no general capacity issue); instead they showed a particular impairment in the misleading distractor-probe condition. Also, high checkers’ confidence ratings were indicative of a general impairment in metacognitive functioning. We discuss how specific executive dysfunction and general metacognitive impairment may affect memory traces in the short- and in the long-term.

Current research on cognitive aspects of anxiety disorders

PURPOSE OF REVIEW

Cognitive dysfunction is frequently reported in anxiety disorders. Our aim is to describe recent advances concerning these cognitive aspects.

RECENT FINDINGS

Cognitive dysfunction in anxiety disorders can be classified into four domains. The first concerns executive functions, mainly attentional processes. The second concerns memory, including deficits in working, episodic, and autobiographical memory. The third encompasses maladaptive cognitions, or thoughts and beliefs. Finally, a burgeoning area of research (mainly in obsessive-compulsive disorder and posttraumatic stress disorder) concerns metacognitions, or thoughts and beliefs about one's own thoughts and beliefs. All of these dysfunctions may contribute to maintain or aggravate anxiety disorders. When developing and implementing interventions, researchers and clinicians alike must consider these cognitive aspects, and may need to tailor their approaches accordingly.

SUMMARY

Advances have clearly been made in the elucidation of the cognitive functioning associated with anxiety disorders. It remains unclear if particular cognitive profiles can help to distinguish anxiety disorders from one another, although emerging evidence suggests this may be the case. Further clarification will add to our understanding of the development and maintenance of these disorders, and may provide targets for future therapy and endophenotypes.