What checkers actually check: an eye tracking study of inhibitory control and working memory

A narrative review of factors affecting memory confidence in the context of compulsive checking: A search for evidence-based potential therapeutic targets to improve memory confidence

BACKGROUND AND OBJECTIVES

According to current models of compulsive checking, memory confidence greatly contributes to the development and maintenance of checking behaviours. However, how to intervene in memory confidence in an evidence-based manner has not yet been fully understood. Thus, the purpose of the current paper was to identify the factors influencing memory confidence through the review of experimental evidence.

METHODS

PubMed, Google Scholar, OpenGrey and ProQuest databases were searched by combining two sets of keywords related to memory confidence and checking. Our search yielded 24 experiments. Due to the considerable heterogeneity of the studies regarding questionnaires, tasks and paradigms used, data were synthesized using a narrative review approach.

RESULTS

Six factors emerged from a thorough review of the literature, including negative memory belief, higher memory standard, inflated sense of responsibility, familiarization with the checked stimuli, number of checks and anxious valence of the checked stimuli.

CONCLUSION

The findings have important implications for the treatment of compulsive checking. We suggested general guidelines to translate these factors into a novel intervention to increase memory confidence in compulsive checkers.

From Cognitive Function to Treatment Efficacy in Obsessive-Compulsive Disorder: Insights from a Multidimensional Meta-Analytic Approach

Meta-analysis is a statistical tool used to combine and synthesise the results of multiple independent studies on a particular topic. To this end, researchers isolate important moderators and mediators to investigate their influence on outcomes. This paper introduces a novel approach to meta-analysis, known as multidimensional meta-analysis (mi-MA), to study memory performance in those with obsessive-compulsive disorder (OCD). Unlike traditional meta-analyses, mi-MA allows researchers to extract multiple data points (e.g., using different measures) from single studies and groups of participants, facilitating the exploration of relationships between various moderators while avoiding multicollinearity issues. Therefore, in the first instance, we outline the use of the mi-MA approach to quantify the impact of complex models of memory performance in individuals with OCD. This approach provides novel insights into the complex relationship between various factors affecting memory in people with OCD. By showcasing the effectiveness of mi-MA in analysing intricate data and modelling complex phenomena, the paper establishes it as a valuable tool for researchers exploring multifaceted phenomena, both within OCD research and beyond.

Visuospatial working memory capacity moderates the relationship between anxiety and OCD related checking behaviors

BACKGROUND

Compulsive checking behavior is the most prevalent compulsive behavior in patients with obsessive-compulsive disorder (OCD). While some studies have shown that anxiety and executive function influence compulsive checking behavior, the relationship between these constructs is inconclusive. Hence, we sought to explore the interplay between executive function, anxiety and compulsive checking behavior.

MATERIALS AND METHODS

47 healthy participants (HC) and 51 patients with OCD participated in the study. Symptoms and emotional states were assessed using the Yale-Brown Obsessive Compulsive Scale, the Obsessive-Compulsive Inventory-Revised, the Beck Anxiety Inventory, and the Beck Depression Inventory. Participants also completed three tests of neuropsychological functioning: the Stop Signal Task, the Spatial working memory Task, and the Wisconsin card sorting test. We analyzed the relationships between anxiety, executive function, and compulsive checking symptoms.

RESULTS

Patients with OCD showed significantly greater anxiety (p < 0.001) and impairments in visuospatial working memory function (p = 0.030) compared to HC participants, while inhibition and set-shifting were not significantly different between the two groups. Visuospatial working memory was negatively related to compulsive checking behavior (p = 0.016). Visuospatial working memory also played a moderating role in the positive relationship between anxiety and compulsive checking behavior (β = -0.281, p = 0.022).

CONCLUSION

Anxiety symptoms play an important role in explaining compulsive checking behavior in patients with OCD who have relatively weak visuospatial working memory ability. These findings provide a foundation for further research regarding the roles of emotion and cognitive inflexibility in compulsive checking behavior in patients with OCD.

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.

Time for a Systems Biological Approach to Cognitive Aging?-A Critical Review

The underlying premise of current theories of cognitive decline with age tend to be primarily cognitive or biological explanations, with relatively few theories adequately integrating both aspects. Though literature has also emphasized the importance of several factors that contribute to cognitive aging including: (a) decline in sensory abilities; (b) the effect of motor speed on paper-pencil measures of cognitive speed; (c) the impact of level of education and physical activity; and (d) molecular biological changes that occur with age, these factors have seldom been implicated into any single theoretical model of cognitive aging. Indeed, such an integrated bio-cognitive model of aging has the potential to provide a more comprehensive understanding of attention, perception, learning, and memory across the lifespan. Thus, the aim of this review was to critically evaluate common theories of age-related cognitive decline and highlight the need for a more comprehensive systems neuroscience approach to cognitive aging.

Differential patterns of brain activation between hoarding disorder and obsessive-compulsive disorder during executive performance

BACKGROUND

Preliminary evidence suggests that hoarding disorder (HD) and obsessive-compulsive disorder (OCD) may show distinct patterns of brain activation during executive performance, although results have been inconclusive regarding the specific neural correlates of their differential executive dysfunction. In the current study, we aim to evaluate differences in brain activation between patients with HD, OCD and healthy controls (HCs) during response inhibition, response switching and error processing.

METHODS

We assessed 17 patients with HD, 18 patients with OCD and 19 HCs. Executive processing was assessed inside a magnetic resonance scanner by means of two variants of a cognitive control protocol (i.e. stop- and switch-signal tasks), which allowed for the assessment of the aforementioned executive domains.

RESULTS

OCD patients performed similar to the HCs, differing only in the number of successful go trials in the switch-signal task. However, they showed an anomalous hyperactivation of the right rostral anterior cingulate cortex during error processing in the switch-signal task. Conversely, HD patients performed worse than OCD and HC participants in both tasks, showing an impulsive-like pattern of response (i.e. shorter reaction time and more commission errors). They also exhibited hyperactivation of the right lateral orbitofrontal cortex during successful response switching and abnormal deactivation of frontal regions during error processing in both tasks.

CONCLUSIONS

Our results support that patients with HD and OCD present dissimilar cognitive profiles, supported by distinct neural mechanisms. Specifically, while alterations in HD resemble an impulsive pattern of response, patients with OCD present increased error processing during response conflict protocols.

Situation Awareness in Obsessive Compulsive Disorder and Their Relatives: an Endophenotype Study

Introduction

It has been theorized that endophenotype models will help to understand the etiology of heterogeneous brain disorders such as obsessive-compulsive disorder (OCD). In this study, it was aimed to determine whether "situational awareness" impairments which can be defined as partially naturalistic working memory deficits, are an endofenotype for OCD.

Methods

In this study, situational awareness (SA) task performances of 67 OCD patients, 50 their unaffected first-degree relatives, and 41 healthy controls who matched with regard to sex, age and years of education were measured to investigate endophenotypes in OCD. For this purpose, a visuospatial working memory test was used.

Results

As a result, the relatives showed a task performance between patients with OCD and control group in both SA1 and SA2 tasks. Patients with OCD performed significantly worse than control group on SA1 single and dual task. On the other hand, there were no significant differences between relatives and patients of any SA assessment.

Conclusion

These results indicated that poor situational awareness may be a candidate endophenotype for OCD. Early perceptual dysfunctions such as poor performance on SA1 task can mediate the genetic risk for OCD.

Patients With Obsessive-Compulsive Disorder Check Excessively in Response to Mild Uncertainty

Patients with obsessive-compulsive disorder (OCD) not only respond to obsessions with perseverative checking, but also engage in more general checking, irrespective of their obsessive concerns. This study investigated whether general checking is specific to OCD and exacerbated when only mild uncertainty is induced. Thirty-one patients with OCD, 26 anxiety- and 31 healthy controls performed a visual search task with eye-tracking and indicated in 50 search displays whether a target was "present" or "absent". Target-present trials were unambiguous, whereas target-absent trials induced mild uncertainty, because participants had to rely on not overlooking the target. Checking behavior was measured by assessing search time and the number of fixations, measured with an eye-tracker. Results showed that in both target-present and target-absent trials patients with OCD searched longer and made more fixations than healthy and anxiety controls. However, the difference in checking behavior between patients with OCD and the control groups was larger in target-absent trials (where mild uncertainty was induced). Anxiety and healthy controls did not differ in checking behavior. Thus, mild uncertainty appears to specifically promote checking in patients with OCD, which has implications for treatment.

"Not Just Right Experiences" are specific to obsessive-compulsive disorder: further evidence from Italian clinical samples

Not Just Right Experiences (NJREs) are considered to be a perceptually tinged phenomenon mainly related to obsessive-compulsive disorder (OCD). The evidence of an association between NJREs and OCD or OC symptoms have been accumulating in the last few years, whereas there is a paucity of studies about the role of this construct in other clinical conditions considered part of the "OCD spectrum". In the current study, the NJRE-Q-R Severity scale (a well-validated measure of NJREs) was administered to 41 patients with OCD, 53 with hair-pulling disorder (HPD), 38 with gambling disorder (GD) and 43 with eating disorders (ED) along with measures of OC symptoms and general distress. In each group, NJREs were consistently associated with OC symptoms; moreover, the pattern of associations appeared coherent with the main clinical features of each disorder. The OCD group reported higher levels of NJREs severity than GD and ED, whereas there were no differences between the OCD and HPD groups. However, HPD patients did not have higher scores of NJREs severity than GD and ED counterparts. NJREs appear to be specific to OCD, but further study is needed to establish the role of this construct in OCD-related disorders.

Excessive checking behavior during an image comparison task in schizophrenia

BACKGROUND

Patients with schizophrenia display significant working memory and executive deficits. In patients with obsessive-compulsive disorder (OCD), several studies suggest that working memory dysfunction may be one of the causes of compulsive checking behaviors. Hence, this study aimed at assessing whether patients with schizophrenia were impaired on an image comparison task used to measure checking behaviors, and whether the origin and profile of impairment on this task was different between schizophrenia and OCD.

METHODS

Eye movement recordings were used to assess the checking behavior of 24 patients with schizophrenia and 24 control participants who had to decide whether two images were different or identical. The verbal and visuo-spatial components of participants' working memory were measured using the reading span and backward location span tests.

RESULTS

Compared to controls, patients with schizophrenia had reduced working memory spans and showed excessive checking behavior when comparing the two images. However, the intensity of their checking behavior was not significantly related to their working memory deficits.

CONCLUSIONS

Several recent studies demonstrated that the excessive checking behaviors displayed by patients with OCD were related to working memory dysfunction. The absence of a relationship between the excessive checking behavior of patients with schizophrenia and their working memory deficits suggests that checking behaviors do not have the same origin in the two disorders.

Neural correlates of impaired cognitive control over working memory in schizophrenia

BACKGROUND

One of the most common deficits in patients with schizophrenia (SZ) is in working memory (WM), which has wide-reaching impacts across cognition. However, previous approaches to studying WM in SZ have used tasks that require multiple cognitive-control processes, making it difficult to determine which specific cognitive and neural processes underlie the WM impairment.

METHODS

We used functional magnetic resonance imaging to investigate component processes of WM in SZ. Eighteen healthy controls (HCs) and 18 patients with SZ performed an item-recognition task that permitted separate neural assessments of 1) WM maintenance, 2) inhibition, and 3) interference control in response to recognition probes.

RESULTS

Before inhibitory demands, posterior ventrolateral prefrontal cortex (VLPFC), an area involved in WM maintenance, was activated to a similar degree in both HCs and patients, indicating preserved maintenance operations in SZ. When cued to inhibit items from WM, HCs showed reduced activation in posterior VLPFC, commensurate with appropriately inhibiting items from WM. However, these inhibition-related reductions were absent in patients. When later probed with items that should have been inhibited, patients showed reduced behavioral performance and increased activation in mid-VLPFC, an area implicated in interference control. A mediation analysis indicated that impaired inhibition led to increased reliance on interference control and reduced behavioral performance.

CONCLUSIONS

In SZ, impaired control over memory, manifested through proactive inhibitory deficits, leads to increased reliance on reactive interference-control processes. The strain on interference-control processes results in reduced behavioral performance. Thus, inhibitory deficits in SZ may underlie widespread impairments in WM and cognition.

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.