Hostname: page-component-745bb68f8f-5r2nc Total loading time: 0 Render date: 2025-02-04T10:14:05.235Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive functioning in obsessive-compulsive disorder: a meta-analysis

Published online by Cambridge University Press:  19 July 2013

N. Y. Shin ,
T. Y. Lee ,
E. Kim  and
J. S. Kwon
N. Y. Shin
Affiliation:
Interdisciplinary Cognitive Science Program, Seoul National University, Seoul, South Korea
T. Y. Lee
Affiliation:
Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
E. Kim
Affiliation:
Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
J. S. Kwon*
Affiliation:
Interdisciplinary Cognitive Science Program, Seoul National University, Seoul, South Korea Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea Department of Brain & Cognitive Sciences, Seoul National University College of Natural Science, Seoul, South Korea
*
*Address for correspondence: J. S. Kwon, M.D., Ph.D., Department of Psychiatry, Seoul National University College of Medicine, 28 Yeongon-dong, Chongno-gu, Seoul, South Korea 110-744. (Email: kwonjs@snu.ac.kr)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Substantial empirical evidence has indicated impairment in the cognitive functioning of patients with obsessive-compulsive disorder (OCD) despite inconsistencies. Although several confounding factors have been investigated to explain the conflicting results, the findings remain mixed. This study aimed to investigate cognitive dysfunction in patients with OCD using a meta-analytic approach.

Method

The PubMed database was searched between 1980 and October 2012, and reference lists of review papers were examined. A total of 221 studies were identified, of which 88 studies met inclusion criteria. Neuropsychological performance and demographic and clinical variables were extracted from each study.

Results

Patients with OCD were significantly impaired in tasks that measured visuospatial memory, executive function, verbal memory and verbal fluency, whereas auditory attention was preserved in these individuals. The largest effect size was found in the ability to recall complex visual stimuli. Overall effect estimates were in the small to medium ranges for executive function, verbal memory and verbal fluency. The effects of potentially confounding factors including educational level, symptom severity, medication status and co-morbid disorders were not significant.

Conclusions

Patients with OCD appear to have wide-ranging cognitive deficits, although their impairment is not so large in general. The different test forms and methods of testing may have influenced the performance of patients with OCD, indicating the need to select carefully the test forms and methods of testing used in future research. The effects of various confounding variables on cognitive functioning need to be investigated further and to be controlled before a definite conclusion can be made.

Keywords

Cognitive functionmeta-analysisobsessive-compulsive disorder
Type
Review Article
Information
Psychological Medicine , Volume 44 , Issue 6 , April 2014 , pp. 1121 - 1130
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abbruzzese, M, Bellodi, L, Ferri, S, Scarone, S (1995). Frontal lobe dysfunction in schizophrenia and obsessive–compulsive disorder: a neuropsychological study. Brain and Cognition 27, 202–212.Google Scholar
Abbruzzese, M, Ferri, S, Scarone, S (1997). The selective breakdown of frontal functions in patients with obsessive–compulsive disorder and in patients with schizophrenia: a double dissociation experimental finding. Neuropsychologia 35, 907–912.CrossRefGoogle ScholarPubMed
Abramovitch, A, Dar, R, Schweiger, A, Hermesh, H (2011). Neuropsychological impairments and their association with obsessive–compulsive symptom severity in obsessive–compulsive disorder. Archives of Clinical Neuropsychology 26, 364–376.Google Scholar
Aigner, M, Sachs, G, Bruckmuller, E, Winklbaur, B, Zitterl, W, Kryspin-Exner, I, Gur, R, Katschnig, H (2007). Cognitive and emotion recognition deficits in obsessive-compulsive disorder. Psychiatry Research 149, 121–128.CrossRefGoogle ScholarPubMed
Aycicegi, A, Dinn, WM, Harris, CL, Erkmen, H (2003). Neuropsychological function in obsessive–compulsive disorder: effects of comorbid conditions on task performance. European Psychiatry 18, 241–248.CrossRefGoogle ScholarPubMed
Bohne, A, Savage, CR, Deckersbach, T, Keuthen, NJ, Jenike, MA, Tuschen-Caffier, B, Wilhelm, S (2005). Visuospatial abilities, memory, and executive functioning in trichotillomania and obsessive-compulsive disorder. Journal of Clinical and Experimental Neuropsychology 27, 385–399.CrossRefGoogle ScholarPubMed
Boone, KB, Ananth, J, Philpott, L, Kaur, A (1991). Neuropsychological characteristics of nondepressed adults with obsessive–compulsive disorder. Neuropsychiatry, Neuropsychology and Behavioral Neurology 4, 96–109.Google Scholar
Borges, MC, Braga, DT, Iego, S, D'Alcante, CC, Sidrim, I, Machado, MC, Pinto, PS, Cordioli, AV, do Rosario, MC, Petribu, K, Mendlowicz, MV, Mari, JJ, Miguel, EC, Fontenelle, LF (2011). Cognitive dysfunction in post-traumatic obsessive–compulsive disorder. Australian and New Zealand Journal of Psychiatry 45, 76–85.Google Scholar
Bucci, P, Galderisi, S, Catapano, F, Di Benedetto, R, Piegari, G, Mucci, A, Maj, M (2007). Neurocognitive indices of executive hypercontrol in obsessive-compulsive disorder. Acta Psychiatry Scandinavica 115, 380–387.Google Scholar
Cavallaro, R, Cavedini, P, Mistretta, P, Bassi, T, Angelone, SM, Ubbiali, A, Bellodi, L (2003). Basal-corticofrontal circuits in schizophrenia and obsessive–compulsive disorder: a controlled, double dissociation study. Biological Psychiatry 54, 437–443.Google Scholar
Cavedini, P, Cisima, M, Riboldi, G, D'Annucci, A, Bellodi, L (2001). A neuropsychological study of dissociation in cortical and subcortical functioning in obsessive–compulsive disorder by Tower of Hanoi task. Brain and Cognition 46, 357–363.Google Scholar
Cavedini, P, Gorini, A, Bellodi, L (2006). Understanding obsessive–compulsive disorder: focus on decision making. Neuropsychology Review 16, 3–15.Google Scholar
Cavedini, P, Zorzi, C, Piccinni, M, Cavallini, MC, Bellodi, L (2010). Executive dysfunctions in obsessive–compulsive patients and unaffected relatives: searching for a new intermediate phenotype. Biological Psychiatry 67, 1178–1184.CrossRefGoogle ScholarPubMed
Ceschi, G, Van der Linden, M, Dunker, D, Perroud, A, Bredart, S (2003). Further exploration memory bias in compulsive washers. Behaviour Research and Therapy 41, 737–748.CrossRefGoogle ScholarPubMed
Cha, KR, Koo, MS, Kim, CH, Kim, JW, Oh, WJ, Suh, HS, Lee, HS (2008). Nonverbal memory dysfunction in obsessive–compulsive disorder patients with checking compulsions. Depression and Anxiety 25, E115–E120.Google Scholar
Chamberlain, SR, Blackwell, AD, Fineberg, NA, Robbins, TW, Sahakian, BJ (2005). The neuropsychology of obsessive compulsive disorder: the importance of failures in cognitive and behavioural inhibition as candidate endophenotypic markers. Neuroscience and Biobehavioral Reviews 29, 399–419.Google Scholar
Chamberlain, SR, Fineberg, NA, Blackwell, AD, Clark, L, Robbins, TW, Sahakian, BJ (2007). A neuropsychological comparison of obsessive–compulsive disorder and trichotillomania. Neuropsychologia 45, 654–662.Google Scholar
Choi, JS, Kang, DH, Kim, JJ, Ha, TH, Lee, JM, Youn, T, Kim, IY, Kim, SI, Kwon, JS (2004). Left anterior subregion of orbitofrontal cortex volume reduction and impaired organizational strategies in obsessive-compulsive disorder. Journal of Psychiatry Research 38, 193–199.CrossRefGoogle ScholarPubMed
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Earlbaum: Hillsdale, NJ.Google Scholar
Cohen, Y, Lachenmeyer, JR, Springer, C (2003). Anxiety and selective attention in obsessive–compulsive disorder. Behaviour Research and Therapy 41, 1311–1323.Google Scholar
Deckersbach, T, Savage, CR, Reilly-Harrington, N, Clark, L, Sachs, G, Rauch, SL (2004). Episodic memory impairment in bipolar disorder and obsessive–compulsive disorder: the role of memory strategies. Bipolar Disorders 6, 233–244.Google Scholar
de Geus, F, Denys, DA, Sitskoorn, MM, Westenberg, HG (2007). Attention and cognition in patients with obsessive-compulsive disorder. Psychiatry and Clinical Neurosciences 61, 45–53.Google Scholar
Duval, S, Tweedie, R (2000). Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455–463.CrossRefGoogle ScholarPubMed
Egger, M, Smith, GD, Schneider, M, Minder, C (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629–634.Google Scholar
Fenger, MM, Gade, A, Adams, KH, Hansen, ES, Bolwig, TG, Knudsen, GM (2005). Cognitive deficits in obsessive–compulsive disorder on tests of frontal lobe functions. Nordic Journal of Psychiatry 59, 39–44.CrossRefGoogle ScholarPubMed
Gambini, O, Abbruzzese, M, Scarone, S (1993). Smooth pursuit and saccadic eye movements and Wisconsin Card Sorting Test performance in obsessive-compulsive disorder. Psychiatry Research 48, 191–200.Google Scholar
Goncalves, OF, Marques, TR, Lori, NF, Sampaio, A, Branco, MC (2010). Obsessive–compulsive disorder as a visual processing impairment. Medical Hypotheses 74, 107–109.Google Scholar
Hedges, L, Holkin, I (1985). Statistical Methods for Meta-Analysis. Academic Press: New York, NY.Google Scholar
Henin, A, Savage, CR, Rauch, SL, Deckersbach, T, Wilhelm, S, Baer, L, Otto, MW, Jenike, MA (2001). Is age at symptom onset associated with severity of memory impairment in adults with obsessive–compulsive disorder? American Journal of Psychiatry 158, 137–139.Google Scholar
Hur, JW, Shin, NY, Kim, SN, Jang, JH, Choi, JS, Shin, YC, Kwon, JS (2012). Do pathological gambling and obsessive-compulsive disorder overlap? A neurocognitive perspective. CNS Spectrums 17, 207–213.CrossRefGoogle ScholarPubMed
Hwang, SH, Kwon, JS, Shin, YW, Lee, KJ, Kim, YY, Kim, MS (2007). Neuropsychological profiles of patients with obsessive–compulsive disorder: early onset versus late onset. Journal of the International Neuropsychological Society 13, 30–37.Google Scholar
Kitis, A, Akdede, BB, Alptekin, K, Akvardar, Y, Arkar, H, Erol, A, Kaya, N (2007). Cognitive dysfunctions in patients with obsessive-compulsive disorder compared to the patients with schizophrenia patients: relation to overvalued ideas. Progress in Neuro-Psychopharmacology and Biological Psychiatry 31, 254–261.CrossRefGoogle Scholar
Kuelz, AK, Hohagen, F, Voderholzer, U (2004). Neuropsychological performance in obsessive–compulsive disorder: a critical review. Biological Psychology 65, 185–236.Google Scholar
Lacerda, AL, Dalgalarrondo, P, Caetano, D, Haas, GL, Camargo, EE, Keshavan, MS (2003). Neuropsychological performance and regional cerebral blood flow in obsessive-compulsive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry 27, 657–665.Google Scholar
Lawrence, NS, Wooderson, S, Mataix-Cols, D, David, R, Speckens, A, Phillips, ML (2006). Decision making and set shifting impairments are associated with distinct symptom dimensions in obsessive-compulsive disorder. Neuropsychology 20, 409–419.CrossRefGoogle ScholarPubMed
Lucey, JV, Burness, CE, Costa, DC, Gacinovic, S, Pilowsky, LS, Ell, PJ, Marks, IM, Kerwin, RW (1997). Wisconsin Card Sorting Task (WCST) errors and cerebral blood flow in obsessive-compulsive disorder (OCD). British Journal of Medical Psychology 70 403–411.Google Scholar
Melloni, M, Urbistondo, C, Sedeño, L, Gelormini, C, Kichic, R, Ibanez, A (2012). The extended fronto-striatal model of obsessive compulsive disorder: convergence from event-related potentials, neuropsychology and neuroimaging. Frontiers in Human Neuroscience 6, 259.Google Scholar
Menzies, L, Chamberlain, SR, Laird, AR, Thelen, SM, Sahakian, BJ, Bullmore, ET (2008). Integrating evidence from neuroimaging and neuropsychological studies of obsessive–compulsive disorder: the orbitofronto-striatal model revisited. Neuroscience and Biobehavioral Reviews 32, 525–549.Google Scholar
Muller, J, Roberts, JE (2005). Memory and attention in obsessive–compulsive disorder: a review. Journal of Anxiety Disorders 19, 1–28.Google Scholar
Murphy, R, Nutzinger, DO, Paul, T, Leplow, B (2004). Conditional-associative learning in eating disorders: a comparison with OCD. Journal of Clinical and Experimental Neuropsychology 26, 190–199.Google Scholar
Nakao, T, Nakagawa, A, Yoshiura, T, Nakatani, E, Nabeyama, M, Yoshizato, C, Kudoh, A, Tada, K, Yoshioka, K, Kawamoto, M (2005). A functional MRI comparison of patients with obsessive-compulsive disorder and normal controls during a Chinese character Stroop task. Psychiatry Research 139, 101–114.CrossRefGoogle ScholarPubMed
Nakao, T, Nakagawa, A, Yoshiura, T, Nakatani, E, Nabeyama, M, Sanematsu, H, Togao, O, Yoshioka, K, Tomita, M, Kuroki, T, Kanba, S (2009). Duration effect of obsessive–compulsive disorder on cognitive function: a functional MRI study. Depression and Anxiety 26, 814–823.Google Scholar
Nedeljkovic, M, Kyrios, M, Moulding, R, Doron, G, Wainwright, K, Pantelis, C, Purcell, R, Maruff, P (2009). Differences in neuropsychological performance between subtypes of obsessive–compulsive disorder. Australian New Zealand Journal of Psychiatry 43, 216–226.CrossRefGoogle ScholarPubMed
Nielen, MM, Den Boer, JA (2003). Neuropsychological performance of OCD patients before and after treatment with fluoxetine: evidence for persistent cognitive deficits. Psychological Medicine 33, 917–925.Google Scholar
Olley, A, Malhi, G, Sachdev, P (2007). Memory and executive functioning in obsessive–compulsive disorder: a selective review. Journal of Affective Disorders 104, 15–23.Google Scholar
Penades, R, Catalan, R, Rubia, K, Andres, S, Salamero, M, Gasto, C (2007). Impaired response inhibition in obsessive compulsive disorder. European Psychiatry 22, 404–410.CrossRefGoogle ScholarPubMed
Purcell, R, Maruff, P, Kyrios, M, Pantelis, C (1998). Neuropsychological deficits in obsessive-compulsive disorder: a comparison with unipolar depression, panic disorder, and normal controls. Archives of General Psychiatry 55, 415–423.Google Scholar
Radua, J, van den Heuvel, OA, Surguladze, S, Mataix-Cols, D (2010). Meta-analytical comparison of voxel-based morphometry studies in obsessive–compulsive disorder vs other anxiety disorders. Archives of General Psychiatry 67, 701–711.Google Scholar
Rajender, G, Bhatia, MS, Kanwal, K, Malhotra, S, Singh, TB, Chaudhary, D (2011). Study of neurocognitive endophenotypes in drug-naive obsessive–compulsive disorder patients, their first-degree relatives and healthy controls. Acta Psychiatrica Scandinavica 124, 152–161.Google Scholar
Rampacher, F, Lennertz, L, Vogeley, A, Schulze-Rauschenbach, S, Kathmann, N, Falkai, P, Wagner, M (2010). Evidence for specific cognitive deficits in visual information processing in patients with OCD compared to patients with unipolar depression. Progress in Neuro-psychopharmacology and Biological Psychiatry 34, 984–991.Google Scholar
Roth, RM, Milovan, D, Baribeau, J, O'Connor, K (2005). Neuropsychological functioning in early- and late-onset obsessive–compulsive disorder. Journal of Neuropsychiatry and Clinical Neuroscience 17, 208–213.CrossRefGoogle ScholarPubMed
Savage, CR, Baer, L, Keuthen, NJ, Brown, HD, Rauch, SL, Jenike, MA (1999). Organizational strategies mediate nonverbal memory impairment in obsessive–compulsive disorder. Biological Psychiatry 45, 905–916.Google Scholar
Savage, CR, Deckersbach, T, Wilhelm, S, Rauch, SL, Baer, L, Reid, T, Jenike, MA (2000). Strategic processing and episodic memory impairment in obsessive compulsive disorder. Neuropsychology 14, 141–151.Google Scholar
Schmidtke, K, Schorb, A, Winkelmann, G, Hohagen, F (1998). Cognitive frontal lobe dysfunction in obsessive–compulsive disorder. Biological Psychiatry 43, 666–673.Google Scholar
Segalas, C, Alonso, P, Real, E, Garcia, A, Minambres, A, Labad, J, Pertusa, A, Bueno, B, Jimenez-Murcia, S, Menchon, JM (2010). Memory and strategic processing in first-degree relatives of obsessive compulsive patients. Psychological Medicine 40, 2001–2011.Google Scholar
Shin, MS, Park, SJ, Kim, MS, Lee, YH, Ha, TH, Kwon, JS (2004). Deficits of organizational strategy and visual memory in obsessive–compulsive disorder. Neuropsychology 18, 665–672.Google Scholar
Simpson, HB, Rosen, W, Huppert, JD, Lin, SH, Foa, EB, Liebowitz, MR (2006). Are there reliable neuropsychological deficits in obsessive-compulsive disorder? Journal of Psychiatric Research 40, 247–257.Google Scholar
Starcke, K, Tuschen-Caffier, B, Markowitsch, HJ, Brand, M (2010). Dissociation of decisions in ambiguous and risky situations in obsessive–compulsive disorder. Psychiatry Research 175, 114–120.Google Scholar
Trivedi, JK, Dhyani, M, Goel, D, Sharma, S, Singh, AP, Sinha, PK, Tandon, R (2008). Neurocognitive dysfunction in patients with obsessive compulsive disorder. African Journal of Psychiatry 11, 204–209.Google Scholar
Tukel, R, Gurvit, H, Ertekin, BA, Oflaz, S, Ertekin, E, Baran, B, Kalem, SA, Kandemir, PE, Ozdemiroglu, FA, Atalay, F (2012). Neuropsychological function in obsessive–compulsive disorder. Comprehensive Psychiatry 53, 167–175.Google Scholar
Tumkaya, S, Karadag, F, Oguzhanoglu, NK, Tekkanat, C, Varma, G, Ozdel, O, Atesci, F (2009). Schizophrenia with obsessive–compulsive disorder and obsessive–compulsive disorder with poor insight: a neuropsychological comparison. Psychiatry Research 165, 38–46.Google Scholar
Veale, DM, Sahakian, BJ, Owen, AM, Marks, IM (1996). Specific cognitive deficits in tests sensitive to frontal lobe dysfunction in obsessive-compulsive disorder. Psychological Medicine 26, 1261–1269.Google Scholar
Wobrock, T, Gruber, O, McIntosh, AM, Kraft, S, Klinghardt, A, Scherk, H, Reith, W, Schneider-Axmann, T, Lawrie, SM, Falkai, P, Moorhead, TW (2010). Reduced prefrontal gyrification in obsessive–compulsive disorder. European Archives of Psychiatry and Clinical Neurosciences 260, 455–464.Google Scholar
Supplementary material: File

Shin supplementary material

Shin supplementary material

Download Shin supplementary material(File)
File 163.8 KB